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Health Technology Assessment and Evaluation

This article deals with the question of whether health technology assessment (HTA) should be regarded as a kind of evaluation. Following Michael Scriven, we define evaluation as the determination of value – value covering the merit or worth for all those affected – by use of valid methods. Mainstream HTA entails scientific research into the effects and associated costs of health technologies. It shows a tendency towards judging rather than improving technology; employs a positivist rather than a constructivist scientific paradigm; and features a strong emphasis on internal validity. If HTA is regarded as a kind of evaluation, it has limited scope. Although we agree that information on costs and effects is important for policy making in the field of healthcare, our view is that HTA as it is commonly practised is a goal-based tool rather than a type of evaluation. To ameliorate this problem, commissioners of HTA should take more risks in financing research that is still experimental, but has the potential of revitalizing HTA as a science of valuing. In this respect, social constructivism may have something to offer.