This article provides a critical analysis of the impact of health technology assessment (HTA) on priority setting in The Netherlands. It describes the limited steering powers of the Dutch government; its complex interactions with insurers, health-care providers, and patients; and the role of HTA in this context as an attempt to rationalize the debate about cost-effectiveness issues. HTA has been drawn upon for decision making on the health insurance package. Also, HTA findings have been linked to the national guideline development programs of the medical community. However, these impacts by no means have been straightforward. We argue that the political nature of the priority-setting debate asks for a broader approach to what constitutes HTA, and how it should be drawn upon in priority setting. Suggestions are made on how to do justice to the social dynamics of decision making and the behavior of stakeholders in health-care systems.

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Keywords Health technology assessment, The Netherlands
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Journal International Journal of Technology Assessment in Health Care
Note This paper is partly based on Berg M, van der Grinten TED. Priority Setting in Dutch Health Care. In: Ham C, Robert G, eds: Reasonable rationing: International experience of priority setting in health care. Open University Press, Buckingham-Philadelphia, 2003.
Berg, M, van der Grinten, T.E.D, & Klazinga, N.S. (2004). Technology assessment, priority setting, and appropriate care in Dutch health care. International Journal of Technology Assessment in Health Care, 20, 35–43. Retrieved from