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.