A technology anthology. Recent writings and remarks on the state of the state-of-the-art

Early this year, the Health Care Financing Administration (HCFA) backed down from plans to publish a final regulation governing the criteria for coverage of medical technologies in the Medicare program. Originally drafted in 1989, the rules spawned an eight-year controversy, largely because they proposed making "cost-effectiveness" one factor in deciding whether certain procedures would be reimbursed. It was one of the first attempts to articulate the precise role cost-effectiveness should play in coverage policy in either the public or private sectors. Many groups opposed the introduction of cost-effectiveness into the equation, but none so actively as medical device manufacturers, represented by the Health Industry Manufacturers Association (HIMA). Following are excerpts from their exchanges, beginning with HCFA's proposed rule in January of 1989.