Because medical technology is the most important controllable component of health spending growth, the success of strategies for limiting spending growth depends upon their impact on technology dissemination. Technology assessment is fundamental to any strategy for controlling the adoption of medical technologies. Cost-effectiveness analysis holds particular promise as a method for evaluating alternative health care technologies because it explicitly incorporates costs. This paper describes how the widespread adoption of health insurance promoted the dissemination of medical technologies and how technology dissemination fueled spending growth. It then describes approaches to technology assessment and the ways in which technology assessment, in the form of cost-effectiveness analysis, can be applied to help control spending growth.