Appropriateness in healthcare delivery: definition, measurement and policy implications

A major focus of the current healthcare debate is the notion that a substantial proportion of the healthcare delivered in Canada is inappropriate. There are two types of appropriateness: appropriateness of a service and appropriateness of the setting in which care is provided (i.e., inpatient v. outpatient or home care). Measuring both types objectively requires the comparison of observed patterns of care with explicit criteria for appropriate care. The few studies of appropriateness conducted in Canada have shown that inappropriate services are provided and inappropriate settings are used. Reducing inappropriate healthcare delivery could involve active strategies for the implementation of guidelines and better cooperation and coordination within the healthcare system. However, lower rates of healthcare delivery or even inappropriate healthcare will not necessarily translate into higher quality care or lower costs overall.