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.