Health technology assessment in the context of private and public models of national health systems

The increasing costs of healthcare delivery in all industrialized countries are raising serious concerns about the financial sustainability of national and regional healthcare delivery systems. Studies have shown that innovations in medical technology are one of the stronger factors that drive the upward trend of healthcare delivery costs. Many national and regional healthcare agencies and policy makers are recognizing the need for more accurate knowledge on the generation and diffusion of innovations in healthcare technologies. The focus of this paper is a comparison of the assessment of health and medical technologies in two different models of national health delivery systems: Italy and the United States. The role of health technology as a significant driver of the rising costs of healthcare delivery is well documented. Less studied is the manner in which health technologies are acquired and adopted by providers in different national systems. The authors frame the issues and compare the factors that impinge upon the diffusion of medical technologies from industry to providers in a publicly planned and funded health system and in a mostly privately-funded national health system. As the two national systems seem to converge in many aspects of national policy making, the authors explore the assessment of healthcare technologies in the short and longer terms. Are there differences and similarities in the assessment methodologies used by the different systems and, if so, how do these affect the healthcare delivery system? The authors suggest some possible answers.