This article surveys attempts by the Finnish government to plan and budget health care since the Primary Health Care Act of 1972. A national board of health allocates approved resources to local authorities who develop plans for preventative and primary health care and hospital services. The acquisition of expensive technologies are debated at the national level. The author presents studies which suggest that there is a considerable need for expansion of both diagnostic and therapeutic technologies in Finland. These adjustments will be necessary to meet the needs of an economically, socially, and demographically changing country.

Magnetic resonance (MR) undoubtedly constitutes a major technological advance, but as yet we do not know whether this invention also represents a breakthrough from the clinician's point of view.

Guyatt and Drummond suggest that the clinical value of MR is tested by means of a randomized clinical trial (RCT) in a well-defined and limited clinical area, and I fully agree with the authors that the use of such trials should not be confined to the testing of new treatments. In this particular field, however, I miss a discussion of alternative options. With few exceptions, new drugs can only be tested satisfactorily by means of an RCT, but the superiority of one imaging technique over another can sometimes be proved in other ways. Imagine, for instance, that the CT-scan is normal but that MR reveals a space-occupying lesion, the presence of which is confirmed by surgical operation or an autopsy. In that case the diagnostic superiority of MR has been proved in that particular patient. If such cases are seen frequently, and if it is known from controlled therapeutic trials that they are susceptible to treatment, then the value of MR has been proved without doing an RCT.

This review of publications based on data from the Veterans Affairs Normative Aging Study identified four articles that were considered assessments of health care technologies. Three evaluated methods for research on body composition, the fourth studied ventricular size in patients with presenile dementia. Several additional articles are discussed that provided data on baseline values or risk factors for disease that might be useful in generating hypotheses to be tested in later assessments of technologies.

When planning for health services, questions of production and distribution as well as cost and quality are key issues for health planners and decision makers. The lack of available objective data often makes this work difficult. This paper presents recent efforts in Finland to improve the collection of information needed for planning in the field of physiotherapy.

In September 1986, the American College of Physicians initiated the planning phase of its Physicians Network, an effort aimed at tapping the resources of the College's membership to collect information on physician practice patterns and their relationship to the outcomes of care. Funding for the planning has been approved by the Henry J. Kaiser Family Foundation, Menlo Park, California, and will support the 15 month project.

Prenatal diagnosis is now offered to the majority of pregnant women in Europe and the United States. Advances in obstetric and laboratory techniques mean that increasing numbers of conditions can be diagnosed prenatally; indeed, gene carriers can be identified before pregnancy in some cases. Current obstetric and laboratory techniques for prenatal screening and diagnosis of genetic disorders are discussed.

The implications of effectiveness research are far-reaching. Thus, the specification of a broad research agenda and the soundness of the underlying research methodologies and data bases are critical. This article discusses the quality of administrative data and the infrastructure supporting an ongoing effectiveness research effort.

Our assessment of influences affecting MRI acquisition, described in Part I of this paper, also elicited interesting parallels between the acquisition, operation, and marketing of this new technology and experiences with x-ray computed tomography (CT). We noted that acquirers' personal experiences with CT and how individuals perceived the occurrences surrounding the diffusion of CT in general strongly determined their approach to MRI. Specifically, we found that potential and actual acquirers of MRI had learned three categories of lessons from experiences with CT: (a) “Optimal” timing for acquiring MRI; (b) how acquisition decisions are made; and (c) how to best acquire, operate, and market MRI.

Traditional software development methodologies enhanced by a clinical component result in information systems that support the practice of nursing. This paper describes the clinical informatics model used to develop and evaluate a mobile computer assessment tool. Data entry of atomic-level elements, with storage in a relational database, allows the synthesis and analysis by multiple disciplines to aid in real-time decision making. The system is designed to improve the recording and accessibility of patient data and nursing observations on a geriatric unit at the Salt Lake VA Medical Center.

For the past 25 years, attempts have been made to treat respiratory distress syndrome (RDS) by administration of surfactant into the airways. This practice is not yet an accepted form of therapy. Lack of generally available surfactant during the present era of prospective studies will hopefully decrease the therapeutic misuse of this novel medicine.

Professional societies in general are designed to support and raise the prestige of the professions they represent, and the most overt way in which they do this is by attempting to keep the level of information concerning their profession as high as possible.

Traditionally, the predominant type of transfer of information has been scientific papers presented at meetings for the memebership, and this it still so in many cases. The large amount of information communication in this way, and its significance, is beyoned doubt.

This essay traces the evolution in France of a clinical research program to perfect an artifical parenteral nutrition device which would be well tolerated by the patient, an ambulatory system which could eventually be used at home. It began in 1970, when we were struck by the number of patients being treated in hospitals for denutrition and the length of time required to reestablish nutritional equilibrium. Moreover, the denutrition of these patients retarded their oncological therapy. Our main goal was home nutrition. Adequate nutrition should be viewed as an adjunct therapy and since people generally eat at home, why not artifical nutrition at home?

A rapid development in health care delivery has been the increasing use of technology. Technology will continue to transform medical practice and all health care workers are involved with technology by accident or design. This has resulted in technology dominating many health policy decisions (4).

The International Journal of Technology Assessment in Health Care (IJTAHC) is part of the so-called Cambridge Core, the “home of academic content” (1). As such, not surprisingly, it is judged by standard scientific standards such as the Journal’s Impact Factor (IF). Although on the rise, there is still significant room for improvement (2). In this Editorial, I will discuss the relevance of the IF to the Journal and offer some suggestions as to how it might be given new impetus. I will conclude by briefly discussing some challenges associated with assessing impact in the context of health technology assessment (HTA).