BOOKS OF RtfiDIfGS - PAHO/WHO

Inqliry/Voluite XIV. September 1977
- 340 -
problems so as to take advantage of specific
expertise. In particular, it helps distinguish
and sort out issues of fact, conjecture, preference,
strategy, probability of outcome, and
value of outcome. This is very helpful for
gearing available expertise lo those aspects
for which it is uniquely suited (e.g., questions
of fact vs. issues of stralegy vs. malters
of preference).
O It aids decision-makers in sorting out their
own altitudes and preferences with respect
to situations of risk, uncertainty, and indeterminancy
(as these terms are defined by
decision theorists).
O it helps keep debate within decision-making
groups focused upon important, objective
aspects of the problem at hand by providing
a 'picture" (e.g., the decision tree
or table) from which to work.
Possible Weaknesses:
O The outcome or payoff corresponding to
a givea alternative oftea is a complex bundle
of conaquences not readily summarized by
avaiable quantitative m ures, sch as
dolian or patients treated. Where such
eaures are uses, ,he risk of ovenimplificiation
is substantial.
O Oucome asociated s with pouibe alternativs
often are highly uncenain entitea for
wbhkl aoly rough estimates can be made.
Tie p t prc~hn of a single-valued
payoff may be higy mbkding.
O Tbe dicrete, maunldpnAít alternatives
Mequired in deciba thbeory dtr. may not
be approprite, tbive tauaal situatioa.
This a esrpecily true whbe te trnge of
poaible ernati ve i actuly continuous
(as contrasted wth dicrete), whre no
man flor meaurina the reuts of a given
alternative eicats, or where the environment
a highly unctan or rapidly changing.
O Moai decisiona must be made ina an organizatial
contLt Such eavirames feature
inter- and i-ntarltoa barpining
ova obocv~ and th sbultneous pursuit
of multiple, ac pme y oals.n
'Tluse atn tend to pcddo aplbo
of smne of t major advanta that decioa
theory has to offer. Pua~duly vulnerable
ure uch atrenl u t be cocept
of utility maximization, uniform notions of
optimality, well-defined criteria for choice,
and the like.
O The technique is not concerned with forecasting
per se as much as it is with guiding
decision making when the main dimensions
of the future environment are known, or
can be assumed with reasonable confidence.
A Paradig for Applying Forecasting
Techiqes to Factrs Influendng Future
Dnemnd for Heiltb Services
At this point in the discussion, it is necessary
lo mention a framework within which existing
forecasting techniques can be applied to advantage.
Table 3 provides a first approximation
of this framcwork.
Each of aix major forecasting techniques
discused in the preceding section is represented
in the columnas of TabIe 3. Each of the major
factors influencing demand is represented in
the rows. The cell at the intersection of a given
row and column represents the application of
the column technique to the, row factor. Table
3 representa a single technique applied to
a single factor. In actual practice, of course,
no such limitation would exist. In many cases,
best results would be achieved employing two
(or more) methods jointly.
A representative sample of cells have been
selected because of the attention that the topics
they rprepsent receive in the literature. Blank
cells indicate. areas where little or no research
activity has taken place. As Table 3 indicates,
these unexplored areas predominate over arcas
where work has been done. Each cell is evaluated
in summary fashion in terms of two
criteria. Tiee criteria are intended to express
the overall usefulness of a given technique,
as applied to a given factor. The criteria:
O Validity-to what extent can the technique
be applied to the "essence" of the forecasting
problem (as distinguished from its
peripheral, ifdirectly measurable or readily
undent~od, aspects)?
O Precision-to what extent is the output
of (he technique expressed in precise terms?
Each of these ia expressed along a single
dimeanion-low, moderalte, high.