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82 Va. L. Rev. 1641 (1996)
Technology Assessment and the Doctor-Patient Relationship

handle is hein.journals/valr82 and id is 1659 raw text is: TECHNOLOGY ASSESSMENT AND THE DOCTOR-PATIENT RELATIONSHIP Amy L. Wax* Professor Elhauge's main thesis is that technology assessment is un- likely to slow the cost explosion in health care.' Ideally, technology as- sessment would identify unnecessary, ineffective, or excessively expen- sive methods for treating or evaluating illness, or for delivering health care. But, according to Professor Elhauge, technology assessment does not prove useful in altering the patterns of consumption of medical care or in reducing inefficiencies. Significant savings cannot be achieved over the long run by wringing waste from the system, and neither elimina- tion of medically useless therapies nor the development of more efficient methods of treatment or delivery of care will reduce the inexorable cost escalation that has been a feature of our medical care system for decades. Rather, significant control of health care costs will require moving be- yond a quest for mere efficiency-the achievement of the most benefit for the least cost-to medical rationing, which entails trading off real health care benefits.2 According to Professor Elhauge, the route to cost savings through Professor of Law, University of Virginia School of Law. I am grateful for the able research assistance of Eliza Platts-Mills. I Einer Elhauge, The Limited Potential of Technology Assessment, 82 Va. L. Rev. 1525 (1996). Professor Elhauge distinguishes purely informational technology assessment from regulatory technology assessment. He describes regulatory technology assessment as the process of using information to allocate health care resources. Informational technology assessment is the process of gathering systematic data about the benefits and costs of medical therapies, techniques, and treatment strategies. See id. at 1527-29. Medical technology assessment, or a component of what Professor Elhauge refers to as informational technology assessment, typically takes the form of outcomes research, which involves examining large amounts of data about rates of various outcomes given various treatments in well-defined populations of patients. Fred Gifford, Outcomes Research and Practice Guidelines: Upstream Issues for Downstream Users, Hastings Ctr. Rpt., Mar.-Apr. 1996, at 38, 38. It requires statistical analyses of outcome data drawn from very large data bases. Id. These include data sets generated specifically for the purpose of evaluating the therapies at issue, as well as pre-existing data compilations in the form of company records, insurance files, or hospital charts. Id. at 38- 39; see also Sandra J. Tanenbaum, Knowing and Acting in Medical Practice: The Epistemological Politics of Outcomes Research, 19 J. Health Pol. Pol'y & L. 27 (1994). 2 Elhauge, supra note 1, at 1546-47. I use the term medical rationing in reference to Professor Elhauge's notion that if there is to be a reduction in the ever-increasing portion of national wealth devoted to medical care, some patients within the system must sacrifice some degree of the well-being that could be achieved by providing all potentially available care. 1641

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