If health care is to be rationed on the basis of research, governments should be expected to fund appropriate outcome studies that ask meaningful questions likely to yield answers that go beyond obvious issues of patient choice.
Home care is a case in point.
Although elaborate prospective studies are feasible, there is no routine need for evidence from cost-effectiveness studies to show that home care is preferable to hospital care in some situations. Furthermore, it is a basic premise of outcome research that the right of patients to participate in treatment decisions must be respected as a component of quality of care and as a determinant of quality of life. Stuart M. MacLeod, MD, PhD Professor Clinical Epidemiology and Biostatistics, Medicine and Paediatrics McMaster University Hamilton, Ont.