New Medical Devices Invention, Development, and Use (1988) / Chapter Skim
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How Trends Will Interact: The Perspective of the Hospital
How Trends Will Interact: The Perspective of the Hospital
Pages 127-137
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From page 127... ...
After two unsuccessful attempts at surgical removal of the fat deposits clogging an artery in his left leg, some doctors concluded that an amputation was the only way to stop the severe pain. But a team of surgeons .
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From page 128... ...
These include increased funding for biomedical research, dramatic growth in the availability of health insurance, rapid rises in the numbers and types of medical specialists and subspecialists, and expanding use of medical technologies. The relationship between the financing changes and the changes in medical practice patterns can be briefly summarized in a single sentence: With few limits on the availability of funds, medical practices were often based on the belief that more care was better care.
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From page 129... ...
Although we can argue that high technologies would reduce society's total health care bill over the long term, today's payers have found that they can save far more by looking first at the simple issues of how care is delivered for some very common occurrences such as back pain, normal obstetrical deliveries, and children's sore throats. While these payers clearly hope to reduce the costs of treating all illness including the more complex cases of cancer and heart disease they hope to do so by effecting fundamental changes in the current medical care system.
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From page 130... ...
For the health care world steeped in cost-based reimbursement, it is, however, an unfamiliar perspective. Prospective pricing has forced providers to revise the way they think about such things as capital investments, operating expenses, and market share.
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From page 131... ...
In the current environment, however, even rigorous economic analyses are only marginally useful for hospital managers attempting to malice rational capital investment decisions. This point is easily illustrated by a number of examples.
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From page 132... ...
Faced with such uncertainty, hospitals are apt to adopt progressively more conservative capital investment postures which may well slow the rate of introduction of new and "higher" technology into the health care system. It is arguable that the current reimbursement policy will force a centralization of lithotriptors in regional referral centers, and that may be a good thing.
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From page 133... ...
In retrospect, we now know that the capabilities of CT scanning and the improved ability to do noninvasive diagnostic work have in fact reduced the net cost of treating some diseases most notably, neurological disease (Altman and Blendon, 19791. This example illustrates an important point: To the extent that dissemination of technology becomes dependent on prospective financial analyses, we may miss opportunities to reduce the net costs of health care.
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From page 134... ...
Some observers of the health care scene are quite explicit in their beliefs that curbing the development and diffusion of clinically useful technologies may be the only way to achieve long-term control of health care costs. They argue that even low-risk new technologies with low unit costs add to net health care costs because they are used on many more patients.
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From page 135... ...
On the basis of his work, Brook advocates careful study of the risks and benefits of technologies in a variety of settings ranging from academic medical centers with specially trained staff to community hospitals with their medical staffs as well as the use of formal decision analysis by physicians. Such informed choice, Brook argues, can reduce the growth of health care expenditures sufficiently to permit the continued development and appropriate diffusion of new technologies (Brook and Lohr, 19861.
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From page 136... ...
The relevant changes include increasingly restricted financial resources for health care, payers' attempts to effect fundamental changes in medical care, payers' increasing involvement in clinical decision making through the claims review process and consequent pressure on health care institutions to administer financial controls or incur costs themselves, and health care institutions' early efforts to respond to changed conditions by adopting new rules for economic investment decisions. We have also discussed briefly how those new rules could lead to a form of economic rationing of health care services.
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From page 137... ...
1987. Association of volume with outcome of coronary artery bypass graft surgery.
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