mission of directing its resources for technology assessment toward medical conditions and technologies that have the greatest impact on the well-being of the public and on the public's expenditures for health care. By adhering to this principle, the committee believes that OHTA can identify and evaluate the medical conditions and technologies whose assessment will offer maximum benefits to the nation's citizens.

Several specific benefits of an OHTA priority-setting process include the potential to improve the health and well-being of the public, reduce needless or inappropriate health expenditures, reduce inequities and maldistribution of health care, and inform ethical, legal, and social issues related to candidate topics. The committee enunciated three other objectives of a priority-setting process: it must (1) meet the information needs of users, (2) be efficient, and (3) be sensitive to the assessing organization's political, economic, and social constraints and be—as well as appear to be—objective and fair. A process that satisfies these principles and objectives is summarized in the 11 recommendations that follow.

Recommendations

Recommendation 1

OHTA should adopt a systematic process to assist decision making about which medical conditions and technologies it should assess or reassess. The process should involve a broad spectrum of interested parties and should be open to public view, resistant to control by special interests, and clearly understandable.

The process proposed by the committee would be conducted in two phases: (1) setting weights for criteria, which would be performed approximately every 5 years, and (2) implementing the rest of the priority-setting process, which would be performed approximately every 3 years.

Recommendation 2

OHTA technology assessment, whenever feasible, should focus on a clinical problem (e.g., diagnosis of coronary artery disease) rather than on a technology per se (e.g.. exercise thallium radionuclide scan). Similarly, priority setting should address clinical conditions.

Although concern about a new test or treatment often leads to calls for its assessment, whenever possible, a technology should be evaluated within the context of the clinical condition for which it is being used. There are two reasons for proposing this orientation. First, technology assessment should



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