Health program's efficiency is very important for changes suggested by Health Systems reforms. In the present paper we make a review of recent literature on this subject, from the point of view of evaluative research. We discuss some methodological considerations: concepts and concerns about the validity of measures and research designs. The advantages and constraints of four types of efficiency studies are discussed: costs minimizing, cost-benefit analysis, cost-efficacy/effectiveness analysis, and cost-utility analysis. Problems most commonly found in measuring costs and effects are addressed, and an interdisciplinary approach of Epidemiology and Economics is recommended for minimizing or preventing biases. In the third part, a set for classifying priorities in cost-effectiveness studies in Brazil is suggested, adding some practical examples. Finally, a warning is made about political problems involved in the (mis)use of evaluation results.
Health Programs evaluation; Efficiency in the Health Systems; Cost-effectiveness analysis; Evaluative research
