Abstract

PIP: Medical technology, which holds out the promise of improving public health, is obviously important. Nevertheless, it is also true that in some ways today's medical technology seems out of control. In the US, for example, there has been investment in curative technology even beyond the point where one could hope for small gains, while many possibilities in other areas of health technology have been ignored. Therefore, the important question is how to develop, select, and deploy medical technology that will meet human needs without overtaxing our countries' limited resources. In general, there are 4 types of government policies dealing with medical technology, these being research and development policies, evaluation policies, safety and efficacy policies, and policies governing investments and use. By and large, the nations of Latin America tend to be in need of clearly defined health research policies and of improved coordination and communication between institutions doing applied research. I very important research and development question that has not been clearly answered is whether existing resources can be used to produce a more appropriate technology, for in general the region's limited scientific research effort has not been steered in this direction. Regarding evaluation of medical technology, it appears that no Latin American country has as explicit policy or program concerned with the evaluation of medical technology. In the area of safety and efficacy, the mandatory registration of new pharmaceuticals with the government usually provides a basis for regulation of pharmaceutical technology in Latin America. The nature of this registration process varies greatly from country to country, and in most countries except Brazil, little or no original testing is prformed. Medical devices are not generally regulated for safety of efficacy in Latin America. Regarding investment in medical technologies ad the use of those technologies, a large share of the health services in Latin America is provided through public programs. This means that the decisions to invest in and use certain technologies are not dictated by the individuals who wish to use the services, but rather are made by those controlling the systems, often through explicit policies. Ideally, a well coordinated system for assessing medical technology can be broken down into 4 stages: identification of the technologies to be assessed, testing of those technologies, synthesis of all available information, and dissemination of that information to appropriate properties. At the present time, there is little indication that any of these processes are being preformed in an extensive way in most Latin American countries. However, many cases, it would appear possible to have a program which identified technologies in urgent need of assessment, sought information from various sources, and prepared guidelines for action based on this information. This would not be expensive but could be rather useful.