Containing Costs or Restraining Health Care?

This paper will examine the use of the policy referred to as Health Technology
Assessment (HTA), rational use of medicine (RUM) and evidence-based medicine (EBM)
as employed in strategies for cost-containment, based on recent policy initiatives in the
European Union, the United States, Australia and relevant elements of the WHO
agenda. We will first examine these to establish the essential purpose of the policies
which, rather than empowering both the physician/provider and the individual health
consumer to seek the most appropriate treatment, stresses a top-down approach
reminiscent of the worst avatars of Soviet-style economics. To strengthen the
demonstration, we will look at current practices in Europe, the United States and
Australia where cost-containment strategies are being implemented. In conclusion, we
offer some recommendations on how best to develop a patient-centred approach, going
beyond administrative considerations of meeting public budget targets.