Adopting New Medical Technology (1994) / Chapter Skim
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3. THE IMPACT OF TECHNOLOGY ASSESSMENT ON DECISIONS BY HEALTH CARE PROVIDERS AND PAYERS
3. THE IMPACT OF TECHNOLOGY ASSESSMENT ON DECISIONS BY HEALTH CARE PROVIDERS AND PAYERS
Pages 49-58
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From page 49... ...
and as the "careful evaluation of a medical technology for evidence of its safety, efficacy, cost, cost-effectiveness and ethical and legal implications, both in absolute terms and in comparison with other competing technologies" (Perry, 1988~. Included under the rubric of primary technology assessment are economic, quality-of-life, efficacy, and patient outcome studies.
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From page 50... ...
are focusing on the appropriate use of expensive procedures to combat rising health care expenditures and premiums. In 1989, the Health Care Financing Administration proposed a rule that would explicitly allow the federal government to consider costeffectiveness in making Medicare coverage decisions (Federal Register, 1989~.
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From page 51... ...
RESULTS A summary of our findings is presented in Table 3-1. All of the organizations interviewed are actively engaged in technology assessment activities at some level and use technology assessments in their decisionmaking process.
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From page 52... ...
· All devices/diagnostics over a threshold ranging between $100,000 and $250,000 · Less costly items at the discretion of the requesting department · Pharmaceuticals . - To help make purchase decisions To provide basis for coverage decisions · Formal multidisciplinary committees for broad policy decisions · Multidisciplinary device committees · Formulary committees · Department chiefs · Costly procedures for .
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From page 53... ...
The quality, scope, and future of payer and provider technology assessment activities vary depending on who conducts the analysis, whether the decision is related to purchase or coverage, and whether the technology assessed is a drug, a medical procedure, or a device. Quality Issues The quality of the technology assessments conducted by providers and payers is often less than ideal and generally does not conform to the larger definition of technology assessment established within the research community.
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From page 54... ...
Individual Skill Levels in Technology Assessment Vary Widely Individuals on drug formulary assessment committees are generally familiar with and understand technology assessment methods, primarily through exposure to the relatively abundant pharmaceutical clinical trial literature. By contrast, most other individuals involved in hospital technology purchase decisionmaking have not been trained in the conduct or analysis of technology assessment, nor are they experienced in adapting technology assessment data to their decisionmaking.
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From page 55... ...
· The Health Care Financing Administration proposed regulations to permit consideration of cost-effectiveness analyses in its coverage decisionmaking (Federal Register, 1989~. · The Oregon Medicaid program made an explicit decision to ration health care on the basis of cost-effectiveness analyses (Fox and Leichter, 1991~.
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From page 56... ...
Thus, notwithstanding our respondents' statements, economics clearly plays a major role in the reasons they engage in technology assessment and even in the assessments themselves. One problem with explicitly excluding economic considerations from the analysis is that decisionmakers may miss the impact that a new technology might have on patient management pathways, laboratory test expenditures, number and length of hospital stays, and other factors that affect the total costs of a medical technology.
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From page 57... ...
Efforts could be divided so that the medical drugs and devices industries assess their products, the federal government assesses medical and surgical procedures, and the medical specialty societies focus on guiding the efforts in all areas. Education Government, industry, and medical societies can assert leadership in educating insurers and providers about technology assessment so that responsible decisions can be made.
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From page 58... ...
Finally, whether industry, government, and medical specialty societies capitalize on the opportunities identified above, the demand for technology assessment information will continue. The respondents in the present study have identified needs in education, resources, and research; they uniformly predict that technology assessment activities will become increasingly important in malting their technology purchase and coverage decisions.
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