Researcher-driven versus policy-driven economic appraisal of health technologies: The case of France

Abstract

From the failure of early voluntarist attempts of the 1970's to introduce formal economic assessment in administrative decision-making for public health policies, to the recent introduction of new regulatory mechanisms to control the diffusion and use of health care technologies, the French experience deeply questions the mechanistic idea that reinforcement of cost-containment policies necessarily means successful opportunities for economic appraisal. The article presents various examples from the French health care system showing how ambiguities between the management goals of cost-containment and the promotion of economic appraisal can create barriers for acceptance of any form of economic analysis. But, it also draws some positive lessons about the ways to surpass the traditional opposition between ‘researcher-driven’ vs ‘policy-driven’ research in the field of health economic assessment through institutional innovations and methodological advances.