Medical technology assessment: an overview.

Abstract

I n attempting to address the issue of medical technology assessment, it is important to define technology. There are numerous definitions of technology. From the broadest perspective, John Kenneth Galbraith defined it as organized knowledge. The United States Congress Office of Technology Assessment defines medical technology as “the techniques, drugs, equipment, and procedures used by healthcare professionals in delivering medical care to individuals, and the systems within which such care is delivered.” Assessment of medical technology therefore is the process of examining and reporting properties of a medical technology, such as safety, efficacy, feasibility, effectiveness, and indications for use. The past century has witnessed an explosion of new medical technologies. Once, medical care was relatively inexpensive because interventions were rare and personnel costs were low. As treatments became effective, new drugs and operations were integrated into routine medical practice, increasing the costs of medical care. Increased usefulness and cost led to the development of medical insurance to pay for new technologies. Payment of traditional medical insurance was retrospective; i.e., physicians and hospitals were reimbursed for procedures that had already been performed. Retrospective payment fueled the development of technology because increased use of technology led to increased reimbursement (Fig. l), and technology, especially in the surgical arena, was left to develop unfettered by scientific proof. Every innovative procedure that could be conceived and tried was reimbursed in the 1960s and 1970s. Recently, there have been dramatic ch.mges in the method of medical reimbursement. IncrepFingly, medical bills are reimbursed on a prospective payment system, involving disease-related groups (DiagnosisRelated Groups [DRG]), accepted procedure codes