The WHO Regional Office for Europe convened a meeting for the description and discussion of experience with and the options for institutionalizing health technology assessment (HTA) in different countries and health systems. In this context, institutionalizing meant promoting structures and processes suitable to produce technology assessments that will be powerful in guiding policy and clinical practice towards the best possible health and cost outcomes. The meeting also explored ways of integrating HTA activities with initiatives for quality assurance (QA). The recommendations stressed the legal role of HTA in the health care system and called for the provision of sufficient resources; the integration of methods of HTA and QA; cooperation, communication and networking among HTA institutions in different settings and countries; training and education in HTA with emphasis on the implementation of results by empowering decision-makers; and the further development of HTA methods and processes. [Editor]

Contemporary healthcare governance involves determining whether and under what conditions access to interventions on the healthcare market can be granted. The accountability of these sensitive policy choices is grounded in the scientific knowledge practices they are informed by. Technology assessment has become an important mechanism of governance where scientific analysis advises policy-makers on the societal consequences associated with the uptake and application of technology. In the healthcare sector, health technology assessment (HTA) often takes the form of an expert-led multidisciplinary exercise that uses explicit methodologies to determine the added value of health technologies to national healthcare systems. The gradual institutionalisation of HTA – particularly in Europe – has led to recent legislation that promotes greater harmonisation and cross-national cooperation in assessment practice. As these efforts aim to consolidate scientific quality in HTA, they bring other questions to the surface. In a context where recognition of the diversity of knowledge has become increasingly prominent within institutional discourse, prior critiques of assessment practice have often landed on its privileging of specialist, disciplinary expertise in the determination of health technology’s value. Discussions in the field in parallel have focused on how HTA analysis can better address the complexities of health technologies in practice, through the inclusion of patients’ and technology users’ knowledge. This thesis is concerned with the challenge of how institutional assessments of health technologies can make room for different and incommensurate forms of knowledge, or, how to foster reflexivity within the science of HTA. These are not particularly new questions, yet they have persisted within both HTA and science and technology studies (STS) scholarship studying HTA.

Recoge: 1. Introduction - 2. Health Technology Assessment in Europe - 3. Conclusions - 4. Appendix.

New technologies with the potential to improve the health of populations are continuously being introduced. But not every technological development results in clear health gains. Health technology assessment provides evidence-based information on the coverage and usage of health technologies, enabling them to be evaluated properly and applied to health care efficaciously, promoting the most effective ones while also taking into account organizational, societal and ethical issues. This book reviews the relationship between health technology assessment and policy-making, and examines how to increase the contribution such research makes to policy- and decision-making processes. By communicating the value and potential of health technology assessment to a wider audience, both within and beyond decision-making and health care management, it aims ultimately to contribute to improve the health status of the population through the delivery of optimum health services.

The problem of deciding which health care technologies to evaluate is urgent. With new technologies proliferating alongside steadily increasing health care costs, it is critical to discriminate among technologies to direct tests and treatments at those who can benefit the most. Given the vast number of clinical problems and technologies to be evaluated, the many months of work required to study just one problem, and the relatively few clinicians with highly developed analytic skills, institutions must set priorities for assessment. This book sets forth criteria and a method that can be used by public agencies such as the Office of Health Technology Assessment (in the U.S. Public Health Service) and by any private organization conducting such work to decide which technologies to assess or reassess.