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. 1986 Dec;21(5):681–711.

Government health policy and the diffusion of new medical devices.

B J Hillman
PMCID: PMC1068982  PMID: 3818311

Abstract

The combination of absent financial incentives, aspects of physicians' clinical training, and the uncertainty surrounding the appropriate application of expensive new medical devices have been the most significant factors in promoting their wasteful diffusion and use. This presentation summarizes the forces that have resulted in regulatory and reimbursement initiatives to make more efficient the acquisition and utilization of new medical devices. The case histories of computed tomography (CT) and magnetic resonance imaging (MRI) serve as a paradigm demonstrating why such initiatives have thus far proved ineffectual. More effective would be to abandon distinctions between inpatient and outpatient reimbursement for using new medical devices and to improve the relationship between reimbursement and technology assessment.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson G., Ginsburg P. B. Medicare payment and hospital capital: future policy options. Health Aff (Millwood) 1984 Fall;3(3):35–48. doi: 10.1377/hlthaff.3.3.35. [DOI] [PubMed] [Google Scholar]
  2. Banta D. Computed tomography: cost containment misdirected. Am J Public Health. 1980 Mar;70(3):215–216. doi: 10.2105/ajph.70.3.215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Banta H. D., Behney C. J. Policy formulation and technology assessment. Milbank Mem Fund Q Health Soc. 1981 Summer;59(3):445–479. [PubMed] [Google Scholar]
  4. Banta H. D., Thacker S. B. Policies toward medical technology: the case of electronic fetal monitoring. Am J Public Health. 1979 Sep;69(9):931–935. doi: 10.2105/ajph.69.9.931. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Banta H. D. The diffusion of the computed tomography (CT) scanner in the United States. Int J Health Serv. 1980;10(2):251–269. doi: 10.2190/6D17-3UAU-RAM1-NVTR. [DOI] [PubMed] [Google Scholar]
  6. Brasfield J. M. Health planning reform: a proposal for the eighties. J Health Polit Policy Law. 1982 Winter;6(4):718–738. doi: 10.1215/03616878-6-4-718. [DOI] [PubMed] [Google Scholar]
  7. Braunwald E. Coronary-artery surgery at the crossroads. N Engl J Med. 1977 Sep 22;297(12):661–663. doi: 10.1056/NEJM197709222971209. [DOI] [PubMed] [Google Scholar]
  8. Brown L. D. Common sense meets implementation: certificate-of-need regulation in the states. J Health Polit Policy Law. 1983 Fall;8(3):480–494. doi: 10.1215/03616878-8-3-480. [DOI] [PubMed] [Google Scholar]
  9. Bucci V. A., Reiss J. B., Hall N. C. New obstacles in the path of marketing new medical devices. J Health Care Technol. 1985 Fall;2(2):81–96. [PubMed] [Google Scholar]
  10. Bunker J. P., Fowles J., Schaffarzick R. Evaluation of medical-technology strategies: effects of coverage and reimbursement (first of two parts). N Engl J Med. 1982 Mar 11;306(10):620–624. doi: 10.1056/NEJM198203113061029. [DOI] [PubMed] [Google Scholar]
  11. Capron A. M. An ethical obligation to ensure access to new medical technologies? J Health Care Technol. 1984 Fall;1(2):103–120. [PubMed] [Google Scholar]
  12. Chalmers T. C. Randomization of the first patient. Med Clin North Am. 1975 Jul;59(4):1035–1038. doi: 10.1016/s0025-7125(16)32001-6. [DOI] [PubMed] [Google Scholar]
  13. Chalmers T. C. Randomized controlled clinical trial. National Eye Institute workshop for ophthalmologists. Ethical aspects of clinical trials. Am J Ophthalmol. 1975 May;79(5):753–758. [PubMed] [Google Scholar]
  14. Chalmers T. C. The clinical trial. Milbank Mem Fund Q Health Soc. 1981 Summer;59(3):324–339. [PubMed] [Google Scholar]
  15. Coelen C., Sullivan D. An analysis of the effects of prospective reimbursement programs on hospital expenditures. Health Care Financ Rev. 1981 Winter;2(3):1–40. [PMC free article] [PubMed] [Google Scholar]
  16. Dodd G. D. Radiology and the marketplace. AJR Am J Roentgenol. 1985 Dec;145(6):1120–1121. doi: 10.2214/ajr.145.6.1120. [DOI] [PubMed] [Google Scholar]
  17. Enthoven A. C. The Rand experiment and economical health care. N Engl J Med. 1984 Jun 7;310(23):1528–1530. doi: 10.1056/NEJM198406073102311. [DOI] [PubMed] [Google Scholar]
  18. Evens R. G., Jost R. G., Evens R. G., Jr Economic and utilization analysis of magnetic resonance imaging units in the United States in 1985. AJR Am J Roentgenol. 1985 Aug;145(2):393–398. doi: 10.2214/ajr.145.2.393. [DOI] [PubMed] [Google Scholar]
  19. Evens R. G. The economics of computed tomography: comparison with other health care costs. Radiology. 1980 Aug;136(2):509–510. doi: 10.1148/radiology.136.2.6773103. [DOI] [PubMed] [Google Scholar]
  20. Fineberg H. V., Hiatt H. H. Evaluation of medical practices. The case for technology assessment. N Engl J Med. 1979 Nov 15;301(20):1086–1091. doi: 10.1056/NEJM197911153012004. [DOI] [PubMed] [Google Scholar]
  21. Freeland M. S., Schendler C. E. National health expenditure growth in the 1980's: an aging population, new technologies, and increasing competition. Health Care Financ Rev. 1983 Mar;4(3):1–58. [PMC free article] [PubMed] [Google Scholar]
  22. Gibson R. M. National health expenditures, 1978. Health Care Financ Rev. 1979 Summer;1(1):1–36. [PMC free article] [PubMed] [Google Scholar]
  23. Greer A. L. Advances in the study of diffusion of innovation in health care organizations. Milbank Mem Fund Q Health Soc. 1977 Fall;55(4):505–532. [PubMed] [Google Scholar]
  24. Greer A. L. Medical technology: assessment, adoption, and utilization. J Med Syst. 1981;5(1-2):129–145. doi: 10.1007/BF02222066. [DOI] [PubMed] [Google Scholar]
  25. Hillman A. L., Schwartz J. S. The adoption and diffusion of CT and MRI in the United States. A comparative analysis. Med Care. 1985 Nov;23(11):1283–1294. doi: 10.1097/00005650-198511000-00007. [DOI] [PubMed] [Google Scholar]
  26. Jencks S. F., Dobson A. Strategies for reforming Medicare's physician payments. Physician diagnosis-related groups and other approaches. N Engl J Med. 1985 Jun 6;312(23):1492–1499. doi: 10.1056/NEJM198506063122306. [DOI] [PubMed] [Google Scholar]
  27. Jennett B. High technology medicine: how defined and how regarded. Milbank Mem Fund Q Health Soc. 1985 Winter;63(1):141–173. [PubMed] [Google Scholar]
  28. Larson E. B. Ignorance is not bliss: knowledge, information, and the diagnostic technology problem. AJR Am J Roentgenol. 1985 Dec;145(6):1124–1128. doi: 10.2214/ajr.145.6.1124. [DOI] [PubMed] [Google Scholar]
  29. Lawthers-Higgins A., Taft C., Hodgman J. The impact of certificate of need on CT scanning in Massachusetts. Health Care Manage Rev. 1984 Summer;9(3):71–79. doi: 10.1097/00004010-198400930-00014. [DOI] [PubMed] [Google Scholar]
  30. Lorenz W. Attitudes to controlled clinical trials. Lancet. 1982 Jun 26;1(8287):1460–1461. [PubMed] [Google Scholar]
  31. Luft H. S. How do health-maintenance organizations achieve their "savings"? N Engl J Med. 1978 Jun 15;298(24):1336–1343. doi: 10.1056/NEJM197806152982404. [DOI] [PubMed] [Google Scholar]
  32. Manning W. G., Leibowitz A., Goldberg G. A., Rogers W. H., Newhouse J. P. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. doi: 10.1056/NEJM198406073102305. [DOI] [PubMed] [Google Scholar]
  33. McIntyre N., Popper K. The critical attitude in medicine: the need for a new ethics. Br Med J (Clin Res Ed) 1983 Dec 24;287(6409):1919–1923. doi: 10.1136/bmj.287.6409.1919. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. McKinlay J. B. From "promising report" to "standard procedure": seven stages in the career of a medical innovation. Milbank Mem Fund Q Health Soc. 1981 Summer;59(3):374–411. [PubMed] [Google Scholar]
  35. Mitchell J. B. Physician DRGs. N Engl J Med. 1985 Sep 12;313(11):670–675. doi: 10.1056/NEJM198509123131106. [DOI] [PubMed] [Google Scholar]
  36. Morrisey M. A., Conrad D. A., Shortell S. M., Cook K. S. Hospital rate review. A theory and an empirical review. J Health Econ. 1984 Apr;3(1):25–47. doi: 10.1016/0167-6296(84)90024-9. [DOI] [PubMed] [Google Scholar]
  37. Perry S. Diffusion of new technologies: rational and irrational. J Health Care Technol. 1984 Fall;1(2):73–88. [PubMed] [Google Scholar]
  38. Reeder G. S., Krishan I., Nobrega F. T., Naessens J., Kelly M., Christianson J. B., McAfee M. K. Is percutaneous coronary angioplasty less expensive than bypass surgery? N Engl J Med. 1984 Nov 1;311(18):1157–1162. doi: 10.1056/NEJM198411013111805. [DOI] [PubMed] [Google Scholar]
  39. Relman A. S. Antitrust law and the physician entrepreneur. N Engl J Med. 1985 Oct 3;313(14):884–885. doi: 10.1056/NEJM198510033131408. [DOI] [PubMed] [Google Scholar]
  40. Relman A. S. Dealing with conflicts of interest. N Engl J Med. 1985 Sep 19;313(12):749–751. doi: 10.1056/NEJM198509193131209. [DOI] [PubMed] [Google Scholar]
  41. Rollo F. D. The role of hospitals and physicians in technology diffusion. J Health Care Technol. 1984 Fall;1(2):121–132. [PubMed] [Google Scholar]
  42. Russell L. B. The diffusion of new hospital technologies in the United States. Int J Health Serv. 1976;6(4):557–580. doi: 10.2190/X99R-9HKN-T4H1-KRG2. [DOI] [PubMed] [Google Scholar]
  43. Sacks H. S., Chalmers T. C., Smith H., Jr Sensitivity and specificity of clinical trials. Randomized v historical controls. Arch Intern Med. 1983 Apr;143(4):753–755. [PubMed] [Google Scholar]
  44. Schroeder S. A. Curbing the high costs of medical advances. Bus Health. 1984 Jul-Aug;1(8):7–11. [PubMed] [Google Scholar]
  45. Sloan F. A. Rate regulation as a strategy for hospital cost control: evidence from the last decade. Milbank Mem Fund Q Health Soc. 1983 Spring;61(2):195–221. [PubMed] [Google Scholar]
  46. Steinberg E. P., Sisk J. E., Locke K. E. X-ray CT and magnetic resonance imagers. Diffusion patterns and policy issues. N Engl J Med. 1985 Oct 3;313(14):859–864. doi: 10.1056/NEJM198510033131405. [DOI] [PubMed] [Google Scholar]
  47. Steinberg E. P. The impact of regulation and payment innovations on acquisition of new imaging technologies. Radiol Clin North Am. 1985 Sep;23(3):381–389. [PubMed] [Google Scholar]
  48. Thurow L. C. Medicine versus economics. N Engl J Med. 1985 Sep 5;313(10):611–614. doi: 10.1056/NEJM198509053131005. [DOI] [PubMed] [Google Scholar]
  49. VanAntwerp M. Diffusion of new technologies. Can Medicare payment decisions be made faster and more efficiently? J Health Care Technol. 1985 Fall;2(2):97–103. [PubMed] [Google Scholar]
  50. Wagner J. L. The feasibility of economic evaluation of diagnostic procedures. Soc Sci Med. 1983;17(13):861–869. doi: 10.1016/0277-9536(83)90275-7. [DOI] [PubMed] [Google Scholar]

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