Braslow N M, Shatin D, McCarthy D B, Newcomer L N
Center for Health Care Policy and Evaluation, United HealthCare, Minneapolis, MN 55440, USA.
Am J Manag Care. 1998 Sep 25;4 Spec No:SP139-50.
With the profusion of new medical technology, managed care organizations are faced with the challenge of determining which medical devices and services warrant health benefits coverage. To aid in this decision-making process, managed care companies turn to technology assessment, a process that differs from the Food and Drug Administration's review of medical devices. Health plans typically use a structured approach to implementing coverage requirements in employer group benefits contracts and use technology assessment to evaluate the scientific evidence of effectiveness to support coverage decisions. Also important is the societal context for decisions regarding coverage for new technologies and the options being considered by policy makers for accountability in technology assessment by private insurers and health plans.
随着新医疗技术的大量涌现,管理式医疗组织面临着确定哪些医疗设备和服务应获得健康福利覆盖的挑战。为了协助这一决策过程,管理式医疗公司求助于技术评估,这一过程不同于美国食品药品监督管理局对医疗设备的审查。健康计划通常采用结构化方法来实施雇主团体福利合同中的覆盖要求,并利用技术评估来评估有效性的科学证据,以支持覆盖决策。对于新技术覆盖决策的社会背景以及政策制定者正在考虑的让私人保险公司和健康计划对技术评估负责的选项而言,同样重要。