Including quality attributes in efficiency measures consistent with net benefit: Creating incentives for evidence based medicine in practice

► Include quality attributes in efficiency measures consistent with maximising net benefit. ► Policy rich decomposition of net benefit efficiency into technical and allocative efficiency measures. ► Estimation of shadow prices for quality in the absence of prices for services, such as public hospital admissions. ► Coverage and comparability conditions provide a robust framework to prevent cost shifting and cream skimming incentives. ► Consistently links efficiency & health technology assessment to create incentives for evidence based medicine in practice.