THE NEW REALITIES IN HEALTH-CARE TECHNOLOGY-ASSESSMENT IN US INSTITUTIONS

Changes in US health care financing have prompted changes in technolog y assessment in US health care institutions. Emphasis is shifting from capital budgeting proposals in support of revenue enhancement to marg inal cost analysis in support of cost-reducing measures. This requires skills related to marginal cost finding and analysis, detailed proces s and activity mapping, outcome mapping, and integrative modelling. Th e implementation of these skills also calls for structural adjustments related to top management involvement and governance processes, multi disciplinary analysis teams, financial management outside of capital b udgeting, 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 tech nologies to be used, they must be equipped to make independent judgmen ts about efficiency, effectiveness, quality and value.