The Political Culture of Medical Technology Assessment (Nih, Boundary Spanner, Organization).

Abstract

This dissertation explores how medical technology assessment goes forward within the National Institutes of Health (NIH). The underlying assumption is that organizations involved in the implementation of policy are affected by the environment within which they operate. This study employs a political culture model to examine the symbolic environment surrounding the issue of the Federal role vis-a-vis the conduct and transfer of biomedical research and the effect that environment has on the production of Consensus Development Conferences at the NIH. It then employs an organizational process model to examine the relationship between political culture and organizational behavior. A content analysis of the popular and medical press identifies key frames, or interpretive packages in the political culture of medical technology assessment. These frames entail policy prescriptions concerning medical technologies. A content analysis of the Consensus Statements produced at Consensus Development Conferences reveals that issues and recommendations associated with certain frames are more likely to be represented in these statements. An organizational analysis of the decision-making process leading to the development of Consensus Development Conferences examines how OMAR (an administrative unit within the NIH) filters the use of these frames to affect the outcome of conferences in ways that protect NIH's resources and legitimacy. The data collected in this study suggest the importance of analyzing policy within its broader cultural, social, political and economic context. Specifically, the findings support the notion of a link between political culture and policy choice. The issues and recommendations concerning medical technologies in consensus statements reflected the prominence of various frames, or interpretive packages, in the political culture of medical technology assessment. As the prominence of interpretive packages changed over time, the issues raised in consensus statements narrowed reflecting this change. Organizational shaping led to the exclusion and deemphasis of questions which focus on the economic, ethical, or social implications of the use of medical technologies.