Objective – Management control has been defined by Anthony (1965) as “the process by which managers assure that resources are obtained and used efficiently in the accomplishment of the organization’s objectives”.
In public health care management, hospital-based Health Technology Assessment (HTA) represents one of the most relevant challenge within management control activities. Adopting a multidisciplinary approach, hospital-based HTA is aimed to support investments into Health Technologies (HT). The rapid evolution of new medical technologies and complex interaction of outcome, efficacy, training, support, reimbursement and costs have made evaluation of appropriateness more difficult. Thus, introduction a new technology not always produces an improvement of the services’ quality and a cost saving. Because of greater responsibility and autonomy of health organizations, nowadays the value of a technology is strictly related to the resources and skills available at hospital level. However, given that HTA is usually run by clinicians and biomedical engineers (whose competences considers mainly clinical and technical aspects), the HTA’s main limit regards the lack of managerial competences in supporting the decision-making process.
In order to address this problem, this conceptual paper is aimed to answer to this research question:
“Which are the more appropriate perspectives in order to understand performance within hospital-based HTA?”.
In accordance to performance management (PM) principles, definition of relevant perspectives and related issues represent a starting point for improving technological investment decisions and for supporting the achievement of strategic objectives.
Methods – To answer the research question, it was conducted a review of the literature on the field of hospital-based HTA. It has been selected all relevant studies published between January 1998-July 2016. Research has been conducted on three of main databases – EBSCO, Pubmed and Scopus. Results of the review process have been analysed and codified by N’Vivo 11 software.
Conclusion – Three perspectives are arisen from literature review: clinical perspective; economic perspective and organizational perspective. It has been defined also main issues have to be considered for each perspective.
Mostly of the studies included in the sample underline predominant role of clinical and economic perspective. However, at hospital level technology impacts directly on operative modalities and on the quality of service delivered. Thus, evaluation process cannot neglect organizational issues, which not only increase the quality of assessment process and the likelihood of a successful implementation of a new technology, but also allow managers to better understanding overall organization performance,
Contribution – This paper contributes to the field of healthcare management by arguing why HTA activities needs a managerial support in its implementation and which are perspectives to be considered for improving and structuring evaluation process. In particular this contribution underlines the necessity of a “balanced” consideration of performance achieved by a HT under assessment.
It may be considered a starting point for further researches aimed to explore how management accounting principles could support the achievement of hospital-based HTA purposes. It also represents a contribution for practitioners for improving current modalities adopted for decisions about resources employment.
