Keywords: capitation contracts, negotiated prices, diseconomy of scale, health care, technology assessment
The new realities in health care technology assessment in US institutions
Changes in US health care financing have prompted changes in technology assessment in US health care institutions. Emphasis is shifting from capital budgeting proposals in support of revenue enhancement to marginal cost analysis in support of cost-reducing measures. This requires skills related to marginal cost finding and analysis, detailed process and activity mapping, outcome mapping, and integrative modelling. The implementation of these skills also calls for structural adjustments related to top management involvement and governance processes, multidisciplinary analysis teams, financial management outside of capital budgeting, and institutional values with respect to resource allocation, skills which many institutions currently lack. If they are not to be at the mercy of vendors and payers who are trying to specify the technologies to be used, they must be equipped to make independent judgments about efficiency, effectiveness, quality and value.