The use of personal health information for controlling the costs of delivering health care: does the end justify the means?

With the increasing costs of medical care many countries are seeking ways of controlling costs. Two approaches are discussed; the accounting control of costs and the medicalised control of costs. The former provides a very blunt and insensitive instrument while the latter can support best practice and reduce unnecesssary examinations. However, the medicalised approach requires limited access to the patients' medical files thus breaching the medical secret. The paper discusses the strict controls necessary to make this approach work in an acceptable fashion.