Coverage of New Health Care Technologies in the US: An Investigation of Principles, Processes and the Use of Cost-Effectiveness Information
Posted: 16 Jun 2007
Research Objectives: The research sought to describe technology coverage policy in a number of US health care organizations; to elicit views of stakeholders on coverage policy and, specifically, on the use of cost-effectiveness information; and to recommend how coverage policy might be strengthened.
Study Design: The research involved a literature review, and data collection from 4 US case studies (Kaiser-Permanente, Aetna, Blue Cross Blue Shield, and the Veterans Health Administration). The methodology was predominantly qualitative with data collection involving documentary analysis, interviews with key professionals and workshops with senior decision makers.
Principal Findings: In many settings in the US, there exists a formal, evidence-based, policy process through which consideration is given to the adoption and use of new technologies. A positive feature, seen in some settings, is of a structured and organization-wide attempt to achieve input and buy-in to the policy formation process. The evidence focus when considering new technologies, in all organizations studied is principally 'effectiveness'. Cost and cost-effectiveness analysis (CEA) information tends not to be considered.
Conclusions: There is now increasing use of CEA approaches outside the US, most notably in the UK, with evidence of considerable success in its use as an aid to decision making. The picture in the US is very different. The main barriers to use of CEA in the US include a fear amongst health plans of litigation and of public backlash, mistrust of industry and of CEA methods, and a strong belief that other approaches can be used more effectively to manage scarcity.
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