Essential Elements of a Technology and Outcomes Assessment Initiative

Each year Americans spend more than $2 trillion on health care. Unfortunately, some of this $2 trillion buys services of little or no value. This waste has been attributed to misleading advertisements, media hype, misguided state and federal mandates, fear of malpractice litigation, misaligned reimbursement incentives and generous insurance plans that encourage patients to ignore costs. For decades, calls for more systematic assessments of medical technologies and outcomes have gone unheeded. The efforts that have taken place to date have been largely uncoordinated and far from comprehensive. Because technology evaluations are for the public good and do not only benefit the organizations that bear the costs, they have not been well funded.

In this paper, the authors argue that an intervention's value resides in its ability to reduce mortality, morbidity or lower costs. Novelty cannot be equated with benefit. What is needed, therefore, is better information on whether new tests and treatments really do improve health, how the improvement compares with the effects of currently available tests and treatments and what are the incremental costs. The authors recommend a new technology assessment initiative built on administrative independence, dedicated funding, reliable research, trustworthy methods, wide dissemination of both cost and effectiveness and legitimacy of process. In an era of increasing costs and growing complexity of care, few health initiatives are as important as a substantial program in the evaluation of medical technology and outcomes.