Health technology assessment of medical devices

ecomes an innovation if it is somehowadapted by the market and integrated intoa technology, process or organizationallandscape. Any innovation comprisesthree dimensions.1. Kind of innovation: What is new?Product, process, input, organizational,social.2. Subjectivity of innovation: New forwhom? Individual, group, organization,industry, society.3. Degree of innovation: How new?Market, technology, organization,environment.The Global Forum for Health Researchproposes this very short working definitionof innovation: “Innovation encompassesthe entire process from the generationof new ideas to the transformationof those ideas into useful things(health services, products, methods,management practices and policies) totheir implementation” (22). In accordancewith this concept of innovation, HTA playsa major role in innovation by shaping theconditions of successful implementationin health systems.Overall, the use of HTA to inform nationalcoverage policies leads to a more explicitand transparent resource-allocationprocess, improving not only technical orallocative efficiency, but also health equity.A case study of Argentina illustratesthe importance of HTA for transparentresource allocation in countries withfragmented health systems (23). Acontext-oriented concept of innovationmay also explain the increasing useof HTA in different levels of decisionmakingwithin health systems, includinghospitals. In order to support innovation,HTA must support decision-making notonly on what to implement, but also onhow to implement a new technology.It is valuable for any discussion ofinnovation to take into account theoverall objective of the use of healthtechnologies for a population. In a casestudy of the Israeli health system, theinvestigators state, “Innovation playsa key role in medical progress, andcontributes significantly to public health.Reimbursement provides a significantincentive for innovation, with the twoforming a feedback cycle. Nevertheless,it should be kept in mind that it is healththat people desire, and health technologyutilization is merely the means to achieveit” (24).8.4 Health technologyassessment as part of goodhealth governanceIn their 2008 book Access: how dogood health technologies get to poorpeople in poor countries? Laura Frostand Michael Reich from the HarvardCentre for Population and DevelopmentStudies illustrate a number of barriersto an equitable access to beneficialhealth technologies. Their case studies“highlight the importance of expertconsensus, both within the directlyinvolved international technical agenciesand the broader international publichealth community” (25). The vision ofHTA as an interdisciplinary, contextinformedapproach for evidence-basedconsensus building should be promoted.This will help build a stronger communityof practice and discourse between theproducers of HTA and the policy anddecision-makers who use the information.This sets the stage for the need for goodgovernance and leadership.Arminee Kazanjian and Carolyn Green,from the University of British Columbia,Canada, pointed out that healthtechnology assessment is a necessarypart of the public accountabilityframework in a health system (26). TheWorld Bank recently released a reportstating that “good governance as an entrypoint can help to focus on performance in20Health technology assessment of medical devices