Abstract
The combined pressures of “medical inflation,”1 fiscal constraints, and a shift in attitudes towards publicly funded services during the 1980s have made the search for measures of quality, efficiency, and effectiveness in health care a government priority in industrialised countries. Providers of health services are increasingly required to account for the resources they use. In order to do so they must devise ways of measuring the outcomes of their activities and the extent to which these meet specified objectives, be they medical, social, or financial.