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Administrators must balance time, cost, benefits, and safety against technological innovations when assessing medical efficacy, a task requiring assertiveness, well-chosen priorities, and familiarity with patient care.
Technology--consisting of equipment, supplies, procedures, and techniques--can play a central role in the management of pregnancy-related complications. Implementing proven interventions in developing countries and low-resource settings has been difficult, however, because skilled human and financial resources are constrained, and the physical and epidemiological environments are challenging. This article examines the limitations and challenges affecting health technologies in low-resource settings and suggests a framework for characterizing specific technology-based solutions. It also provides examples of pregnancy-related problems in which the introduction of new or modified technologies (drugs for prevention and management of postpartum hemorrhage, infection treatment, manual vacuum aspiration, preeclampsia detection and eclampsia management, partograms, and vacuum extraction) could help save women's lives. The authors call for a more complete assessment of the technology needs associated with pregnancy-related problems in low-resource settings, including evaluating alternative technology-based possibilities, carefully synthesizing and disseminating existing information, and characterizing the nature of current challenges. When accompanied by appropriate provider knowledge and skills, practice guidelines, financing and distribution systems, and community support, technology-based solutions can contribute to a significant reduction in maternal morbidity and mortality around the world.
OBJECTIVES: An assessment of the current status of magnetic resonance imaging (MRI) was undertaken to provide input for future government decisions on the introduction of new technologies in Asia. The objective of the study is to describe and explain the diffusion pattern of this costly technology in several Asian settings. METHODS: Data on the diffusion pattern of MRI for different Asian countries (the Republic of Korea, Malaysia, Indonesia, the Philippines and Thailand) and regions (the cities of Shanghai and Hong Kong in China and the state of Tamil Nadu in India) were obtained from national representatives of professional bodies by using standardized questionnaires for the year 1997-98. In addition, utilization data were collected at the hospital level in three countries before and after the economic crisis in the region. For four countries plus Hong Kong, background information on the legal framework for "big ticket" technologies was collected. RESULTS: Since the introduction of the first MRI in the region in 1987, the number of MRIs has gradually increased both in public and private facilities in Asia. In 1998 the average number of MRI machines installed varied from less than 0.5 machine per million population to more than 5 machines per million population. The maintenance and operating costs, and not the absence of regulation, account for the low number of MRIs in the Philippines and Malaysia. Overall, installed MRIs have low magnetic field strength, vary with respect to brand and type, and are mostly in the private sector and in the urban areas of the region. The diffusion pattern of MRIs in countries of the Asian region appears to follow two types of patterns of diffusion: one set of countries seems to be composed of mostly early adopters and another set of countries appears to be composed mostly of late adopters. CONCLUSIONS: Total number of MRIs per population in this region, though quite small compared to most OECD countries, reflects a higher share of the country's health-resource devoted to expensive high-technology devices. It is difficult to state the appropriate number of MRIs for each country; however, the study shows that there are observable problems in terms of efficiency, equity, and quality of MRI services. The research team proposes a few key recommendations to counteract these problems. Purchasing and regulatory bodies must be empowered with skill and knowledge of health technology assessment. Likewise, the fundamental problems resulting from inefficient and unfair health financing should not be overlooked, so that there is more equitable use of the technology.
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OBJECTIVE: To analyse the results of the policy of encouraging rational use of analgesics in Spain. DESIGN: Longitudinal retrospective and observational study, on the exhaustive information deriving from the filling out of Analgesic Extra-therapeutic Dose notebooks. SITE. Primary Care treatment of terminal oncological patients carried out basically in the Province of Barcelona. PARTICIPANTS: All treatments carried out under the extra-therapeutic dose notebook during the last quarter of 1988 and the first quarters of 1989, 1990, and 1991. MAIN MEASUREMENTS AND RESULTS: Revision of initial treatment, change of medication and posology and returns on the basis of the extensive documentation generated. Consumption has risen from 157 authorized cases in 1989 to 404 in 1991. CONCLUSIONS: Consumption has increased sharply, although the opinion that such analgesics are under-used still predominates. Along with the quantitative increase there has been a corresponding deterioration in the rationale informing use and control, both medically (patterns of treatment, excesses) and socially (cost effectiveness, fair allocation). The evaluation in force before the advent of new technology and policies should be reinstated if we wish to achieve the desired level of effectiveness, adapting national health care by coordinating social and health care and bringing up to standard the training and supply of information to health workers. It is suggested that a "Consensus" Conference should be organised to bring up to date the basis on which analgesics are used and regulated.
This review focuses on evaluations of particular clinical problems or technologies in dentistry that have used the recently developed technology assessment techniques of decision analysis, meta-analysis, and cost-effectiveness analysis. It also discusses general methodologic and implementation issues in the assessment of health-care technologies.
Lasers continue to be a highly useful and important surgical tool, and, in today's competitive healthcare environment, they are also an effective marketing tool. The public perceives lasers to be "high-tech" instruments, associating them with excellence of care. And the availability of state-of-the-art equipment such as lasers is often critical to medical staff recruitment. However, lasers are not universal surgical tools, as some proponents suggest. They are costly, and other less expensive technologies are acceptable and sometimes more desirable for certain procedures. Also, marketing reasons alone cannot justify laser acquisition. Faced with new, more restrictive federal regulations for Medicare reimbursement of capital expenses, hospitals need effective technology planning more than ever, particularly when planning for such "high-ticket" items as lasers. They can no longer afford to acquire lasers based on the perceptions of the public or the demands of one or even a few physicians; poor planning in the past has caused many new lasers to collect dust from low utilization. (ECRI's 1991 user survey on general-purpose surgical lasers found that, on average, hospitals use lasers in less than 5% of their total surgical procedures.) Hospitals need to approach the acquisition of laser technology cautiously to ensure that the appropriate equipment is obtained, that it will be well utilized for procedures in which it offers a demonstrable improvement over alternative technologies, and that it will also conform to the overall strategic plan of the institution. The purpose of this article is to provide guidance on the technology acquisition process, whether a hospital is acquiring its first laser or has a well-established laser program.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cassetteless digital x-ray (DX) systems combine film-quality images and fast patient throughput. Because they are expensive, they need to be versatile enough to perform most or all radiographic projections. To meet this challenge, DX manufacturers have developed a variety of imaging detectors and gantry configurations. This presents facilities with an array of choices. In this Evaluation, we examine cassetteless DX systems from six suppliers: Canon, Fujifilm, Imaging Dynamics, Kodak, Siemens, and Swissray. We compare them with the three systems--from Del Medical, GE, and Philips--that we evaluated in our November 2001 issue. Our testing examines the ability of these systems to provide at least the same amount of diagnostic information as conventional screen-film systems while significantly increasing the overall efficiency of the radiology department. Each system provides a slightly different trade-off between image quality and usability. We rate three systems Preferred due to their excellent image quality, good ease of use, and the wide range of exams they can provide using a single detector. The remaining six devices are all rated Acceptable, although one of them is ranked slightly superior to the other five.
This paper reviews the literature on health economics assessment (HEA) for liver transplantation (LT) in Europe and USA, and considers prospects in Japan where HEA is currently rarely performed. LT is one of the most expensive health technologies but the health outcome is generally good. It provides the only well-established treatment for end-stage liver disease (ESLD) in the Western world, while in Japan it has yet to be fully implemented because public acceptance is still very low. MEDLINE and Japana Centra Revuo Medicina WEB version Ver. 2 (JCRM2) were systematically used for the literature search. As a result, 6 original papers in Europe and USA that employed accurate methods for HEA were identified through MEDLINE, indicating that LT is cost-effective on long term follow-up. In Japan, however, only one study could be good which tried to estimate it's cost-effectiveness, and the methodology was different from that used in Europe and USA. Through accurate HEA for LT in Japan, we hope that this procedure may become a well-accepted health technology in the future.
Health care technology (defined as all drugs, devices, and medical and surgical procedures used in medical care as well as the organizational and supportive systems within which such care is provided) is widely regarded as an important driver of escalating health care spending in the United States. Many new health care technologies are adopted and used in clinical practice with little or no evidence that their use is associated with improved patient outcomes. Orthopaedic surgeons are facing increasing scrutiny from hospitals and payers regarding the adoption and use of new technology for the treatment of patients with musculoskeletal disease. Health care technology assessment is a growing field that is concerned with the multidisciplinary evaluation of clinical data on the basis of safety and efficacy as well as economic aspects of technology acquisition. Through an understanding of the relevant literature and the concepts of health care technology assessment, orthopaedic surgeons have an opportunity to participate in the assessment process and thus influence clinical and health policy decisions regarding the adoption and use of new and existing technologies in the field of orthopaedic surgery.
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Health care administrators and physicians are under intense pressure from the government, industry, and the public at large to contain the escalating cost of health care. Operating margins of hospitals are averaging about 1%, and some hospitals are closing their doors. Health care providers are thus faced with the dilemma of how to bring costly high technology to a community hospital in a timely and effective manner without incurring serious financial setbacks. Despite all these pressures, we have presented several reasons why a community hospital should bring costly technology to its medical staff, and thus to its patients. We have described Kettering Medical Center's approach to this problem and our success in bringing it to the community early and cost-effectively, which has benefited the local community as well as the medical center. Our desire to be one of the "early adopters" may not work for everyone, since it requires extremely careful and perceptive evaluation of the technologic developments. It requires an intelligent, progressive, and committed board, administration, and medical staff, and it requires clever financing, such as large outside grants and help from a medical school. Such partnerships and research organizations, or liaisons with government agencies such as the Veterans Affairs system, are believed to be the keys in getting costly high technology into a community hospital. To achieve this, administration and key medical staff should constantly be on the lookout, evaluating high-technology developments. Once the hospital decides to get into a costly new high technology, it must seek alliances or partnerships with others. To identify, assess, and acquire new technology is an ongoing process.(ABSTRACT TRUNCATED AT 250 WORDS)