> HMO's in the US tend to skew the system in the opposite direction in the name
> of efficiency. Treatments that are necessary may be denied as unnecessary in
> the name of efficiiency.
One point, Ken. Denying treatments by HMOs is not done in the name of "efficiency", but simply to limit costs, which in this context is a very different thing. Efficiency means providing the most benefit (reducing sickness, enhancing health) for a given cost. Or, the other side of the coin, providing a given benefit at the least cost.
Denying necessary care reduces both benefits and costs, which means benefit/costs could either rise (increase in efficiency) or fall (decrease), depending on the particulars. More than that, denying care that is needed will result in more costs in the future (unless of course the patient simply dies). So it seems clear that the denial of necessary care is more likely to decrease the efficiency of health care service provision.
It sure raises insurance company profits in the short run, though.
RO