This post is part of the Health Affairs Blog short series, “Value Assessment: Where Do We Go Post-COVID?” The series explores what we have learned about value assessment and related issues during the coronavirus pandemic, how we might think about value in health care going forward, and how these ideas might translate into policy. The series is produced with the support of the Innovation and Value Initiative (IVI) and grew out of a group of webinars hosted jointly by IVI and ISPOR—The Professional Society for Health Economics and Outcomes Research. Included posts are reviewed and edited by Health Affairs Blog staff; the opinions expressed are those of the authors.
Proposals for a national entity to produce and assess evidence about the relative value of medical technology have found new energy in recent years. Efforts to create such an organization, however, are not new. The history of health policy in the United States includes multiple abandoned efforts to establish this type of body. Within the federal government, these include the National Center for Health Care Technology, established in 1978 and sunsetted in 1981; the Congressional Office of Technology Assessment (OTA), established in 1972 and defunded in 1995; and the Agency for Health Care Policy and Research’s clinical guidelines development program, established in 1989 and ended in 1996 in the wake of controversy surrounding a guideline for treating lower back pain.
But this history is not just limited to discarded efforts. Some examples of federal capabilities that continue to the present include assessments that support Medicare’s National Coverage Determination process, the work of the United States Preventive Services Task Force, and the technology assessment program of the General Accountability Office, among others. At the state level, California and other jurisdictions have established their own programs to review proposed health insurance benefit laws. The many private-sector assessment efforts, whether independent or serving particular stakeholders, as well as examples from other countries, such as the Canadian Agency for Drugs and Technology Technologies and in Health and the UK’s National Institute for Health and Care Excellence, provide clear evidence for the feasibility and benefit of such agencies.
Because of, or perhaps in spite of, this history, proposals for a new value assessing entity emerge somewhat regularly, often articulating evidence needs not currently being fulfilled by existing capabilities. The recent USC Schaeffer Center for Health Policy and Economics/Aspen Institute task force report lays out the market failures that support the idea of a new national entity to assess the value of both new and established health care technologies and services …….