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Adopting New Medical Technology

Adopting New Medical Technology

  • Author: Dawkins, Holly V.; Gelijns, Annetine C.
  • Publisher: National Academies Press
  • ISBN: 9780309050357
  • eISBN Pdf: 9780309586412
  • Place of publication:  United States
  • Year of digital publication: 1994
  • Month: January
  • Pages: 241
  • Language: English

What information and decision-making processes determine how and whether an experimental medical technology becomes accepted and used?

Adopting New Medical Technology reviews the strengths and weaknesses of present coverage and adoption practices, highlights opportunities for improving both the decision-making processes and the underlying information base, and considers approaches to instituting a much-needed increase in financial support for evaluative research.

Essays explore the nature of technological change; the use of technology assessment in decisions by health care providers and federal, for-profit, and not-for-profit payers; the role of the courts in determining benefits coverage; strengthening the connections between evaluative research and coverage decision-making; manufacturers' responses to the increased demand for outcomes research; and the implications of health care reform for technology policy.

  • Adopting New Medical Technology
  • Copyright
  • Acknowledgments
  • Contents
  • PART I Setting the Stage
    • 1 Introduction
      • REFERENCES
    • 2 The Nature of Technological Change: Incentives Matter!
      • INTRODUCTION
      • A BRIEF RECENT HISTORY OF HEALTH CARE IN THE UNITED STATES: TECHNOLOGICAL CHANGE AND THE GROWTH OF...
      • DEFINING "HEALTH CARE"
      • EFFECTS OF RESEARCH AND DEVELOPMENT (TECHNOLOGICAL CHANGE) ON THE HEALTH CARE INSURANCE SYSTEM
      • EFFECTS OF THE INSURANCE/FINANCE SYSTEM ON RESEARCH AND DEVELOPMENT
      • EFFECTS OF INSURANCE ON CHOICE OF TECHNOLOGY AND QUALITY OF HEALTH CARE IN THE SHORT RUN, WITH TECHN...
      • CONCLUDING REMARKS
      • REFERENCES
    • 3 The Impact of Technology Assessment on Decisions by Health Care Providers and Payers
      • OBJECTIVE
      • METHODOLOGY
      • RESULTS
      • DISCUSSION
        • Quality Issues
          • Individual Skill Levels in Technology Assessment Vary Widely
          • Technology Assessment Research is Expensive
          • Timely Technology Assessment Information is Scarce
        • Scope Issues
        • Future Issues
          • Education
          • Financial Support
          • Information
      • REFERENCES
  • PART II Provider Decisionmaking
    • 4 Role of the Hospital in the Acquisition of Technology
      • THE CHANGING FINANCIAL ENVIRONMENT
      • MODELS OF HOSPITAL BEHAVIOR
      • TECHNOLOGY ASSESSMENT: SOCIETAL VERSUS HOSPITAL PERSPECTIVE
        • Societal Versus Hospital Perspective: Some Examples
      • POLICY CONSIDERATIONS
      • CONCLUSION
      • REFERENCES
    • 5 Physicians' Decisions Regarding the Acquisition of Technology
      • INCENTIVES FOR THE ADOPTION OF MEDICAL INNOVATIONS
      • CONCEPTUAL MODEL
        • Innovation Characteristics
        • Provider Characteristics
        • Knowledge
        • Awareness
        • Judgment
        • Trial
        • Adoption
        • Evaluation
      • SUMMARY
      • REFERENCES
  • PART III Third Party Payer Coverage Decisions
    • 6 Decisionmaking in the Health Care Financing Administration
      • BACKGROUND ON MEDICARE COVERAGE
      • PROBLEMS WITH THIS APPROACH
      • PAYMENT CHANGES
      • TOWARD A MORE REASONABLE COVERAGE APPROACH
      • CONCLUSION
      • REFERENCES
    • 7 Blue Cross and Blue Shield Association Initiatives in Technology Assessment
      • TECHNOLOGY ASSESSMENT
        • Recent Changes to Program
      • THE DEMONSTRATION PROJECT ON BREAST CANCER TREATMENT
      • FUTURE DIRECTIONS
      • REFERENCES
    • 8 Kaiser Permanente's New Technology Committee: Coverage Decisionmaking in a Group Model Health Mai...
      • THE KAISER PERMANENTE PROGRAM
      • THE NEW TECHNOLOGY COMMITTEE
      • CATEGORIES OF NEW TECHNOLOGIES
      • COSTS OF NEW TECHNOLOGIES
        • Research Done by the Committee
      • FACTORS AFFECTING DECISIONMAKING
        • Experimental Exclusions
      • CONCLUSION
    • 9 Autologous Bone Marrow Transplantation: A Microcosm of the U.S. Health Care System
      • THE CONTROVERSY SURROUNDING HDC-ABMT
      • OUTCOMES-BASED DECISIONMAKING
      • PAYER PERSPECTIVE
      • PROPOSAL
      • RATIONALE
      • DISCUSSION
      • REFERENCES
    • 10 Technology Assessment, Benefit Coverage, and the Courts
      • LEGAL HISTORY OF EXPERIMENTAL EXCLUSIONS
      • EFFECTS OF SOCIAL CHANGES
      • INSURERS' OPTIONS
      • CONCLUSIONS
      • REFERENCES
  • PART IV Increasing the Rationality of Coverage Decisionmaking
    • 11 Strengthening the Connection Between Evaluative Research and Coverage Decisionmaking
      • EVALUATIVE RESEARCH
      • DOES IT WORK?
        • Types of Outcomes
          • Clinical Outcomes
          • Health Status, Functional Capacity, and Quality of Life Outcomes
        • Sources of Outcomes Data
        • Measuring Outcomes
          • The Randomized Clinical Trial
          • Uncontrolled Clinical Series
          • Data Registries
          • Cohort-Controlled Studies
          • Hospital Patient Records
          • Statewide Discharge Databases
          • Claims Data Analysis
          • The Uniform Clinical Data Set
        • Evaluating Outcomes Data
          • Meta-Analysis
          • Appropriateness Studies
        • PORT Projects
      • FOR WHOM IS THE TREATMENT INDICATED?
        • Decision Analysis
          • Appropriateness Methodology
          • Practice Guidelines
      • SHOULD IT BE PROVIDED?
        • How Great is the Potential Benefit?
        • Cost-Effectiveness
        • Is It Worth It?
      • MAJOR PROBLEMS IN THE APPLICATION OF EVALUATIVE RESEARCH
        • Inadequate Resources
        • We Fail to Deal with Costs and Trade-offs
        • We Have Not Made Decisionmaking a Public Process
      • RECOMMENDATIONS
        • The Federal Government's Role
        • An Optimal Evaluation and Approval Process
        • New Technologies
          • Established Technologies
          • Payers' Roles
          • A Public Process
      • REFERENCES
    • 12 Manufacturers' Responses to the Increased Demand for Outcomes Research
      • TECHNOLOGY ASSESSMENT AND OUTCOMES RESEARCH
      • THE TECHNOLOGY ASSESSMENT TREND: WHY NOW?
      • MANUFACTURERS' RESPONSE TO THE TECHNOLOGY ASSESSMENT TREND3
        • Device Companies
        • Pharmaceutical Companies
        • Biotechnology Pharmaceutical Companies
        • Summary Observations
      • IMPLICATIONS FOR THE HEALTH CARE INDUSTRY AND MEDICAL INNOVATION
      • CONCLUSION
      • REFERENCES
    • 13 Paying for Evaluative Research
      • WHAT IS TECHNOLOGY ASSESSMENT?
      • WHO PERFORMS TECHNOLOGY ASSESSMENTS IN THE UNITED STATES?
        • Identifying the Sponsors
          • Producers
          • Consumers
          • Payers
        • Expenditures for Evaluative Research
        • Selection of Technologies for Evaluative Research
      • WHO SHOULD SPONSOR TECHNOLOGY ASSESSMENT?
        • Producers of Medical Technology
        • Consumers of Medical Technology
        • Payers for Use of Medical Technology
        • Other Sponsors
      • SPONSORING EVALUATIONS OF MEDICAL TECHNOLOGY
        • Previous Proposals for Sponsoring Technology Assessment
        • Sponsorship of Stage III Assessments: The Leading Role of Payers
        • Alternatives to Payer Sponsorship
        • Tax Incidence for Evaluative Research
        • Sponsorship for Early-Stage Technology Assessment
        • Standards for Evaluative Research
      • CONCLUSIONS
      • REFERENCES
    • 14 Health Care Reform: Some Reflections on Technology
      • LEGISLATIVE BACKGROUND
      • AN ANALYTIC MODEL
      • IMPLICATIONS FOR MEDICAL TECHNOLOGY POLICY
      • REFERENCES
  • APPENDIXES
    • APPENDIX A Workshop Agenda
      • IMPROVING THE TRANSLATION OF RESEARCH FINDINGS INTO CLINICAL PRACTICE: WORKSHOP IV
        • Examining Coverage and Adoption Decisions About Medical Technologies
      • SESSION I. SETTING THE STAGE
      • SESSION II. PROVIDER DECISIONMAKING
      • SESSION III. THIRD PARTY PAYER COVERAGE DECISIONS
      • SESSION IV. INCREASING THE RATIONALITY OF COVERAGE DECISIONMAKING
    • APPENDIX B Contributors
  • Index

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