Why is the model needed? Why can decision makers continue to make decisions as they do now?
It is extremely difficult for decision makers today to anticipate the consequences of the options they face, with any real quantitative or even qualitative accuracy. The reason is that virtually every important decision involves dozens of factors that are intertwined in extraordinarily complex ways. It is barely possible to understand each factor by itself. It is virtually impossible to understand the effects of all the factors considered together or their interactions. For example, no one knows precisely how changing performance on some evidence-based guideline for cholesterol will affect, say, the rate of heart attacks or costs. We don’t know this for any particular guideline or performance measure, much less for how the different guidelines or measures compare. One should not assume that “evidence-based” or “prevention” means “cost saving”. All evidence-based guidelines or performance measures are not equal in their effects on quality and cost. As a consequence, many if not most dec
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