概论当前的联邦政策是减少政府对卫生保健及其评价的责任,尽可能代之以市场机制。同时,授权地方当局采取剩余控制(residual cont-rol)。为了达到这一目的,管理部门已经建议国会大幅度地减少用于医学技术评价方面的费用。国家卫生医疗研究与卫生统计中心、卫生保健财政总署研究与发展部分的预算大幅度地减少以及中止对国家卫生保健技术中心提供资金等现象就反映了这种观点。国家卫生研究院(NIH)的预算也已经相对地有所紧缩。NIH所提供的资金即使是很小的削减也会对技术评价与临床试验产生影响。而这种减少恰恰发生在无论是学术机构或是私人与政府承保人都要求更广泛地进行医学技术策略评价的呼声日益增高的时候。能够部分解决这种矛盾的一项办法是建立一种私立的保健评价机构(IIICE)。早就有人指出建立这种机构的必要性。这种机构应当是一种非盈利企业,其职责是承担国家 Introduction The current federal policy is to reduce the government’s responsibility for health care and its evaluation and replace it with market mechanisms whenever possible. At the same time, local authorities are authorized to take residual cont-rol. In order to achieve this goal, management has suggested that Congress substantially reduce the costs for medical technology evaluation. This view is reflected in the dramatic reductions in the budgets of the National Health and Medical Research and Health Statistics Center, the Research and Development Department of the Health Care Financial Administration, and the suspension of funding for the National Health Technology Center. The National Institutes of Health (NIH) budget has also been tightened relatively. Even a small reduction in funding provided by the NIH will have an impact on technical evaluation and clinical trials. This reduction occurred precisely when the demand for more comprehensive medical technology strategy evaluations by academic institutions or private and government insurers has increased. One way to partially resolve this conflict is to establish a private health assessment agency (IIICE). It has long been pointed out that the establishment of such institutions is necessary. This institution should be a non-profit enterprise whose responsibility is to assume the national responsibility.