Arulambalam A; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1994; Abstract No. 081.
Coopers & Lybrand, Auckland, New Zealand.
Over the last three years, New Zealand's health system has undergone sweeping reform in which government as the dominant funder (90%) has separated itself from the provision of services. Public hospitals have been restructured as limited liability companies required to make a financial return on their assets. Now, before funding is made available to any provider there are to be contestable contractual arrangements. Not surprisingly, there has been considerable angst amongst health professionals about these changes, most of whom see the reforms as taking away their previous role in making healthcare decisions. It is against the above background that TA is failing. In the past, government budgetary processes were a simple rationing tool which induced technology control. Our current research indicates that this is no longer the case--that competition between providers is now heavily focussed on each attempting to gain a technology-based edge in order to obtain market advantages. In the last year, for instance the number of MRI facilities in the country (of 3.4 million people) has risen from one to five. However, there has been no change to the health status of the population, nor has there been any discernible quality gains in treatments. What is beginning to happen on the other hand is that although health services have been restructured and rationalized, cost increases are being associated with the greater use of technology (e.g., CTs, pharmaceuticals). As a result these pressures on the health budgets, the attention of health managers is not on whether the real health needs of the population are being met, but rather on "staying within budgets.8 Paradoxically, consumer awareness of the availability of technology-based diagnostic/treatment procedures is high and increasing. For the sake of consumer choice, TA is being singularly ignored by the respective funding agencies as well as by the providers. Consequently, technology-based services are not necessarily being managed downwards with the sacrifices (i.e., budget cuts) being made elsewhere, e.g., low-tech community care services, etc. Our view is that this will continue unless the funding agencies develop the courage to require appropriate levels of TA, and providers are accordingly given market signals which have the correct incentives for the wise use of technology. Our examination of the failure of TA so far (and the possible solutions) reveal that as will be the case internationally, credible TA work first needs to be undertaken within short timeframes (while the subject is still the hot topic of the month) and then promulgated to key opinion-makers in both the healthcare arena and in wider society. Given the country's radical dismantling of almost all regulatory mechanisms in commerce and industry (including social services), there is a new found aversion to regulatory policy being used to drive change. So, government policy on the need for TA (cf. USA's CON arrangements) is unlikely to be implemented here. In this context, we identify "market signals8 that could work and discuss the ethical issues these raise and the dilemmas posed for healthcare professionals and for those who profess to be involved in TA.
Publication Types:
Keywords:
- Budgets
- Delivery of Health Care
- Health Services Needs and Demand
- Hospitals, Public
- New Zealand
- Social Welfare
- economics
- ethics
- hsrmtgs
Other ID:
UI: 102211648
From Meeting Abstracts