Constructive technology assessment and extramural/assistive technology: a strong combination

Technology Assessment and Medical Technology Assessment were developed as forms ol policy oriented r-esearch to help pollcy makers taking decis¡ons about technologies with wide ranging societal impacts. They are reactive in the sense thal are used by other parties than the developers to evaluate existing technologies. Several attempts have also been made to design technologies without unwanied side-etfécts: an anticipatory, constructive approach. With the help of theoretical concepts from innovation theory and from science and technology dynamics, these experiences were generalized into an approach which was coined Constructive Technology Assessment (CTA). CTA not only aims at ¡mproving the input of information about all the relevant aspects and at optimizing the timing of that input during the developmental process, but also pays attention to: ' the way end users and relevant parties can be involved in the design process in practical ways; 'the embedding of the technology into the technical, organizational and institutional infrastructure; ' the normative integration of the technology -which means moslly mutual adiustmenþ into the value system of the users and into the culture and legal system of society. These aspects of technology development have appeared crucial in ¡/vo areas where existing hospital technologies or consumer products are introduced in the private life and homes of people with reduced physical abilities: Extramural Technology, the technologies used for medical treatment and care used outside the hospital system, and Assistive Technology, technological products, systems and services used to increase the independence and quality of life of people with reduced physical capabilities. These areas have become important both because of the combination of increasing costs ol intramural health care, demographic trends and lhe .demands and emancipation of elderly or handicapped people involved. The paper will describe how this CTA approach was developed and is applied: ' in a program for the development ol guidelines for the introduct¡on of technology ¡nto home care (e.9. home infusion of antibiotics or analgetics) and into the health benefit package; ' in a strategic advice, prepared for the Dutch parliament, about policies for technical aids for the handicapped in the Netherlands for the situation after the introduclion of a important new law: ' in a strategic study analyzing the possible synergies between the policies of various public authorities and private organizations for innovation, evalualion and d¡stribution of technologies for home care, the elderly and handicapped people (assistive technology); ' studies on the innovation, evaluation and (obligatory or voluntary) certification ol specific technological products and services for people with reduced physical abilities, with an emphasis on the eldely (e.9. alarm systems.'rollators' and 'insulin-pens').