• John A Romley, Peter S Hussey, Han de Vries, Margaret C Wang, Paul G Shekelle, and Elizabeth A McGlynn.
• RAND Corporation, Santa Monica, CA 90407-2138, USA. romley@rand.org
• Am J Manag Care. 2009 Nov 1; 15 (11): 842-5.

ObjectiveTo help health professionals understand and evaluate the concept of efficiency and its measurement in practice.Study DesignWe reviewed conceptual and practical analyses of healthcare efficiency and its measurement and describe our findings.MethodsWe searched the following 3 sources: the MEDLINE and EconLit databases for articles published from 1990 to 2008 using the keywords efficiency, inefficiency, productivity, and economic profiling; seminal economic studies of efficiency identified in MEDLINE or EconLit or in economics reference materials; and the "gray literature" on efficiency measures developed by private organizations.ResultsAn essential element of efficiency is that healthcare outputs are as large as possible given their inputs. An efficiency measure specifies outputs and inputs appropriate to the goals of the assessment. Participants in the healthcare system have differing perspectives about the goals of efficiency assessments, relevant outputs and inputs, and validity of measures.ConclusionThe broad meaning and the value of healthcare efficiency seem uncontroversial, yet any particular application may be confronted with conflicting perspectives and with practical challenges.

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