BARRIERS TO HEALTH

TECHNOLOGY ASSESSMENT
PREPARED BY: IAN RAY VAN MATT EDWARD A. GUINID RPH
 BARRIERS TO HEALTH TECHNOLOGY
ASSESSMENT
1. TECHNOLOGICALLY IMPERATIVE- PARTICULARLY IN THE US AND OTHER WEALTHY COUNTRIES, THERE IS
A “TECHNOLOGICAL IMPERATIVE” COMPRISING AN ABIDING FASCINATION WITH TECHNOLOGY, THE
EXPECTATION THAT NEW IS BETTER, AND THE INCLINATION TO USE A TECHNOLOGY THAT HAS POTENTIAL FOR
SOME BENEFIT, HOWEVER MARGINAL OR EVEN POORLY SUBSTANTIATED ( DEYO 2002 ).  SOME ARGUE THAT
THE INCREASED POTENTIAL OF TECHNOLOGY ONLY RAISES THE IMPERATIVE TO CONDUCT HTA (HOFFMAN
2002). 
2. LIMITED RESOURCES FOR HTA- AS IS SO FOR OTHER EFFORTS, RESOURCES FOR HTA ARE LIMITED. 
ALTHOUGH SOME HTA PROGRAMS AND CERTAIN HTA FINDINGS ARE NATIONALLY OR INTERNATIONALLY
RECOGNIZED, THE RESOURCES ALLOCATED FOR HTA, EVEN IN THE WEALTHY NATIONS, ARE VANISHINGLY
SMALL COMPARED TO NATIONAL HEALTH CARE SPENDING.
3. INSUFFICIENT PRIMARY DATA- LACK OF PRIMARY STUDIES AND OTHER DATA SOURCES
LIMITS THE EVIDENCE BASE FOR HTA.  THIS ALSO INCLUDES LACK OF LOCAL OR
REGIONAL DATA TO CONDUCT HTA PERTAINING TO A PARTICULAR NATION, REGION,
OR HEALTH CARE FACILITY AND LACK OF DATA PERTAINING TO
PARTICULAR POPULATION
SUBGROUPS FOR WHICH A TECHNOLOGY MAY BE APPLICABLE.
 BARRIERS TO HEALTH TECHNOLOGY
ASSESSMENT
4. TIMING MISALIGNMENT- THE TIMING OF HTA MAY BE MISALIGNED WITH DECISION-
MAKING NEEDS AND OTHER EVENTS. THIS MAY ARISE IN DELAYS IN REQUESTING OR
ALLOCATING FUNDING FOR AN HTA, ONGOING ADOPTION AND USE OF TECHNOLOGIES
WHILE HTA IS BEING CONDUCTED, DELAYS BETWEEN RELEASE OF HTA FINDINGS AND THEIR
ADOPTION IN POLICY AND PRACTICE, AND THE “MOVING TARGET PROBLEM,” IN WHICH THE
RELEVANCE OF HTA FINDINGS IS DIMINISHED BY CHANGES IN TECHNOLOGIES, THEIR
COMPARATORS, OR HOW THEY ARE USED.   
5. PRESTIGIOUS PROPONENTS OF TECHNOLOGY- THE OPINIONS OF HIGHLY REGARDED OR
POWERFUL PROPONENTS OR “CHAMPIONS” OF ADOPTING A TECHNOLOGY MAY PREVAIL,
EVEN IN THE ABSENCE OF CREDIBLE SUPPORTING EVIDENCE. 
6. MARKETING- INCREASINGLY EFFECTIVE AND TARGETED MARKETING AND PROMOTION
OF HEALTH TECHNOLOGIES, INCLUDING SHORT COURSES SPONSORED BY HEALTH CARE
PRODUCT COMPANIES TO TRAIN PHYSICIANS IN USING THESE PRODUCTS AND DIRECT-TO-
CONSUMER ADVERTISING (WHERE THIS IS PERMITTED) CAN WEIGH AGAINST HTA FINDINGS.
 BARRIERS TO HEALTH TECHNOLOGY
ASSESSMENT
7. FINANCIAL INCENTIVES- HEALTH CARE SYSTEMS THAT REIMBURSE HOSPITALS, PHYSICIANS,
AND OTHER PROVIDERS EVERY TIME A TECHNOLOGY IS PROVIDED, I.E., “FEE-FOR-SERVICE”
HEALTH CARE, TEND TO INCREASE THE VOLUME OF TECHNOLOGY USE, EVEN WHEN SUPPORTING
EVIDENCE IS LACKING.  HOSPITALS AND PHYSICIAN GROUPS THAT HAVE INVESTED IN MAJOR
CAPITAL EQUIPMENT AND SUPPORTING INFRASTRUCTURE SUCH AS FOR DIAGNOSTIC
RADIOLOGY, RADIATION ONCOLOGY, AND ROBOTIC SURGERY, HAVE INCENTIVES TO USE THESE
TECHNOLOGIES (GARRISON 2011; JACOBS 2013).  ALSO, PATIENTS WITH LITTLE OR NO EXPOSURE
TO COSTS TEND TO SEEK MORE HEALTH CARE.  THESE FINANCIAL INCENTIVES CAN CONTRIBUTE
TO THE INERTIA OF EXISTING PAYMENT SYSTEMS THAT REWARD USE OF TECHNOLOGIES DESPITE
LACK OF SUPPORTING EVIDENCE AND RELATED POLICIES AND CLINICAL PRACTICE GUIDELINES. 
8. POLITICAL ACTIONS- HTA MAY BE CIRCUMVENTED BY POLITICAL ACTIONS, OFTEN PROMPTED
BY “LOBBYING” OR “PRESSURE GROUPS.”  THIS OCCURS, FOR EXAMPLE, WHEN LAWS ARE PASSED
TO MANDATE (OR ELIMINATE) COVERAGE BY GOVERNMENT OR PRIVATE SECTOR PAYERS FOR
CERTAIN TECHNOLOGIES, IN CONTRAST TO FINDINGS BASED ON AVAILABLE EVIDENCE, OR IN
THE ABSENCE OF RIGOROUS EVIDENCE.
 BARRIERS TO HEALTH TECHNOLOGY
ASSESSMENT
9. IMPLEMENTATION BARRIERS- THERE ARE VARIOUS BARRIERS TO IMPLEMENTING SOME
HTA FINDINGS AND RECOMMENDATIONS BY DECISION MAKERS AND POLICYMAKERS FOR
WHOM HTA REPORTS ARE INTENDED.  AMONG THESE ARE:  LACK OF ACCESS TO HTA REPORTS,
COMPLEX AND TECHNICAL FORMATS OF HTA REPORTS, QUESTIONABLE DATA QUALITY,
ABSENCE OF REAL-WORLD APPLICATIONS, AND NARROW FOCUS ( HENSHALL 2002 ).  HTA
FINDINGS AND RECOMMENDATIONS MAY BE DIFFICULT TO IMPLEMENT GIVEN CLINICIANS’
AND OTHER PROVIDERS’ RELUCTANCE TO CHANGE LONG-STANDING PRACTICE ROUTINES,
INERTIA OF EXISTING PAYMENT POLICIES, AND RAPIDLY OUTDATED EDUCATION AND
TRAINING IN SOME INSTANCES.  INSUFFICIENT OPPORTUNITY OR ENCOURAGEMENT FOR
SCIENTIFIC INQUIRY AND SKEPTICISM IN CLINICAL EDUCATION CONTRIBUTES TO THIS
INERTIA.  IMPLEMENTATION OF HTA FINDINGS ALSO MAY BE LIMITED DUE TO PRACTICAL
EXTERNAL CONSTRAINTS, SUCH AS WHEN ADOPTING A NEW TECHNOLOGY REQUIRES A
PARTICULAR ENVIRONMENT (E.G., SPECIAL SHIELDED ROOMS, INSTRUMENTATION, AND
RELATED FACILITIES FOR DIAGNOSTIC AND THERAPEUTIC PROCEDURES USING IONIZING
RADIATION), PROFESSIONAL TRAINING, OR OTHER RESOURCES THAT ARE UNAVAILABLE IN A
PARTICULAR FACILITY.
 PHARMACOECONOMICS AND THE PHARMACY
FIELD
1) COMMUNITY- CHOOSING THE MEDICATION THAT HAS A GOOD QUALITY BUT A CHEAPER PRICE. PATIENT
COUNSELING IS ESSENTIAL EX: GENERIC PRODUCTS AND BRANDED GENERICS
2) HOSPITAL/ CLINICAL- TREATMENT ALGORITHMS THAT ARE BE OF HELP IN CHOOSING THE BEST
TREATMENT TO THE PATIENT IN ORDER TO REDUCE HOSPITALIZATIONS. GOOD QUALITY + CHEAPER
PRICE
3) MANUFACTURING- INDUSTRIAL COMPANIES MANUFACTURE GENERIC MEDICATIONS TO PROVIDE
QUALITY AND AFFORDABLE MEDICINES
4) ACADEME- TRAINING FUTURE PHARMACISTS TO BE ESSENTIAL HEALTH WORKERS AND SCIENTISTS IN
THE FUTURE
5) PHARMACOVIGILANCE- ANTIBIOTIC STEWARDSHIP AND ADR MONITORING REDUCES
HOSPITALIZATIONS AND DISEASE RECURRENCE
6) PUBLIC HEALTH- EDUCATING THE PUBLIC OR COMMUNITY ABOUT PROGRAMS THAT CAN BE OF HELP
EX: HYPERTENSION AND DIABETES CLUB
 REFERENCE:

• NATIONAL LIBRARY OF MEDICINE. (2020). HTA 101: X. SELECTED ISSUES IN HTA.

RETRIEVED MAY 11, 2021 FROM
HTTPS://WWW.NLM.NIH.GOV/NICHSR/HTA101/TA101012.HTML#HEADING1
GOOD LUCK WITH YOUR LAST QUIZ !!!!