Int J Technol Assess Health Care. 2018 Jan;34(2):131-133. doi: 10.1017/S0266462318000107. Epub 2018 Apr 3.
I have worked in health technology assessment (HTA) since 1975, beginning in the United States Congress Office of Technology Assessment (OTA), where we were charged with defining "medical technology assessment". My main concern in HTA has always been efficacy of healthcare interventions. After years in OTA, I was invited to the Netherlands in 1985, where the Dutch government invited me to head a special commission concerning future healthcare technology and HTA. From there, I became involved in over forty countries, beginning in Europe and then throughout the world. My most intense involvements, outside the United States and Europe, have been in Brazil, China, and Malaysia. During these 40-plus years, I have seen HTA grow from its earliest beginnings to a worldwide force for better health care for everyone. I have also had some growing concerns, outlined in this Perspective article. Within HTA, I am most disappointed by a narrow perspective of cost-effective analysis, which tends to ignore considerations of culture, society, ethics, and organizational and legal issues. In the general environment affecting HTA and health care, I am most concerned about the need to protect the independence of HTA activities from influences of the healthcare industries.
自 1975 年以来，我一直从事卫生技术评估（HTA）工作，最初在美国国会技术评估办公室（OTA）工作，我们的任务是定义“医疗技术评估”。我在 HTA 中的主要关注点一直是医疗保健干预措施的疗效。在 OTA 工作多年后，我于 1985 年应邀前往荷兰，荷兰政府邀请我领导一个关于未来医疗技术和 HTA 的特别委员会。从那时起，我开始参与四十多个国家的工作，首先是在欧洲，然后是在世界各地。除了美国和欧洲，我最深入参与的是巴西、中国和马来西亚。在这 40 多年里，我见证了 HTA 的发展，从最初的起步阶段发展成为全球范围内为每个人提供更好医疗保健的力量。我也有一些日益增长的担忧，在这篇观点文章中概述了这些担忧。在 HTA 内部，我对成本效益分析的狭隘视角感到最失望，这种视角往往忽略了文化、社会、伦理以及组织和法律问题的考虑。在影响 HTA 和医疗保健的一般环境中，我最关心的是需要保护 HTA 活动的独立性，使其免受医疗保健行业的影响。
