Health Care Technology: Effectiveness, Efficiency and Public Policy

Hannah Gay is a history professor at Simon Fraser University.

The main weakness of this collective project is a failure to clearly define a readership and to write accordingly. It may be that government policy makers, health service planners and individual clinicians will find material of value in this volume, though it will likely only go a short way to fulfilling their needs; but the so-called consumers of health care, to which this book is supposedly largely directed, are likely to bog down in the many complex and prolix methodological discussions.

However, for those willing to make the effort to wade through the difficult prose, some interesting things emerge. The first three chapters argue that any major health care technology must be rigorously evaluated to determine its clinical effectiveness before its widespread adoption and that such evaluation be based on both economic and quality of life considerations. In the fourth chapter, the authors present an assessment model they believe could lead to sensible decisions. Later chapters consider research problems in some detail. In particular the efficacy of therapeutic and diagnostic technologies is considered in some depth: what kinds of trials are needed, what determines an adequate clinical text etc. Economists, we learn, typically argue for the evaluation of new technologies from a societal viewpoint. A machine that saves a physician time and money may prove expensive to society and time consuming to the patient. Finally some case study material is presented. A clinical and economic evaluation, following the model proposed, is made of two diagnostic and one therapeutic technology.

Since I believe that any plan is better than none I was concerned to read that in Canada there is no coordinated national effort and few provincial efforts aimed at the assembly and synthesis of information of the kind suggested in the fourth chapter, on any ongoing basis. Planning depends on good information and a good feature of this book is that it is reasonably clear on the kind of information we need.