Technology assessment and the sociopolitics of health technologies

In a growing number of countries, health technology assessment (HTA) has co me to be seen as a vital component in policy making. Even though the assess ment of the social, political, and ethical aspects of health technology is listed as one of its main objectives, in practice, the integration of such dimensions into HTA remains limited. Recent social scientific research on t he inherently political nature of technology strongly supports such a compr ehensive approach. The growing claims by and on behalf of consumer groups a lso suggest that HTA should be informed by a broader set of perspectives. U sing the example of the cochlear implant in children, this essay compares t he professed objectives of HTA with typical practice and explores possible explanations for the discrepancies observed. A second example, home tele-mo nitoring for elderly persons, demonstrates how the types of evidence consid ered by HTA and the process through which assessments are produced may be r econsidered. We argue for the formal integration of the sociopolitical dime nsions of health care technologies into assessments. The ability of HTA to more fully address important issues from a public policy point of view will increase by making explicit the sociopolitical nature of health care techn ologies.