Improving the contributions of technology assessment to the health care system of the U.S.A. |
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Authors: | Frederick Mosteller Howard S Frazier |
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Institution: | (1) Technology Assessment Group, Harvard School of Public Health, 677 Huntington Avenue, Room LL7A, 02115 Boston, Massachusetts, USA |
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Abstract: | Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we
propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national
debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies
are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping
would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization
and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be
applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment
system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of
health resources need to be discovered once the public is informed about the issues.
Research supported by Andrew W. Mellon Foundation. |
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Keywords: | evaluation allocation of resources clinical trials health reform preferences safety and efficacy of therapies reducing costs |
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