Evaluation of medical action and of action in public health. A clarification of concepts with special reference to quality of care.

This paper attempts to analyse the tangled concepts which make the notion of evaluation so complex. After having given the reason why evaluation of health services is becoming more and more useful, the paper proposes a major distinction between routine and research evaluation. Routine evaluation is based on the conformity to the presently accepted norms. The aim of research evaluation is to establish norms in a continuously changing scientific context. Research evaluation uses tools such as controlled clinical trials, decision analysis, cost-benefit and cost-effectiveness analysis. Most of the paper is concerned with routine evaluation. It adopts the three major axes suggested by Donabedian: resource, procedure, results evaluations. It also gives the fundamental notions, the difficulties, and proposes some examples of each of these approaches.