Health Care Technology Assessment Research Articles

Insuring The Children: A Decade Of Change

Prologue: The hard-fought budget legislation passed at the end of the 101st Congress's second session included a provision to expand Medicaid coverage amidst cuts in other social entitlement programs. The expansion would require states and the federal government to phase in coverage of all poor children through age eighteen by the end of the decade. According to The New York Times (4 November 1990), the Children's Medicaid Coalition, whose members include the Health Insurance Association of America, the U.S. Chamber of Commerce, and children's interest groups, were “motivated by a combination of altruism and financial self-interest” to exert sufficient political pressure to get the expansion through Congress. Medicaid is but one factor in the insurance status of America's children, however, as Peter Cunningham and Alan Monheit of the Agency for Health Care Policy and Research (AHCPR) report in this article. In their analysis, they focus on the role different family characteristics play in determining whether children's health care is covered adequately. They use data from over a decade of national medical surveys to trace changes in children's insurance coverage. Cunningham, a service fellow at AHCPR, received a doctoral degree in sociology from Purdue University in West Lafayette, Indiana. During his four-year tenure at the agency, he has worked on the 1987 National Medical Expenditure Survey. Monheit, a senior economist at AHCPR, received his doctorate in economics from the Graduate Center, City University of New York. In his years at AHCPR and its predecessor agency, the National Center for Health Service Research and Health Care Technology Assessment, he has been deeply involved in research into expenditures for medical care and the causes for uneven insurance coverage in this country.

Health Care Technology Assessment in the Netherlands

Our present-day health sectors are increasingly characterized by both rapid technological change and growing visibility of its considerable consequences in terms of the quality and costs of health care. Improved health care decision-making in such an environment requires adequate and timely information on the benefits, risks, and costs of health care technology. Whereas traditionally, technology assessment focused predominantly on evaluating efficacy and (short-term) safety in a more or less “controlled” environment, an interesting shift in emphasis is now occurring. There is a growing recognition that improved information is also needed on the health and economic outcomes of technology as used in everyday clinical practice, i.e., on its effectiveness, cost-effectiveness, and long-term safety in normal “uncontrolled” daily medical life. Moreover, because the treatment of particular clinical conditions (such as stable angina, gallstones, or prostatism) increasingly involves choices among alternative diagnostic and therapeutic options, these assessments should ideally provide effectiveness and cost-effectiveness information for all the various technological alternatives involved.

The Political Dimension in Health Care Technology Assessment Programs

This article considers technology assessment (TA) to be a comprehensive form of policy research. Technology assessment must then have a relation to policy-making; in the area of health care, TA must relate to such political decisions as resource allocation. Since policies are determined politically, i.e., by factors such as power and influence, technology assessment is, or should be, part of a political process. Technology assessment seems to be developing predominantly as a technical and professional activity, carried out in centers with no relation to the policy-making process. While the impact of technology on health, as well as such broader impacts as those on financial costs, is a key concern, political considerations and political decision-making must always be an important dimension in health care TA.

The 6th annual meetings of the international society of technology assessment in health care

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The 5th Annual Meeting of the International Society of Technology Assessment in Health Care

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The Swedish Council on Technology Assessment in Health Care.

During its first year of operation (1988) the Swedish Council on Technology Assessment in Health Care focused on nine areas. Additional activities will be added as need requires and resources permit. Also, preparations for 1989 projects have begun. The nine areas include: identification of technologies needing assessment, including international comparisons; review and synthesis of the value of preoperative routines; review and synthesis of the value of gastroscopy for diagnosing stomach pain; assessment of different treatment methods for back pain; assessment of the value of vascular surgery for vascular spasms in the legs; organization of a strategy conference concerning medical technology assessment in Sweden; creation of a strategy that addresses an international review of medical technology, future technologies in health care, waiting lists for medical care--the importance of medical technology, resource utilization and organizational and educational aspects of introducing new technology in health care, and costs and medical technology; translation of foreign assessment studies, with comments; national and international cooperation. SCTA has discussed the need for assessing specific technology such as bone marrow transplantation and surgical treatment of epilepsy. SCTA's Scientific Advisory Committee has additionally considered the following subjects for future projects: medical, social, and economic consequences of alternative technologies screening for prostate, colorectal, breast, and cervical cancer; costs, indications, and medical benefit of surgery for varicose vains; and modern urology technologies, particularly those related to prostate care.

Technology assessment in health care in Australia.

In 1977, in the middle of a protracted debate on the costs and methods of paying for health care, the federal minister for health established a Committee on Applications and Costs of Modern Technology in Medical Practice. In 1978, the committee produced its report, which reviewed a number of cost containment strategies, including the reduction or regulation of fees paid to medical practitioners for specific procedures. It recommended that a national panel be established to collect information on medical technology and advise on its introduction in Australia.In 1982, the National Health Technology Advisory Panel (NHTAP) was created to identify and examine existing and emerging medical technology, to determine methods and priorities for assessment, and to make recommendations to the minister for health with respect to assessment and funding of new technology.

The 5th Annual Meeting of the International Society of Technology Assessment in Health Care

The 5th Annual Meeting of the International Society of Technology Assessment in Health Care

Current issues in health care technology assessment.

This article presents an overview of technology assessment in the United States. The authors argue that while there are numerous institutions carrying out assessments, the United States requires an overall plan that would provide a national system for technology assessment. If technology assessment were more organized and systematized, the authors argue, it would be more efficient and would reach the public and the medical world effectively.

Mandating Health Coverage for Working Americans

Prologue: Recent government estimates place the number of Americans who lack health insurance between thirty-one and thirty-seven million. Of this number, three-fourths have jobs or are dependents of those who work. In fact, around 14 percent of American workers lack health insurance, according to findings of a new study by economists Alan Monheit and Pamela Farley Short, based on data from the 1987 National Medical Expenditure Survey. Mandating employers to provide health insurance to their workers first gained presidential support during the Nixon administration. More recently, it has been the favored approach of key congressional Democrats—Sen. Edward Kennedy (D-MA) and Rep. Henry Waxman (D-CA). This year, the Senate Labor and Human Resources Committee, of which Senator Kennedy is chair, reported a mandated benefits bill on a straight party-line vote with all Republicans opposed. An employer mandate would extend coverage to about two-thirds of the uninsured who work at least twenty hours per week, the authors conclude. In this article, Monheit and Short examine the impact of employer mandates on uninsured workers, and also on those workers whose employers already provide health coverage. “The largest single group [of currently insured workers] experiencing a change in coverage would be the thirteen million employees now covered by a spouse's employment-related insurance who would be required to accept the coverage offered by their own employers, ”they report. Monheit is a senior economist in the Division of Intramural Research at the National Center for Health Services Research and Health Care Technology Assessment (NCHSR). He received his doctorate in economics from the Graduate Center, City University of New York. Short, who holds a doctorate in economics from Yale, is a senior research manager at NCHSR. The two economists have done extensive research on the determinants of health insurance coverage while at NCHSR.

Call for Information for Assessment of Refractive Keratoplasty Procedures

The Office of Health Technology Assessment (OHTA) of the National Center for Health Services Research (NCHSR) and Health Care Technology Assessment has the direct responsibility to conduct technology evaluations and make Public Health Service coverage recommendations in response to requests from agencies administering Federally-financed health programs. One such agency is the Health Care Financing Administration (HCFA). These requests may originate in the public or private sector. Requests frequently originate when claims for reimbursement are filed. For example, in the case of refractive surgery, the source of inquiry regarding reimbursement from HCFA was a medical optics firm and several ophthalmologists. HCFA subsequently asked the OHTA to assess the status of refractive surgery. OHTA announced the impending assessment in the Federal Register, soliciting public input. The Office also conducts a literature search and obtains information from such groups as clinical specialty organizations and manufacturer's associations. Scientific findings as well as specific recommendations are obtained from other Federal agencies. In the case of refractive surgery, for instance, the National Eye Institute will provide scientific advice on the technology. OHTA assessments represent comprehensive evaluations of the safety, clinical effectiveness, and the appropriate use of the technology. While the OHTA performs evaluations that may take into account cost-effectiveness, social, ethical, and economic impacts, the primary concern of OHTA, in making its coverage recommendations, are the safety and clinical effectiveness of the technology. AU pertinent information, from controlled clinical trials to qualified medical opinion, are summarized and analyzed to determine if they are valid and significant. From this evaluation appropriate judgments and conclusions are formulated about the technology's safety and effectiveness. Based on the information received, OHTA suggests how HCFA should deal with the reimbursement question. OHTA may recommend that a technology be covered, not covered, or covered with certain restrictions or guidelines. OHTA provides HCFA with a written coverage recommendation and the completed assessment report. HCFA has final responsibility for making decisions on what diagnostic and therapeutic techniques and procedures will be covered. NCHSR publishes and disseminates the OHTA assessment reports to the public. Health Technology Assessment Reports concerning ophthalmology include: * Computer Enhanced Perimetry, 1983 * Nd:YAG Laser for Posterior Capsulotomies, 1984 * Laser Trabeculoplasty for Open Angle Glaucoma, 1984.

Americans' Views on Health Care: Foolish Inconsistencies?

Prologue: The ebb and flow of public policy making, American style, is influenced by a wide variety of factors, certainly not the least of which is public opinion. While a large segment of the public pays little attention to federal and state policy making, most citizens do have opinions on the major issues of the day, including health and medical questions. Time and again, private interests and publie decisionmakers employ the results of public opinion surveys as a way to influence policy. Recently, the American Association of Retired Persons, under attack from some quarters of the elderly lobby for its advocacy of Medicare's new benefit to cover catastrophic medical expenses, unveiled a public opinion survey that 65 percent of those people over age sixty-five who were asked favored the new benefit. For the last decade, the Health Insurance Association of America (HIAA) has surveyed 1,500 American households annually in an effort to chart trends in the public's view of health care. In this paper Jon Gabel and Steven Fink of the HIAA and Howard Cohen, who recently departed that association after eight years for a position on Capitol Hill, report on the conflicting views of most Americans in relation to health care as reported by public opinion surveys. To the degree that their views conflict, they mirror those of most policymakers who are enthusiastic about expanding health care benefits, but a good deal less certain about how to pay their costs. Gabel, who is associate director; research and development, at HIAA, formerly worked as a senior economist at the National Center for Health Services Research and Health Care Technology Assessment. Fink, who oversees the daily conduct of polling at HIAA, holds a master's degree in sociology from the University of Connecticut. Cohen joined the Republican staff of the House Energy and Commerce Subcommittee on Health and the Environment at the beginning of 1989. He holds a doctorate in psychology from the University of Massachusetts and a law degree from George Washington University.

The 5th Annual Meeting of the International Society of Technology Assessment in Health Care

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Technology assessment in health care: the U.S. perspective

Formal programs in medical technology assessment in the United States have become increasingly prominent in health care during the last 10 years in large part stimulated by remarkable technologic innovation, expansion in medical knowledge and increasing health care expenditures. The establishment of the Consensus Development Program of the National Institutes of Health initiated a decade of activities in technology assessment in both the public and private sectors and it was intensified by efforts to contain expenditures, particularly the Prospective Payment System. However, in spite of the wide range of evaluation activities, deficiencies remain which will have to be remedied if medical and policy decisions regarding technologies are to be made on sound bases.

Economic considerations in technology assessment: the case of genetic disease

This paper describes economic issues pertinent to health care technology assessment. Of interest are the allocation of resources between health and other sectors of the economy, between alternative services within the health sectors, and the costs of producing the services that are selected. These issues are discussed and then illustrated by reference to a specific area of health care technology: screening for and intervention against genetic diseases. It is concluded that investments in screening programs for Tay Sachs disease and Down Syndrome are allocatively efficient. Indications are that such investments are also efficient for interventions against Neural Tube Defects; however, there are complex ethical issues involved. There are many genetic diseases for which screening tests have yet to be developed. As such tests become available, each will have to be evaluated on its own merits relative to alternative health sector investments.

The Fourth Annual Meeting of the International Society of Technology Assessment in Health Care

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Medical devices and biomaterials pathology. Primary data for health care technology assessment.

Through the postmortem examination, pathologists offer the ultimate clinico-pathologic assessment of the efficacy of medical care. Similarly, pathologists can offer a clinico-pathologic assessment of the efficacy of health care technology. Assessment by pathologists has diagnostic authority because it draws on the resources of the laboratories of surgical and necropsy pathology. In this essay we argue for enhancing the accuracy of medical device and biomaterials technology assessment by systematically collecting pathology-oriented data. We recommend the establishment of a pathology-based medical device registry to assess implantable medical device technology by accumulating reports routinely issued by pathology departments throughout the country. We further suggest that establishment of a university-based, industry-supported Medical Device and Biomaterials Pathology Institute to operate the registry, collect recovered, used health care devices, and generate definitive, pathology-based, primary data for health care technology assessment.

International Society for Technology Assessment in Health Care: Constitution and Bylaws

International Society for Technology Assessment in Health Care: <i>Constitution and Bylaws</i>

How the U.S. spent its health care dollar: 1929-1980.

Prologue: The cost of medical care has become an overriding interest of the health sphere, government, and private payers because medicine has demonstrated a capacity to consume an increasing portion of the gross national product at the expense of other goods and services. Based on the estimates of the Health Care Financing Administration (HCFA) that health care will be a $1.4 trillion annual enterprise by the year 2000, there is every indication the interest in costs and their moderation will only increase. One dimension of the cost picture that has received less attention is how America spends its medical care dollar. In this essay, authors Marc Berk, Alan Monheit, and Michael Hagan focus on that subject by looking at spending trends over a fifty-year period ending in 1980. Berk joined Project HOPE's Center for Health Affairs in early 1988 as a senior policy analyst after spending nine years at the National Center for Health Services Research and Health Care Technology Assessment (NCHSR), where he was one of the principal designers of the National Medical Care Expenditure Survey. Berk, who took much of his graduate training at Brown University, received a doctorate in sociology from New York University in 1980. He joined the National Opinion Research Center soon afterward to work on the National Medical Care Expenditure Survey, which was underwritten by NCHSR. Berk's research pursuits have included the analysis of the rising costs of medical expenditure surveys and health policy issues relating to access to care (particularly among Hispanics, divorced women, and the elderly), and Medicare and Medicaid. Monheit, who holds a doctorate in economics (from the City University of New York), is a labor economist who has worked at NCHSR for a decade. He is best known in the research community for his work on the relationship between employment and health insurance (see Monheit et al., “Health Insurance for the Unemployed: Is Federal Legislation Needed?” Health Affairs, Spring 1984). Hagan, who also is a labor economist, formerly worked at NCHSR as a research analyst.

Regulation and Competition: The Eras That Werenʼt

Thomas W. Bice is Service Fellow, Division of Intramural Research, National Center for Health Services Research and Health Care Technology Assessment, United States Public Health Service, Rockville, Maryland.