Innovation and diffusion of health-related technologies. A conceptual framework.

The development and diffusion of health-related technologies constitute an extremely complex process. This article examines the phenomenon of technological innovation; discusses the factors determining the diffusion of high, medium, and low technologies; and suggests strategies for controlling the diffusion of these technologies. A research program is also proposed that should improve our understanding of the process of development and diffusion of health-related technologies.

Medical care in the last twelve months of life: the relation between age, functional status, and medical care expenditures.

Medical care expenditures of a group of decedents during their last year of life suggest that high-technology medical services may be allocated most rationally than is generally assumed. Patients who received intensive hospital and physician services were largely the "young old," aged 65 to 79 years with good functional status, while the frail "older old," aged 80 years and over, received largely supportive care. Total care expenses of the older old were only slightly below those of the most expensive decedents, however, as expenses for nursing home and home health care more than offset lower medical service expenses. Further studies are needed before concluding that the major cause of high costs at teh end of life is the inappropriate use of high-technology care.

More than bells and whistles.

What should a health care executive keep up with what's happening in medical technology? After all, it's only one factor in a complex, competitive environment. The consequences of regulatory changes, reimbursement policies, and changes in the economy and in population demographics, as well as power shifts among suppliers, providers, and consumers, are more acutely felt and command immediate attention. The answer is embarrassingly obvious.

Look to Norway! (But not uncritically).

The authors of the paper argue that Norway's national health service, despite public perceptions, is both inexpensive and technologically advanced. Norway has a highly regulated medical system at both the national and local levels, and many distribution issues take the form of political debate. As a result, the authors believe that medical care and equipment is equitably distributed, but perhaps over-densely, throughout the country. Although the overall picture is optimistic, there is some concern that technologies, health care priorities, and decision-making processes should be more carefully examined by consensus conferences, advisory groups, and experts in technology assessment.

Trends in the diffusion of selected medical technology in the Federal Republic of Germany.

This article contends that the German social and economic situation is conductive to the rapid diffusion of innovative medical technology. While there is public control over hospital facilities, the pluralistic health care system and decentralized government responsibilities contribute to an essentially laissez faire regulatory environment. There is perfunctory planning and regulation for major medical expenditures, but the essential constraints are financial. This is no comprehensive program for the assessment of diagnostic technologies and the effective imposition of guidelines depends on the cooperative effort of various financing organizations, professional interests, and public pressure groups.

Medical technology and its diffusion in Australia.

The author examines the Australian health care system by surveying the financing techniques, physical organization, and government activity. He explains the impact of the public and private sectors and comments on the effectiveness of current evaluation procedures. While the author believes that the system is relatively healthy and cost effective, he recognizes a need for more comprehensive and scientific oversight. Using regression analysis and focusing on the installation of medical technology in hospitals, the author attempts to determine the specific factors that influence technology diffusion. He concludes by stressing that further studies analyzing the actual use of specific technologies are vital.

Are limits on the spread of new technologies inevitable? If so, how can they best be achieved?

Costly new technologies continue to spread rapidly--often, before their usefulness in routine patient care is established or despite indications that an appropriate level of diffusion has already been reached. Hospitals and other providers can contain health care costs by exercising restraint in their decisions about new technologies and may face renewed technology-acquisition controls if they fail to do so.

Rationing expensive lifesaving medical treatments.

In the last fifteen years, medical technology has made significant and spectacular advances. Hemodialysis, coronary artery bypass graft surgery, CT scanners, and organ transplants are among the treatments now available to patients. In recent months, in fact, the media has reported the increased use of artificial hearts, heart transplants, and liver transplants. These technological advances, however, have been accompanied by troublesome legal and ethical issues. For example, someone must decide which patients will receive a medical resource when demand exceeds supply. Similarly, and more commonly, someone must decide whether the significant number of patients who cannot afford an available treatment should receive it despite the cost. In response to these troublesome issues, hospitals, doctors, and commentators have either proposed or implemented rationing systems based on criteria such as the social worth of the patient, likelihood of survival after the operation, and ability to pay. In this Article, Professor Mehlman examines the possible systems for rationing expensive lifesaving medical technologies. First, he concludes that the costs of any rationing system probably exceed its benefits. Consequently, he rejects the rationing of expensive but available lifesaving medical technologies. Second, he argues that the increased availability of the technologies and the recent expansion of patient rights to sue will result in a substantial number of judicial challenges to rationing. Finally, he suggests detailed criteria to aid the courts in deciding whether a resource has been improperly rationed.