[Making the case for a more sustainable health care system - The role of technology assessment]

Health Technology Assessment (HTA) is established as a tool for evidence-based decision support in the health care sector. HTA aims to determine the value of a health technology at different points in its life cycle and to promote an equitable, efficient and high-quality health care system. The health care sector is estimated to be responsible for 5% of greenhouse gas emissions and raw material consumption. Buildings, anesthetic gases, metered dose inhalers, pharmaceuticals and medical devices are important drivers of these emissions. So far, sustainability as (according to Brundtland) a development that meets the needs of the present without compromising the ability of future generations to meet their own needs, has not played a role as a decision-making criterion in the introduction and provision of health care technologies. The concept of sustainability could extend HTA to the entire life cycle (the 'first' and the 'last' mile) and thus establish the ecological footprint as a further dimension in the assessment process. Despite international efforts to achieve climate neutrality in the health care sector, there are as yet no concrete strategies for implementation in Germany and Europe, with the exception of the UK. The political mood is even moving in the direction of climate policy regression. A sustainability strategy could draw on a large number of national and European regulations outside the health care sector and integrate them into existing methodological approaches, such as the incremental carbon footprint effectiveness ratio. At the practical level, these findings could be incorporated into climate-sensitive health counseling. The future federal government, professional associations and health care professionals should take urgent action.