Health Policy 90 (2009) 81–88 Contents lists available at ScienceDirect Health Policy journal homepage: www.elsevier.com/locate/healthpol Priority setting for technology adoption at a hospital level: Relevant issues from the literature Emanuele Lettieri ∗ , Cristina Masella Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy article info Keywords: Priority setting Health Technology Assessment Healthcare technology Health policy Decision making Hospital abstract Objectives: The increasing pace of development of healthcare technologies obliges hospi- tals to increase both the rationality and the accountability of priority setting for technology adoption. This paper aims at identifying which are the relevant issues for technology assess- ment and selection at a hospital level and at grouping them in a reference framework. Methods: An electronic search from January 1990 onwards, covering PubMed, Medline and CILEA, has been carried out in order to collect the relevant contributions. A total of 20 studies were selected from the fields of health policy, management of technology and biomedical engineering. Results: Two main assessment perspectives have been identified and detailed: value gener- ation at a hospital level and level of sustainability in the implementation stage. Four types of investment in technology at a hospital level have been identified combining the perspec- tives. Moreover, the two perspectives have been deployed in a list of 19 relevant issues that should be reviewed during the budget process. Conclusion: The proposed framework can aid priority setting for technology adoption at a hospital level and contribute to increase both the rationality and the accountability of technology assessment and selection in the budget process. © 2008 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The increasing pace of development of innovative healthcare technologies is forcing both regulators and providers of healthcare services to be responsible and also accountable for the technologies that have to be promoted or implemented [1]. In fact, many economists and policy analysts consider innovation in technology – along with weak cost-containment measures – to be a major driver in rising healthcare costs [2]. Over the last few years, the disci- pline of Health Technology Assessment (HTA) has received an increasing attention from Health Policy scholars as an instrument to support decision making at each level in healthcare [3]. In particular, decision making should be ∗ Corresponding author. Tel.: +39 02 2399 4077; fax: +39 02 2399 2720. E-mail address: emanuele.lettieri@polimi.it (E. Lettieri). evidence-informed [4] and oriented to select healthcare programs or technologies that are “value for money” [5]. However, even a cursory review of literature would identify that Health Policy and HTA paid a larger attention to decision making at a national/regional level than at a hos- pital level. Reeleder et al. claimed that priority setting for technology adoption at a hospital level is largely overlooked and wide research efforts should be paid to this emerging issue [6]. Other authors stated that HTA guidelines should be extended at a hospital level in order to facilitate the creation of a culture of responsibility and accountability among hospitals [7–10]. Recently, the Health Technology Assessment International (HTAi) network minted the term “hospital-based HTA” to remark both the relevance and the peculiarities of HTA at a hospital level. Despite that, priority setting for technology adoption is not a novelty for hospitals. The budget process copes with this issue at least one a year. Resources that can be 0168-8510/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2008.07.007