Government health policy and the diffusion of new medical devices.

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.

Influence of federal and state regulations on the acquisition and operation by hospitals of magnetic resonance imaging scanners.

The article introduces key health planning issues considered in the initial introduction of an emerging medical technology. Health planning is defined in historical perspective with an emphasis on Certificate of Need (CoN) legislation at the state and broader health planning legislation at the federal level. The article explains how the CoN process attempts to deal with the issues outlined earlier. In conclusion the article points to the limited effect the CoN process has had as a regulatory measure, suggesting that the future role of legislated health planning in connection with the new medical technology remains an unanswered issue for the future.

The adoption and diffusion of CT and MRI in the United States. A comparative analysis.

This study examines and compares the rates and patterns of diffusion of computerized tomography (CT) and magnetic resonance imaging (MRI) over the first 4 years of their availability. Although early diffusion of CT was more rapid than that of MRI, adoption of MRI in nonhospital settings equaled that of CT. Analysis of attributes of the technologies and attributes of the regulatory, reimbursement, and market environments surrounding the early diffusion of these technologies provides insight into their different diffusion patterns. In particular, the technical and financial uncertainties surrounding MRI have inhibited its diffusion compared with that of CT. Medicare's DRG-based prospective reimbursement system and certificate-of-need (CON) regulation by states have reduced overall MRI diffusion and stimulated purchases of MRI by nonhospital organizations. The FDA's premarket approval (PMA) program has changed marketing strategies and influenced the diffusion of MRI to a lesser degree. This analysis identifies problems in how the present health care system evaluates and adopts new, expensive, diagnostic technologies and suggests changes to make the system more responsive to present needs.

Trustee melds technology goals of competing hospitals.

Magnetic resonance imaging (MRI) has come Glendale, CA, in what is believed to be the first facility to be jointly owned by competing hospitals and radiologists. But that accomplishment very likely would still be an unfulfilled dream without the determined efforts of board chairman Robert Sandison.