B. Horisberger - Böcker

In view of the continuing preoccupation of all industrialized countries with the rising share of national resources devoted to health care, it is valuable to compare the fmanc­ ing and breakdown of health care expenditure on an international basis. How far should public spending on health care be regarded as a capital investment in the improvement of the health of the population and how far as subsidies to individual consumption? This question is of major importance to policy makers, including the me­ dical profession, politicians, employers, social security officials as well as to the public at large. In order to obtain some insight into the incentive structures enhancing competition among suppliers which have been built into the health care delivery systems in the various countries, the Interdisciplinary Research Centre for Public Health at St. Gall, in close co­ operation with the Institute of Insurance Economics and the Institute of Public Finance and Fiscal Law, both afftliated with the Saint Gall Graduate School of Economics, Business and Public Administration, initiated an international seminar held at Wolfsberg, Switzerland, 20-23 March 1979. The purposes of the Seminar were: 1. to review present experience on the development of health care costs and their financing - particularly the role of health insurance and the institutional relationships between public !illd private health insurance policies; 2.

All too frequently, the largest effective barrier to interdisciplinary communication is jargon. The symposium whose proceedings appear in the following pages sought, of course, to eliminate unnecessary and obscurantist jargon; but it sought also to do something far more ambitious - to confront the intellectual issues that are attached to the use of the word "evaluation" in medicine and health services. To this end a carefully selected group of experts in medicine, epidemiology, and health econom­ ics was invited to present papers. They were selected for their reputations either as conceptualizers or as empirical evaluators, or - the rarest breed of expert - as both. The context was to be empirical. Three procedures were selected that had been subject to evaluation but that posed rather different types of problem. The first was the treatment of renal failure by dialysis of various kinds. This has a relatively long history of evaluation, with a large literature, and particularly raises broad policy is­ sues within the health services of Western societies as to - the size of programmes to be provided; the type, location, and mix of treatments; the selection of patients to receive treatment; and the measurement of the success of various strategies. The second was the treatment of duodenal ulcer by a new species of drug - the hista­ mine Hrreceptor antagonists (specifically, cimetidine).