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Biomedical subjects

D Banta

Publications and source records attributed to D Banta.

At least 19 recordsLinked to original sources
PubMed2000

Introduction: health technology assessment and the European Union.

Health technology assessment (HTA) has become increasingly important in the European Union as an aid to decision making. As agencies and programs have been established, there is increasing attention to coordination of HTA at the European level, especially considering the growing role of the European Union in public health in Europe. This series of papers describes and analyzes the situation with regard to HTA in the 15 members of the European Union, plus Switzerland. The final paper draws some conclusions, especially concerning the future involvement of the European Commission in HTA.

European Union↗
PubMed2000

Health technology assessment in France.

The French healthcare system combines freedom of medical practice with nationwide social security. It is compulsory for every legal resident. A range of public and private institutions provide care, and patients have free access to physicians. The health coverage system is characterized by solidarity and universal responsibility. Although the French system is highly regulated, funding of health-related expenses is a chronic social problem. Since the 1996 healthcare reform, the national objective for reimbursed healthcare expenditures is voted by the parliament, and the annual increase of hospital funding is controlled at the regional level. An agency for hospitals has been established in every region, and it quantifies needs indexes for future equipment and beds. However, establishing appropriate reference ratios based on objective assessment is difficult. The idea of basing policy and practice decisions on objective assessment grew for years, until the National Agency for the Development of Medical Evaluation was established in 1989. The 1996 healthcare reform expanded this agency to encompass hospital accreditation and renamed it the National Agency for Accreditation and Evaluation in Health. In March 1999, the National Agency for Health Products was established. It controls the safety of medical products and evaluates products' medical benefits before reimbursement decisions. Health technology assessment is now related to virtually every health policy process in France, and its role increases continually.

Delivery of Health Care↗
PubMed2000

Health technology assessment in Sweden.

Sweden has a welfare system that is based on the fundamental principle that all citizens are entitled to good health and medical care, regardless of where they live or what their economic circumstances are. Health and medical care are considered to be public sector responsibilities. However, there is growing interest in establishing more private alternatives to public care. An important characteristic of the Swedish healthcare system is its decentralization, with a major role for county councils. County councils are now merging into larger administrative units (region). The whole Swedish system is in the process of reform, mainly because of perceptions that it was too rigid and had insufficient patient orientation. An important factor in the reforms is that power in the system will be even more decentralized and will have greater public input. This change is seen as calling for increased central follow-up and evaluation of matters such as social, ethical, and economic aspects. Although the state has decentralized control, it still attempts to control the general direction of the system through regulation, subsidy, recommendations, and guidelines. An important actor in the system is the Swedish Council on Technology Assessment in Health Care (SBU). SBU began in 1987 with assessments of health technologies, but its success has recently led policy makers to extend its coverage to dental care. Health technology assessment is increasingly visible to policy makers, who find it useful in decision making.

Delivery of Health Care↗
PubMed2000

Health technology assessment and health care in the European Union.

The papers on the 16 European countries presented in this issue show their great diversity of health systems. Health technology assessment (HTA) has been institutionalized in a number of members of the European Union and has a growing impact on health policy. A remaining challenge is to see HTA visible and useful at the European level, which requires more active coordination of national and regional activities. A network of HTA programs and researchers has been established. The HTA-Europe Steering Committee has suggested a number of actions by the European Commission to promote further coordination. The most important conclusion of the HTA-Europe report is that a permanent coordinating structure is needed at the European level.

Delivery of Health Care↗
PubMed1999

Identification and priority setting for health technology assessment in The Netherlands: actors and activities.

This article describes the actual situation at the beginning of 1999 with regard to identification and priority setting for health technology assessment (HTA) on a national level in the Netherlands. For this purpose the literature on HTA published in 1980-1998, mainly national, was thoroughly reviewed. Many policy documents and other reports from the 'grey literature' of identification and priority setting for HTA in the Netherlands were also used. The results show that attempts to identify and set priorities for HTA is a new activity in the Netherlands. The three most important actors in the field are the Health Council, the Council for Health Research and the Health Insurance Council. Methodologies differ depending on the content and scope of each programme. In addition, the methods used are not always transparent and the activities are not co-ordinated. The lack of co-ordination is due to the fact that there is no single organisation that is authorized to identify and set priorities for HTA. Suggestions for improving co-ordination are proposed with the aim of developing a truly national effort in this field, which will enable a more balanced and efficient set of HTA activities.

Decision Making, Organizational↗
PubMed1995

Evaluation and diffusion of excimer laser treatment of myopia in the United States and in The Netherlands.

Excimer laser photorefractive keratectomy (PRK) is an experimental treatment to correct myopia (short-sightedness) that is diffusing into use without convincing evidence of safety and efficacy. It has been claimed that PRK may render conventional methods of correcting myopia, such as wearing glasses or contact lenses, obsolete. Since about 25% of the world's population is myopic, the consequences of this technology in terms of benefits, risks, and costs could be truly enormous. The fee for the procedure in various countries such as the United States, the Netherlands, and Australia varies from about US $1500 to US $2250 per eye. In the United States, the Food and Drug Administration, acting as authorized in the Medical Devices Act of 1976, has limited the use of PRK to patients participating in clinical trials. In the Netherlands, in contrast, where medical equipment is not regulated, the method has diffused without controls, although it is not reimbursed by health insurance agencies. The procedure has become controversial in the Netherlands because it is provided privately and has been aggressively and inappropriately promoted. The case illustrates the limitations of health policy concerning technologies provided privately and raises a number of social and political questions.

Diffusion of Innovation↗
PubMed1992

Health care technology transfer in Latin America and the Caribbean.

The greatest problem concerning health care technology for developing countries is that they are dependent upon the industrialized world for technology. The only short-term solution to this problem is to improve the choices that are available to them. This goal will require changes in the structure and processes of policy making. A particular difficulty for these countries is the lack of trained personnel in fields related to technology assessment.

Developing Countries↗
PubMed1992

Developing outcome standards for quality assurance activities.

When quality assurance programmes began to develop actively, 20 or so years ago, information connecting outcome and process was very scanty. However, with the development of the field of health care technology assessment, there is now much information on efficacy that has not been applied in the field to improve quality. At the same time, patient's satisfaction with care is coming to be seen as a valid measure of outcome of care. On the other hand, process measures of quality developed by practitioners working with a particular problem are often of doubtful validity, and could even be harmful. Increasingly, quality assurance programmes will be based on outcomes of care, or on process measures that have been linked clearly to outcome. Informatics can contribute to quality assurance in two ways. One is in the development of information on efficacy and safety of care through data banks, such as those reporting hospital death rates or insurance claims data. The other is to monitor outcomes of care directly. Up until now, technology assessment and quality assurance have developed as largely independent activities. A constructive approach to developing systems of quality assurance would be to incorporate technology assessment as part of the development of guidelines for quality assurance programmes.

Adult↗
PubMed1991

The relation between quantity and quality with coronary artery bypass graft (CABG) surgery.

Many technical procedures may be done with better quality at higher volumes. In this paper, we examine the experience with coronary artery bypass graft (CABG) surgery. Immediate death rates (death during the hospital admission) with CABG vary widely, from lows of 1 percent or so to highs approaching 15 percent and perhaps higher. Research from the United States demonstrates clearly that there is a volume effect. Centres and surgeons with higher volumes have lower immediate mortality. The volume effect persists even at relatively high levels, that is, above 650 procedures a year for a hospital and above 116 procedures a year for a physician. This fact strongly supports regulation to centralize CABG facilities. In The Netherlands and Sweden, CABG is so regulated. No other European countries have strong regulation to centralize CABG provisions. Outcomes could be improved by such regulation.

Coronary Artery Bypass↗
PubMed1991

Diffusion of in-vitro fertilization in The Netherlands and England. An exploratory study.

In-vitro fertilization (IVF) is a relatively recent approach to overcoming human fertility problems. This study explored factors in the diffusion of IVF in England and in the Netherlands. Many factors were common to the two countries. Governments in both countries have been passive, apparently wishing to avoid entering a controversial field. Technology assessment has played little part in the diffusion process in these two countries.

Bioethics↗