The issue of health benefits coverage—and its relation to health technology assessment (HTA)—has gained increasing attention in recent years. Economic constraints on health care, as well as the rapid pace of technological change, have forced European countries to face difficult choices in providing such care. The active use of coverage decision making has been proposed as a tool to help rationalize health care, and HTA has been advocated as a necessary activity to improve coverage decisions.

Health technology assessment (HTA) in France covers a variety of activities performed for different customers (e.g., health professionals in the field and policy makers in government) for the benefit of patients. To promote the improvement of quality in health care, France has set up a series of distinct agencies that report to the Ministry of Health but are also accountable to their other customers. We place particular emphasis on ANAES (National Agency for Accreditation and Evaluation in Health) whose main remit is HTA. We show how the diversity of HTA activities and their decentralization suggests tight collaboration among all the different bodies which perform HTA or are closely involved with HTA, and we provide examples of such collaboration.

Objectives: To examine determinants of use of cardiacprocedures after acute myocardial infarction and identifyvariation factors.

Methods: Observational prospective cohort study of 2,519 patients in 48centers with a two-level logistic-regression analysis.

Results: Elderly patients were less likely to undergo pre- and inhospitalthrombolysis (odds ratios, 0.71 and 0.64; 95% CI, 0.62–0.81 and 0.58–0.69,respectively). The elderly, females, and patients with heart failure on admissionwere less likely to undergo noninvasive tests (0.74, 0.62, and 0.51; 95% CI,0.67–0.81, 0.46–0.83, and 0.38–0.68, respectively) and coronary angiography(0.38, 0.53, and 0.67; 95% CI, 0.34–0.42, 0.38–0.74, and 0.52–0.86,respectively) but not revascularization. Hospital factors were more difficult tointerpret.

Conclusions: Elderly, women, and heart failure patients underwent fewercardiac procedures than lower-risk patients. Physicians should change theirattitude toward these groups and use advanced procedures, bearing in mind thepatients' needs rather than good procedural outcomes.