Assessment and regulation of health care technology - The Dutch experience

Objectives: To evaluate the characteristics, methods, and results of the Dutch Investigative Medicine Program ("ontwikkelingsgeneeskunde") in policy and health care. Methods: Project database analyses of the initial 9 years of the program; description of characteristics, methods, and effects of the program. Results: By the end of 1997, 53 projects had been completed, including implementation in health care policy. In 20 at 53 cases the program worked as an instrument to prevent the introduction of ineffective, inefficient, or even harmful medical interventions. In most other cases the program assisted with proper placement or appropriate application of new technologies,Apart from new or emerging technologies, already existing technologies are evaluated. Conclusion: The Dutch Investigative Medicine Program ("ontwikkelingsgeneeskunde") of the Sickness Funds Council is an effective collaboration of health care providers, medical science, health economics, and a regulatory body in empirical technology assessment. It is also-an example not only of a substantial contribution of technology assessment to decision making in practice and policy but also of a means of regulation of health care by the very activity of technology assessment itself. It appears that the program has evolved into an instrument to rationalize health care and health care policy, although some further possible improvements are identified.