Medical technology and its assesment
life-cycle of the technology
Innovation, Development, and Diffusion
technology defined medicine initially
served to centralize healthcare in hospitals
causes specialization
Funding Biomedical Research and Development
relative spending has decreased
The Diffusion of Technologies
product life-cycle: introduction, takeoff, maturtion, obsolescence
The Appropriate Use of Technologies
Organizing for Technology Assesment
Regulation: A Historical Overview
The Food and Drug Administration
Drug Regulation: expensive and long
Device Regulation
The National Institutes of Health
The Office of Medical Applications of Research: publicize consencus information
The Office of Technology Assesment
The Health Care Financing Administration
Medicare and (federal) Medicaid
Agency for Health Care Policy and Research
Office of Health Technology Assessment
Prospective payment Assesment Commission
Medicare payment changes and DRG relative value changes
Other Government activities
Private Sector Technology Assesment Activities
Pharmaceutical and Device Industries
16% of pharmaceutical sales go into R&D
Insurers, Medical Asociations, and Providers
based on current data, not newly acquiered information
Conclusions
emphesis on existing information
little is known about appropriate use
Methods for Assesment
Identification
substantial role of insurers in identifying technologies based on what they will pay for
Testing
Saftey and Efficacy
blind studies--can’t do them for surgery
databases
Cost-Effectiveness Analysis
Synthesis
Dissemination
do doctors pay attention to new information and assesments? don’t know...
Challenges for Technology Asessment