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View of health technology assessment from the swampy lowlands of general practice

Published online by Cambridge University Press:  23 April 2004

Iona Heath
Iona Heath
Affiliation:
Royal College of General Practitioners
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Abstract

This article seeks to comment on the approaches to health technology assessment (HTA) outlined in the four main country studies in this volume. It is written from the perspective of a general practitioner working in an inner city area in the United Kingdom and argues that, from the point of view of the clinician, HTA delivers considerably less than it promises. The problems center on the inevitability of judgment by both politicians and clinicians and the conflicting foundations of these judgments. Within political decision-making, the needs of the population inevitably outweigh the needs of the individual; within clinical decision making, the opposite is the case. Attempting a scientific rationality, HTA struggles with the impossibility of holding the balance between the two. These difficulties are further compounded by the implications of ever-increasing expectations of perfect health and the effects of multinational commercial pressures.

Keywords

Health technology assessmentGeneral practice
Type
Research Article
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 1 , January 2004 , pp. 81 - 86
Copyright
© 2004 Cambridge University Press

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Footnotes

“Swampy lowlands” is a phrase taken from Schön DA. The reflective practitioner: how professionals think in action. New York: Basic Books; 1984.

References

Fitzpatrick M. 2001 The tyranny of health: Doctors and the regulation of lifestyle. London: Routledge; 3.
Freemantle N, Hill S. 20002 Medicalisation, limits to medicine, or never enough money to go around? BMJ. 324: 864– 865.Google Scholar
Haynes RB, Sackett DL, Taylor DW, Gibson ES, Johnson AL. 1978 Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med. 299: 741– 744.Google Scholar
Hibble A, Kanka D, Pencheon D, Pooles F. 1998 Guidelines in general practice: The new Tower of Babel. BMJ. 317: 862– 863.Google Scholar
Hunt SM. 1999 The researcher's tale: A story of virtue lost and regained. In: Joyce CRB, McGee HM, O'Boyle CA, eds. Individual quality of life: Approaches to conceptualisation and assessment. Amsterdam: Harwood Academic Publishers;
Klein R. 1993 Rationality and rationing: diffused or concentrated decision making? In: Tunbridge M, ed. Rationing of health care in medicine. London: Royal College of Physicians of London;
Klein R, Day P, Redmayne S. 1996 Managing scarcity. Buckingham: Open University Press;
Misselbrook D. 2001 Thinking about patients. Newbury: Petroc Press; 41.
Nord E. 1999 Cost-value analysis in health care. Making sense out of QALYs. Cambridge: Cambridge University Press;
Roberts MJ, Reich MR. 2002 Ethical analysis in public health. Lancet. 359: 1055– 1059.Google Scholar
Walshe K. 2002 The rise of regulation in the NHS. BMJ. 324: 967– 970.Google Scholar
Watt G. 2002 The inverse care law today. Lancet. 360: 252– 254.Google Scholar