RUTH S. HANFT
in the 1990s
"Outcomes" and "effectiveness" have become the bywords of 1990s efforts, by public and private sectors, to increase efficiency in the delivery of health care. While the words "outcomes" and "effectiveness" may be new, they are a subset of the broader concept of "technology assessment," an old and still evolving science and art. In a sense, technology assessment has been with us since the inception of medical care; the trial and error of the physician who tests applied scientific knowledge could be considered a technology assessment. What characterizes more recent efforts in the systematic clinical assessment of health care technology is the analysis of social, economic, and ethical consequences of its use and the translating of findings into "best" practice at the provider/patient level.
There are numerous barriers to achieving the expected goals of technology assessment, including (but not exclusively) methodological questions in medicine and economics, the rapidity of scientific and technological change, and the failure by physicians and consumers to adopt findings. The discussion that follows will provide a brief history of health technology assessment in the United States. This includes the role of the public and private sectors in legitimizing this approach to health policy analysis, and the emergence of technology assessment as an issue in health care reform.
Technology assessment has long been a fundamental practice of the healing profession: observation, trial, and error by individual physicians. As the science of medicine evolved, formalized testing methods, such as case studies, series studies, clinical trials, and randomized-controlled trials, evolved. These methods and newer statistical methods, such as meta-analysis, are designed to provide physicians, patients, and policy makers with information on the probability that the drug, device, or procedure is safe and works, i.e., improves