ever before in history,  health care systems  have had access  to such  an
armamentarium  of  diagnostic  procedures,  treatment  strategies,  and re-
sources to  improve the health care of  individual patients and the health of
populations.   At  the  same  time,  health  care  providers  find  themselves
faced with an ever-growing loss of autonomy.   In parallel,  throughout  the
world,  the systems of health care  delivery and  financing  are increasingly
subject to resource constraints.

s  a result of  continuing medical  innovation combined with  demographic
changes,  in  foreseeable future these constraints  are likely to become even
more  pressing issues in developed market economies.  This  observation  is
true  for National Health  Services  (such  as  Beveridge  type systems,  e.g.,
United  Kingdom),  insurance-based  systems  (Bismarck  model,  e.g., Ger-
many),  as well  as market- and managed  care-driven health  care systems
(e.g., United States of America).

hus  a  need  has  arisen to  balance  evolving opportunities  for  improved
care with  the  current  and future constraints — in particular,  as there  are
strong  reasons to believe  that  the explosive growth  of health care  oppor-
tunities  has not  been matched  by a corresponding  growth  in  rational  re-
source  allocation — including  technology  assessment,   policy  formulation,
and implementation like.