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H D Banta

Publications and source records attributed to H D Banta.

At least 19 recordsLinked to original sources
PubMed2001

Introduction: mass screening, health technology assessment, and health policy in some European countries.

OBJECTIVE: The series of papers in this issue was developed to examine the use of health technology assessment in policies toward prevention-specifically toward mass screening-in European countries. The papers actually examined three screening strategies: mammography screening for breast cancer, prostate-specific antigen screening for prostate cancer, and routine ultrasound in normal pregnancy. METHODS: Papers were sought from the member states of the European Union, plus Switzerland. Ultimately, nine acceptable papers were received, and were reviewed, revised, and edited. RESULTS: Screening is an accepted strategy in many countries for reducing the burden of disease through early detection and intervention. In part, this is because of successful screening programs that have been evaluated and implemented in many countries. At the same time, unevaluated and even useless and harmful screening programs-unjustified medically or economically-are widespread. Health technology assessment could help assure that only effective and cost-effective screening programs are implemented. CONCLUSION: The main conclusion is that screening is an important preventive strategy. Any screening program, however, should be carefully assessed before implementation.

Cost-Benefit Analysis↗
PubMed2001

Health technology assessment and screening in The Netherlands: case studies of mammography in breast cancer, PSA screening in prostate cancer, and ultrasound in normal pregnancy.

OBJECTIVE: To review the assessment and implementation of three screening methods: mammography for breast cancer, screening for prostate cancer, and routine use of ultrasound in pregnancy. METHODS: To review policy documents and published papers dealing with prevention and screening in the Netherlands, focusing on the three screening methods specified. RESULTS: The results indicate that the Netherlands has an active establishment devoted to health technology assessment (HTA). The Netherlands government has also made prevention a high priority in the health services system. Within prevention policy, HTA is given an important place. The general policy is that prevention programs should meet high standards of effectiveness and efficiency, as well as ethical, legal, and social acceptability. In addition, the Netherlands may be unique in the world in having a specific law requiring that proposals for population screening must be carefully assessed before they are implemented. CONCLUSIONS: The three cases examined in this paper have all been assessed, and the conclusions are similar to those presented in the synthesis published in this issue (33). In the case of mammography, the assessment was followed by a rational implementation of a national screening program for breast cancer. In the other two cases, however, despite negative conclusions from assessment, the tests are frequently carried out, especially in what has been termed opportunistic screening. Prostate cancer screening seems to be spreading rapidly. Use of ultrasound in pregnancy is frequent, not necessarily for medical reasons but because parents wish to have a picture of their fetus. The conclusion is that HTA is well established in the Netherlands, as illustrated in these three cases, and policy is based on the assessments done. However, practice is not in accord with the assessment in the cases of prostate cancer and routine ultrasound. Policies to deal effectively with opportunistic screening are difficult to imagine.

Adult↗
PubMed2001

Health technology assessment and screening in Sweden.

OBJECTIVES: To describe health technology assessment (HTA) and policies concerning three screening procedures in Sweden. METHODS: The main source of information was reports from the Swedish Council for Technology Assessment in Health Care (SBU) and other governmental reports, supplemented by the professional literature. RESULTS: Prevention is emphasized in the healthcare services of Sweden. Specifically, screening is encouraged and supported when it is deemed beneficial. Sweden has a strong orientation toward evidence-based health care and HTA. Since its inauguration in 1987, SBU has fostered the use of HTA in making policy and clinical decisions in Sweden. Government policy in Sweden is to encourage services that are beneficial and cost-effective and discourages services that are not. Screening is no exception to this general rule. The three cases examined in this paper-mammography screening, PSA screening, and routine ultrasound screening in pregnancy-have all been formally assessed in Sweden. Assessments have been an integral part of policy making concerning these and other preventive measures. Mammography screening has been widely implemented. However, as in other countries, screening is often carried out in an opportunistic fashion, so that PSA screening, in particular, is carried out more in Sweden than can be justified by the evidence. CONCLUSIONS: Mammography screening is promoted and is completely available to the target group. PSA screening is discouraged, but not with complete success. Ultrasound in pregnancy is widely used, not because of good evidence of impact on mortality and morbidity among newborns, but because it increases the detection rate of congenitally malformed fetuses and because of evidence of positive effects on the management and planning of deliveries, as well as because of psychological and ethical implications of the technology. HTA is an important part of health policy making in Sweden.

Adult↗
PubMed2001

Health policy, health technology assessment, and screening in Europe.

OBJECTIVE: To present a summary of the papers in this volume, illustrating the links between health technology assessment (HTA), health policies and specifically policies toward prevention and screening, and implementation of screening tests in the case of three screening methods: mammography screening for breast cancer, screening for prostate cancer, and routine use of ultrasound in pregnancy. METHOD: To commission papers from eight European countries based on a set of questions to be answered, as well as a paper synthesizing the scientific literature on the three screening procedures. RESULTS: Indicate that few of the countries examined have developed effective links between HTA, health policy, and implementation related to screening procedures. Only Sweden and the Netherlands appear to have developed such links. In the other countries, HTA has a limited role in determining health policy. It also seems to be uncommon for countries to have a specific prevention strategy. CONCLUSION: The major conclusion is that countries of Europe need to develop HTA as part of prevention policies.

Adult↗
PubMed2000

The ethics of assessing health technologies.

Health technology assessment (HTA) consists of the systematic study of the consequences of the introduction or continued use of the technology in a particular context, with the explicit objective to arrive at a judgment of the value or merit of the technology. Ideally, it is aimed at assessing all aspects of a given technology or group of technologies, including non-technical, e.g. socio-ethical, aspects. However, methods for assessing socio-ethical implications of health technology are relatively undeveloped and few mechanisms exist to take action based on the results of such evaluations. Still, the examples of cochlear inplants (CI) and other cases illustrate that HTA is not a matter of merely collecting the facts about a technology. The facts must be plausible and relevant from a particular framework, which is not always shared by different groups. It is here that socio-ethical aspects are encountered. If health technology assessment aims to enhance the accountability of the decision making process regarding funding and use of health technology, it is a major challenge to assessors of health technologies to deal adequately with existing value pluralism. In this respect interactive evaluation may have something to offer.

Beneficence↗
PubMed1998

An early system for the identification and assessment of future health care technology. The Dutch STG Project.

This article is based on the report, Anticipating and Assessing Health Care Technology, written in the Netherlands between 1985-88. The project was carried out because of increasing concern in the Dutch Ministry of Health (STG, then WVC) about the costs and benefits of new technologies for health care. At that time, there were no established models for early identification, so the project was not only the most extensive such effort to that date, but had to develop its own methods. Overseen by a special commission, the project staff identified many future and emerging technologies in health care and assessed selected technologies. Although the actual information produced was quickly dated and the project was discontinued in 1988, it did stimulate the Ministry of Health to ask the Dutch Health Council (Gezondheidsraad) to continuously identify important new technologies. The reports also demonstrated the potential usefulness of such an effort to Dutch policy makers, and probably to those in other countries as well.

Communication↗
PubMed1998

A training course in health technology assessment in Malaysia.

This article describes a 1-week training course in health technology assessment (HTA) presented in Malaysia by the Ministry of Health in 1996. Malaysia established an HTA unit in the Ministry of Health in 1995 and a National Health Technology Assessment Program in 1996. The purpose of the course was to develop HTA knowledge and skills in Malaysia, since these are largely lacking. The course consisted of didactic sessions and group work. Didactic sessions covered the principles of HTA. Group work was for the purpose of developing practical skills, and was based on reports from HTA agencies, published articles, and candidates for assessment suggested by course participants. Course participants were a mix of physicians, nurses, hospital administrators, and Ministry of Health officials. Experiences in this course may be helpful to others who wish to organize training courses in developing countries.

Developing Countries↗
PubMed1997

A history of ISTAHC. A personal perspective on its first 10 years. International Society of Technology Assessment in Health Care.

This reflection on the history of the International Society of Technology Assessment in Health Care is an effort to describe the creation of the Society and its first 10 years of activity. Without analyzing the forces that spurred the growth of technology assessment internationally or linking events, policies, and changes in the various countries, this essay focuses on the persons and events that surrounded the birth and growth of the Society in the past decade.

Global Health↗
PubMed1994

Strategies for successful evaluation and policy-making toward health care technology on the move: the case of medical lasers.

Evaluating new health care technology that is rapidly diffusing is one of the greatest challenges to researchers and policy-makers. If no evaluation is done until the technology is mature, evaluation will not influence processes of diffusion. If evaluation is done early, it may be irrelevant when it is completed, because of developments in the technology and changing indications for its use. Nonetheless, early evaluation seems to be the only strategy possible to improve the integration of evaluation and diffusion. These difficulties are illustrated by the case of lasers. Lasers are diffusing relatively rapidly into health care, and yet few laser applications have been well-evaluated. Looking back over the past 20 years or so, only one public body, the National Eye Institute of the U.S. National Institutes of Health (NIH) seems to have tried to address the problem of laser evaluation. In the case of the Eye Institute, it has consistently identified new technologies for treatment of eye conditions and has mounted well-designed prospective evaluations aimed at influencing clinical practice. However, these evaluations have not been integrated with public policy-making, and therefore their influence has been relatively slow to develop. In recent years, concerns about technology have brought more active attempts to develop public policies to affect diffusion. Excimer laser treatment of coronary artery disease, especially as dealt with in the Netherlands, illustrates how a strategy can be developed. Regulation has allowed diffusion to be constrained while evaluation is carried out. Results of the evaluation will guide subsequent diffusion. In the future, such results will probably be used in determining if the laser treatment should be included in the benefit package of health insurance. A strategy for improving diffusion processes requires continuous monitoring of technological developments in health care to identify candidates for such early assessment. Since assessment resources are limited, setting priorities between candidates for assessment is necessary. Once priorities have been determined, an evaluative strategy can be formulated. As in the case of laser treatment of coronary disease, a mechanism for constraining diffusion until evaluations are completed is necessary. Once the studies are completed, policy-making must be done promptly. The problem of successful implementation of this strategy lies with the public bodies, which are often not prepared to develop an integrated strategy of diffusion based on technology assessment and economic appraisal. Developing such a strategy, which would involve slowing diffusion in some cases and speeding it up in others, seems to have clear benefits.(ABSTRACT TRUNCATED AT 400 WORDS)

Coronary Disease↗
PubMed1994

The future and health care technology: implications of a system for early identification.

Future and emerging health care technologies are increasingly high-impact events for society in terms of the quality and costs of health care. They raise issues of efficacy, safety, resource allocation, ethics, impact on the organization and delivery of care, and broad social effects. This article describes an analysis of future and emerging health care technology, initiated by the government of the Netherlands and carried out formally from 1985 to 1988, and its potential usefulness in a policy and decision-making context. Using the results and experiences of this analysis, it is argued that rational health care planning and decision-making can be strengthened by paying more attention to the possible implications of emerging and future technology.

Coronary Disease↗
PubMed1993

Minimally invasive surgery. Implications for hospitals, health workers, and patients.

Minimally invasive surgery is one of the great innovations of health care in the 20th century. It promises to revolutionise surgery by allowing many more operations to be performed with minimal hospitalisation. Pressure from patients has caused many techniques to spread rapidly before they have been adequately assessed. This must be resisted, and policy makers must pay more attention to minimally invasive surgery to ensure that good assessments are made. The widespread use of minimally invasive techniques has important implications for hospitals and health workers. As more patients are treated on an outpatient basis, fewer hospital beds will be needed, and traditional operating rooms will have to adapt to a greater turnover of patients. Surgeons will have to acquire new operating skills, possibly requiring formal training and accreditation, and, as different specialties fight for control of new technologies, surgery may eventually be merged with internal medicine so that specialists will deal with organ systems. Postoperative care will have to be carried out in the community rather than in hospitals, and policy makers will need to reorganise their health systems to cope with these developments.

Clinical Competence↗
PubMed1993

Quality of life. 1. Perspectives.

Assessing the value of health care interventions is more and more a concern of governments, clinicians, health insurance companies, policy makers, and the general public. One dimension of the outcomes of such interventions that has received relatively little attention until recently is quality of life. However, during the last decade, measuring quality of life has become more frequent. Methodologies have also developed rapidly. At the same time, methodological problems continue to be troubling. In part, this explains the relative lack of use of validated measures of quality of life in clinical trials. In the future, measuring quality of life will certainly become more frequent. It may even be demanded by policy making bodies. Increasingly, too, economic costs will be part of such studies. This requires considering both clinical and economic data.

Cost-Benefit Analysis↗
PubMed1993

Introduction. Minimally invasive therapy in five European countries: diffusion, effectiveness and cost-effectiveness.

Minimally invasive therapy (MIT) is a field that has gained a great deal of attention since the mid-1980s. MIT is a new and rapidly growing area of medical treatment based on developments in endoscopy, vascular catheters, imaging devices, and related technologies. Although endoscopes have been in use for more than 100 years, it is relatively new to use them for therapeutic purposes. Now practically every organ system in the body can be approached by these technologies. The resulting revolution in health care is the subject of this issue of the journal.

Diagnostic Imaging↗
PubMed1993

Diffusion of minimally invasive therapy in The Netherlands.

In the context of the European project, the diffusion of 10 selected cases of minimally invasive therapy (MIT) in the Dutch health care system was documented and analyzed. In each case the diffusion pattern resulting from the balance of stimulating and impeding factors is described, and summarized in a matrix framework. Budgetary pressures, lack of evidence on effectiveness and physician conservatism are the most important factors impeding diffusion of MIT. Patient demand, media reporting and presence of medical innovators are important diffusion-stimulating factors. Finally, a judgment is made on the policy implications of these findings, based on a comparison of the extent and speed of the diffusion of each case, the quality of evidence on effectiveness and cost-effectiveness and, in a few cases, existing policies. In most cases, more active policy making, either stimulating or otherwise guiding diffusion, would be desirable.

Angioplasty, Balloon, Coronary↗