The problem of health technology: policy implications for modern health care systems
International Journal of Integrated Care, 21 November 2007 - ISSN 1568-4156
Book review
The problem of health technology: policy implications for modern health care systems
Pascale Lehoux
New York, Oxon: Routledge, Taylor & Francis Group, 2006, pp 259,
ISBN 978 0 415 94349 8
E. Buskens, Professor of Medical Technology Assessment, University Medical Center Groningen

This book by Pascale Lahoux at times appears lengthy and somewhat obscurely written. However, it presents many examples and a broad vision and understanding of health technology and health technology assessment as it is applied today. The fact that modern medicine is both producer and consumer of technology and in reality cannot be seen as a separate entity is stressed throughout this interesting book.

The first chapter provides an overview of the methods of health technology assessment. The book presents a history of an emerging and developing ‘scientific’ approach to policy decision-making. Particularly, the widely recognised need for considered decision making within a limited health care budget is presented. One should not expect to find an overview of recent methodological developments.

The second chapter describes the nature of technology. Why does technology appeal to us and what does this mean in the realm of health care? Interesting notions one may never become aware of unless they are specifically pointed out.

The third chapter expands on the fact that technology is a force by itself. Values and expectations associated with technology affect use and clear judgement of (clinical) merits. This phenomenon is important to recognise when trying to understand the apparent appeal of technology.

The fourth chapter focuses on the various stakeholders interests. Whether valid or not, given the fact that health care generally may be considered a public service paid with public means (premiums or taxes), different stakeholders may have different interests and may be biased in their judgements. This in turn shapes the arena for decision making, and for those who actually take the decisions clearly relevant to be aware of.

The fifth and final chapter draws inference from the previous chapters and presents a framework for considering (health) technology as a potentially costly and not universally beneficial yet indispensable phenomenon. With some effort one will recognise the take home messages in this chapter.

The role, much rather than the methods, of health technology assessment as it is currently practiced and deployed is discussed at length. Potential for improvement and more efficient use of research efforts in this field are discussed, as are the interests of and associations with various stakeholders such as consumers, politics, industry and health care providers. In fact the book may be perceived as an elaborate summation of the role technology plays in health care and even society at large.

In the latter appears the main drawback of the book; to me it seems that in the author's quest to be complete, the focus is somewhat lost. It is difficult to find concise take home messages, and after reading the book one may feel overloaded with ifs and maybes, without a clear notion as to how to proceed.

Nevertheless, those involved in actual policy decision-making will find it an interesting read with numerous citations and references that may invoke further reading and study. Probably, once the health technology assessor's career has moved him or her to positions where actual decisions are being discussed the relevance of the material presented is recognised.

Those who are students of epidemiology, health economics or health technology assessment may find this book a bit too much and too far from the day-to-day issues they have to tackle. Practitioners and professionals faced with new developments and technologies being presented to them on a daily basis alike would probably be more interested in a more to the point presentation of the issues raised. The lack of clear lessons and guidance mentioned above renders the book less suitable for an audience interested in performing health technology assessment or managers looking for practical solutions. Those involved in and developing integrated care will similarly learn points of global interest yet again may not find practical solutions.

In conclusion, I would recommend this book to veterans and CEOs for instance in the arena of health science, management, financing and politics. For them the book will bring new perspectives they will be able to appreciate. A four out of five star rating would apply. If you are currently struggling to comprehend health technology assessment, first read one of the excellent textbooks available, do several studies yourself and then consider buying this book.