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Prologue:
We live in an age of high technology, whether the subject is medicine, the exploration of space, or unraveling other mysteries of mankind. One small reflection of this reality is the presence on Capitol Hill of the Office of Technology Assessment, an arm of Congress created to assist legislators to better understand the relentless pace of technological change in our society. One of the pursuits of OTA involves a wide range of health related issues, which command the attention of a professional staff numbering about a dozen at any given time. David Banta, a board-certified specialist in preventive medicine, directs this work. One of his senior associates is Jane Willems, a Ph.D economist with a particular interest in technology. The thinking of Banta, as it relates to the appropriate role of government in monitoring technology, has changed in the seven years he has worked on Capitol Hill. Once a devout believer in strong regulation as the primary force to improve the use of technology, Banta has come around to thinking that a variety of instruments may be needed to undertake such tasks in the United States. Willems, on the other hand, has maintained a firm belief in the workings of the marketplace and in decentralized decisionmaking. The paper written by Banta and Willems reflects this tandem of thought. Three congressional committees in particular make use of the OTA 's health work: the Senate Labor and Human Resources Committee, the Senate Finance Committee, and the House Energy and Commerce Committee. Recent studies undertaken by the OTA include technology transfer at the National Institutes of Health, the role of technology in Medicare, alternatives to health and safety regulation in the work place, and technologies for handicapped people.
Several public policy issues converge in the growing concern about the appropriate use of medical technology. Medical technology is made up of drugs, devices, and medical and surgical procedures, as well as the organizational and supportive systems within which such care is delivered.1 There is alarm about rising expenditures for medical technology and misgivings about whether or not the benefits justify the costs of its use. The efficacy of both new and existing medical technologies has been called into question.2 Overuse of technology may lead to greater expenditures...