No European country (as far as the author knows) has a comprehensive strategy for technology assessment and implementation. Many countries undertake some aspects of such a strategy, but none cover all of them. Such a strategy would need to include the technical, clinical, economic and social evaluation of technologies, and the use of this information to set policies and to ensure that they are implemented. Despite the considerable differences in health systems financing and organization there is a surprising degree of similarity in the way we approach technology assessment; more variability exists in the mechanisms used to regulate and control the introduction and use of medical technologies.