NICE and the British National Health Service

THE INTERPLAY AMONG QUALITY of care, technological innovation, and cost control creates a policy challenge for all health care systems. Improvements in the quality of care can reduce health care costs; for example, better management of chronic conditions may lessen the chance of hospitalization, and new drugs and medical devices might improve the quality and efficiency of care. Often, however, innovation comes with a significant additional cost. Even the most affluent health care systems must consider the benefits of medical innovation compared with other efforts to improve the quality of care. This article describes how this policy challenge is being addressed in Britain through the activities of the National Institute for Health and Clinical Excellence (NICE). NICE was established in 1999 to provide health care professionals in England and Wales with advice on securing the highest attainable standards of care for National Health Service (NHS) patients. The institute has a broad mandate to set standards for the use of new technologies and procedures within the NHS and to produce guidance for clinical and public health. NICE therefore sits at the controversial intersection of quality, innovation, access, and cost. The characteristics of the British and US health care systems make direct extrapolation inappropriate, but, as the United States seeks to address the longterm challenges facing its health care system, there may be useful policy lessons to be learned from the structure, methods, and experience of NICE.