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In addition, because cost benefit analysis is explicitly interested in measuring social costs, it ignores difficulties in the way various parties define or experience costs and simple chooses to treat them as universal even though we know that what one party may define as cost may be revenue for another. Can we really argue that cost-benefit analysis provides a social perspective if they do not take into account the views of the different parties involved?

Another problem appears to lie in the fact that cost-benefit studies were supposed to produce comparable data that could be used to identify best practice but this will not be possible because of the lack of comparability of costs, with some costs measured in reimbursement dollars, others in charges (and these do not reflect marginal costs due to hospitals use of full costing). It may be important to recognise that medical professionals may be resisting the change to treating the hospital as the accounting entity simply because they feel this is another threat to their autonomy and professional culture.

As the lecturer has stated, this idea may be more rapidly adopted by relating the rewards and punishments of medical practitioners to the economic performance of the newly defined entities under their control. There are many dysfunctional aspects to narrowing the basis of decision making and accountability and this is where cost-benefit analysis is useful as the ability to adopt a social perspective allows us to view the wider effects of decisions.

Yet cost benefit studies do not produce universally acceptable costs as the authors tend to take the role of expert and define both costs and benefits without consultation of other relevant parties and thus fail to fully give a social perspective. If cost-benefit studies were to be funded by the government with rules for type of data to be used it would lead to unbiased research ensuring the integrity and comparability of the result. Further to this physicians should realise their responsibility to the hospital entity by following best practice although taking into account wider implications of their decisions.

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