All cost effective treatments should be free or, how Archie Cochrane changed my life!

摘要

I must be one of the few people to have met Archie Cochrane without realising they had done so. It happened in 1968 when I was on a two year secondment to the Treasury. Part of my role there was to act as a roving economist, going into various other departments which were still in a state of innocence (ie, which had no economists of their own); the idea being that I would help them to solve their problems. In some cases the problem I was asked to solve was one that the host department didn't know it had, and so it was with my roving commission in the Ministry of Health. At that time the hospital building programme was in full swing, and the Treasury were anxious to find out when it would begin to tail off. The idea was that I would use whatever criteria were currently being applied to determine the size of the programme and its distribution, and then, on that basis, project the future volume of expenditure and estimate when the criteria were likely to be satisfied so that the level of expenditure would fall. It was all a bit like the expectation that once a backlog of accumulated illness has been cleared, NHS expenditure would decline to, and settle at, a lower level.