PubMed Health⌕ Search

Biomedical subjects

H D Banta

Publications and source records attributed to H D Banta.

At least 19 recordsLinked to original sources
PubMed1994

The future and health care technology: implications of a system for early identification.

Future and emerging health care technologies are increasingly high-impact events for society in terms of the quality and costs of health care. They raise issues of efficacy, safety, resource allocation, ethics, impact on the organization and delivery of care, and broad social effects. This article describes an analysis of future and emerging health care technology, initiated by the government of the Netherlands and carried out formally from 1985 to 1988, and its potential usefulness in a policy and decision-making context. Using the results and experiences of this analysis, it is argued that rational health care planning and decision-making can be strengthened by paying more attention to the possible implications of emerging and future technology.

Coronary Disease↗
PubMed1992

Quality assurance issues and PACS.

Quality assessment and assurance is a growing concern in all areas of health care. The concern is fueled by a body of evidence that indicates that quality of care is not optimal, and in many instances, is unacceptably low. Although different standards for quality have been proposed, health outcome is the ultimate standard, since improving health is the goal of the health care system. The effects of PACS on health outcome are not known. A PAC system has the potential to improve quality, especially if it makes the diagnostic process more efficient, but evidence that such improvement actually occurs is so far lacking.

Quality Assurance, Health Care↗
PubMed1992

Volume and outcome of organ transplantation.

In general, technically demanding medical procedures are associated with better outcomes when they are carried out in institutions and by physicians with higher volumes of practice. This paper examines the evidence for a volume-outcome relationship in the case of organ transplantation. Although few studies have been done on this subject, existing evidence is consistent with improved outcomes at higher volumes. Therefore, evidence supports policies that regionalize transplantation services.

Health Policy↗
PubMed1990

The case for reassessment of health care technology. Once is not enough.

Assessment of health care technologies should be an iterative process, not a single event. In the United States there are an increasing number of organized attempts at reassessment of technologies by the health industry, professional societies, and national government agencies, such as the Medical Necessity Project of Blue Cross/Blue Shield, the Clinical Efficacy Assessment Project of the American College of Physicians, and the work of the US Preventive Services Task Force. We examine four clinical practices--electronic fetal monitoring, episiotomy, electroencephalography, and hysterectomy--to illustrate the need to continuously reassess existing technologies and to challenge our current inertia in this critical arena of health practice.

Advisory Committees↗
PubMed1990

The political dimension in health care technology assessment programs.

This article considers technology assessment (TA) to be a comprehensive form of policy research. Technology assessment must then have a relation to policy-making; in the area of health care, TA must relate to such political decisions as resource allocation. Since policies are determined politically, i.e., by factors such as power and influence, technology assessment is, or should be, part of a political process. Technology assessment seems to be developing predominantly as a technical and professional activity, carried out in centers with no relation to the policy-making process. While the impact of technology on health, as well as such broader impacts as those on financial costs, is a key concern, political considerations and political decision-making must always be an important dimension in health care TA.

Communication↗
PubMed1990

The regulation of medical devices and quality of medical care.

Medical devices are now a pervasive part of modern medical care. They are in many cases associated with quality of care. In some cases, the use of devices has certainly improved quality. In other cases, devices can be associated with many problems. The approach to quality of devices has depended largely on regulation. However, regulation of devices in Europe is rather undeveloped, so in many cases the reliability and safety of a device has not been independently established and one cannot assume that a particular device in fact is reliable or safe. In addition, there are many problems in the interface between the machine and the user or the patient that are largely untouched by device regulation, and perhaps should be more often considered in quality assurance programs. As essential as device regulation is, it is not sufficient to assure quality. Education is particularly important in this area. Quality assurance programs need to be familiar with common problems with medical devices and how to approach them.

Contraceptive Devices, Female↗
PubMed1986

Medical technology and developing countries: the case of Brazil.

Developing countries, faced with severe resource limitations, are trying to develop modern health care services that deliver sensible medical technologies. Because of their lack of development, these countries must import much technology, while often lacking the expertise to make wise choices. In this article, the case of Brazil is examined. Brazil has shared many of the problems of other developing countries, including inadequate access of the population to health services, maldistribution and excessive use of technology, a relatively weak national industry for production of drugs and medical devices, a weak policy structure for dealing with medical technology, and little tradition of using research or policy analysis as a guide to action. Since the election in 1985 that returned Brazil to democratic rule, the government has taken active steps to address many of these problems. The example of Brazil is important for all of the developing world to examine and follow, where applicable. In addition, North American and European aid programs could play a much more constructive role in helping less developed countries develop their health care services. International organizations such as the World Health Organization must also be active in assisting such countries to improve their decisions concerning medical technology.

Brazil↗
PubMed1985

Medicare coverage, Medicare costs, and medical technology.

One possible approach to containing Medicare costs involves explicit changes in Medicare's coverage policy with respect to medical technology. This paper first describes the development and diffusion of medical technology in general and then describes how technologies are identified, assessed, and approved for payment by Medicare. Currently, cost is neither a criterion nor an explicit issue in coverage decisions, although coverage policy is an integral part of payment policy. A combination of policies to reduce the rates of adoption and use of certain technologies is needed--including cost considerations in technology assessments for coverage decisions, limiting diffusion of technology to certain providers and sites, limiting utilization to certain indications, and tightening administrative processes. Finally, the interaction between coverage policy and DRG payment needs to be explored more thoroughly.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1983

Assessing the cost-effectiveness of prevention.

In an era of limited resources, cost-effectiveness analysis and cost-benefit analysis (CEA/CBA) can be significant policy-making aids. Because the often stated belief that prevention is cost-effective has not been systematically examined, we surveyed about 250 CEA/CBA articles concerning prevention. We found that few authors have followed generally accepted methodological standards, which raised questions concerning the validity of their findings and conclusions. In addition, prevention itself is a problem in CEA/CBA because of such factors as the long intervals between interventions and outcomes, problems which have rarely been considered in the CEA/CBA prevention literature. At the same time, a number of high quality studies concerning prevention indicates that United States policy makers have not aggressively pursued significant opportunities to improve health through prevention, for example by immunizing the elderly and by screening for and treating hypertension. We recommend that analysts follow general methodological principles in CEA/CBA prevention studies to assure both valid and credible results.

Cost-Benefit Analysis↗
PubMed1983

Social science research on medical technology: utility and limitations.

Policies could be better devised and better implemented if greater use were made of the social sciences. However, the social sciences have quite often not produced knowledge adequate to permit resolution of pressing social problems. An example of both of these statements is found in the area of policies toward medical technology. Medical technology has become a major public policy issue in most industrialized countries, primarily science research has led to general formulations as to how medical technology is developed and diffused. In addition, specific studies of medical technology have identified factors that impede of facilitate the development and diffusion of medical technology. However, few studies have been done of public policy mechanisms. Effects of formal policies have not been evaluated, and organizations developed to implement policies toward medical technologies have not been studied. Programs cannot be improved without evaluation, nor can successful approaches be diffused more widely. The development and implementation of public policy toward medical technology would profit if social scientists were to become involved in its examination.

Diffusion of Innovation↗
PubMed1983

Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860-1980.

The benefits and risks of episiotomy in labor and delivery as recorded in the English language literature in over 350 books and articles published since 1860 are reviewed and analyzed. Episiotomy is performed in over 60 per cent of all deliveries in the United States and in a much higher per cent of primigravidas. Yet, there is no clearly defined evidence for its efficacy, particularly for routine use. In addition, although poorly studied, there is evidence that postpartum pain and discomfort are accentuated after episiotomy, and serious complications, including maternal death, can be associated with the procedure. Therefore, carefully designed controlled trials of benefit and risk should be carried out on the use of episiotomy.

Anal Canal↗
PubMed1982

RCTs and the federal government.

As the federal government's role in health policy has grown, its involvement in the development, adoption, and use of medical technology has grown concomitantly. The government now makes a wide variety of decisions concerning technology. Many of these decisions involve randomized clinical trials (RCTs). The federal government probably funds or requires a majority of the RCTs carried out in the United States. The federal government also uses the results of RCTs increasingly as an important basis for its decisions, especially within the Medicare program. As the scientific basis for medical practice has improved through use of the RCT, policy decisions have been put on a firmer base.

Clinical Trials as Topic↗