Controversies in the adoption of new healthcare technologies.

Healthcare economists generally agree that the development and rapid introduction of new technologies and the expanding utilization of existing ones in national healthcare systems have been significant factors in the dramatic and potentially unsustainable growth in healthcare spending. Creating a rational system for evaluation of emerging technologies in this country has been complicated by 3 broad issues: the often conflicting needs and expectations of the variety of stakeholders; an arcane and often illogical system of service valuation and payment; and the lack of a standardized, transparent and validated approach to the measurement of 'value.' Recent discussions on reforming the elements of healthcare delivery have increased focus on these systemic shortcomings and conflicts. As a specialty that is clinically wedded to modern and increasingly expensive technology, radiation oncology has often been singled out for scrutiny. A thorough examination and understanding of the various factors and controversies involved in technology development, implementation and valuation analysis is essential to rational growth and development of the specialty.