Technology and Health Care in an Era of Limits -- Copyright -- Acknowledgments -- Contents -- List of Abbreviations -- Part I Setting the Stage -- 1 Introduction -- References -- 2 Innovation and the Policies of Limits in a Changing Health Care Economy -- THE SHAPE OF MEDICINE'S BENEFIT-UTILIZATION CURVE -- WHICH RATE IS RIGHT? -- REFORM OF THE DOCTOR-PATIENT RELATIONSHIP -- LINKAGE BETWEEN THE SUPPLY OF RESOURCES AND MEDICINE'S IMPLICIT THEORIES OF EFFICACY -- SEEKING LIMITS -- INNOVATION AND THE POLICIES OF LIMITS -- References -- Part II Managing Care in the United States -- 3 The Growth of Managed Care in the Private Sector -- EMPLOYER-PROVIDED HEALTH CARE BENEFITS IN THE UNITED STATES -- MANAGED CARE AND ITS GROWTH IN THE PRIVATE SECTOR -- IMPLICATIONS OF MANAGED CARE FOR TECHNOLOGY DEVELOPMENT AND DISSEMINATION -- References -- 4 Managing Medical Practice: The Potential of HMOs -- MANAGING CARE AT GHC -- BREAST CANCER SCREENING -- THE HMO AS EFFECTIVENESS LABORATORY -- CONCLUSION -- References -- 5 Cost Containment Efforts in the Public Sector: Oregon's Priority List -- RATIONALE AND BACKGROUND -- RANKING METHODOLOGY -- RESULTS -- DISCUSSION -- ACKNOWLEDGMENTS -- References -- Part III Managing Care in the United Kingdom and Canada -- 6 Priority Setting in a Needs-based System -- PROBLEMS OF THE BRITISH HEALTH CARE SYSTEM -- THE "REFORMED" BRITISH HEALTH CARE SYSTEM -- IMPLICATIONS FOR TECHNOLOGICAL ADVANCE IN MEDICINE -- RATIONING HEALTH CARE: IS IT ETHICAL? -- 7 The Meeting of the Twain: Managing Health Care Capital, Capacity, and Costs in Canada -- WHAT MAKES CANADIAN HEALTH CARE DIFFERENT? -- SO HOW DOES CANADA DO IT? -- Managing Operations -- Managing Capital -- FROM MACRO- TO MICROMANAGEMENT AND BACK AGAIN? -- THE FUTURE OF HEALTH CARE MANAGEMENT IN CANADA -- References -- Part IV Implications for Providers.

8 New Technology Adoption in the Hospital -- NEW TECHNOLOGY: WHAT ARE ITS COMPONENTS? -- FACTORS INFLUENCING THE ADOPTION AND USE OF TECHNOLOGY -- Method of Financing -- Recovery of Operating Costs -- Regulatory Equity -- Level of Competition -- Other Factors That Influence the Adoption of New Technology -- Hidden New Technology -- SUMMARY -- REFERENCES -- 9 Physicians' Acquisition and Use of New Technology in an Era of Economic Constraints -- DIFFUSION OF MAGNETIC RESONANCE IMAGING INTO CLINICAL PRACTICE -- Regulation of Magnetic Resonance Imaging Acquisition -- The Food and Drug Administration -- Certificate of Need Regulations -- Reimbursement for Magnetic Resonance Imaging -- Competition Over Magnetic Resonance Imaging -- Summary: The Acquisition of Magnetic Resonance Imaging -- TECHNOLOGY ACQUISITION IN THE "NEW HEALTH CARE" ERA -- Nature of Technology -- Hospitals and Regulation -- Competition for Patients -- Reimbursement -- Managed Care -- Providers' Turf -- HOW MIGHT PHYSICIANS RESPOND TO THE "NEW HEALTH CARE" ENVIRONMENT? -- References -- Part V Implications for Patients -- 10 The Patient's Stake in the Changing Health Care Economy -- THE PATIENT'S PREDICAMENT: LOW BACK PAIN -- THE PATIENT'S PREDICAMENT: EARLY BREAST CANCER -- THE PROFESSIONAL MODEL: ROLE AND RESPONSIBILITIES -- MARKET AND BUREAUCRATIC MODELS: THE PATIENT'S STAKE -- References -- 11 What is it Like to be a Patient in the 1990s? -- THE VIEW FROM THE PATIENT'S SIDE OF THE BED -- THE NEW CONSUMERISM AND TECHNOLOGICAL CHANGE -- THE DEMAND FOR ACCOUNTABILITY -- THE REVOLUTION IN PATIENT-DOCTOR RELATIONS -- TECHNOLOGICAL INNOVATION AND PATIENT CARE -- References -- Part VI Implications for Innovators -- 12 Managed Care and Pharmaceutical Innovation -- MANAGED CARE PRACTICES, GATEKEEPING, AND HEALTH CARE DELIVERY -- Widening Constraints on Health Care Services.

Pressures on Drug Costs -- The Unknown Effects of Managed Care -- MANAGED CARE GATEKEEPING: EFFECTS ON THE PHARMACEUTICAL INDUSTRY AND PHARMACEUTICAL INNOVATION -- Pressure on Resources for R&D -- Pressure for Products with Well-Defined Costs and Benefits -- Pressure to Limit the Transfer of Information on Drugs -- Increased Economic Risk for Pharmaceutical Innovation -- PHARMACEUTICAL RESEARCH STRATEGIES FOR A CHANGING HEALTH CARE ENVIRONMENT -- The Promising Technology Base -- Enhanced Focus on Innovation -- Complex Development Strategies to Demonstrate Added Value -- NEW POLICY ISSUES CRITICAL TO U.S. COMPETITIVENESS IN PHARMACEUTICALS -- SUMMARY -- References -- 13 Current Strategies for the Development of Medical Devices -- PUBLIC POLICY AND MEDICAL DEVICES: 1965-1976 -- PUBLIC POLICY AND MEDICAL DEVICES: 1976-1983 -- Implications for Medical Device R&D -- PUBLIC POLICY AND MEDICAL DEVICES: 1983 TO THE PRESENT -- Implications for Medical Device R&D -- OBSERVATIONS -- References -- 14 The Changing Health Care Economy: Impact on Surgical Techniques -- THE SURGEON AS INNOVATOR -- THE CURRENT STATUS OF SURGICAL INNOVATION -- ASSESSMENT OF NEW PROCEDURES -- ARE THE COSTS AND BENEFITS OF NEW SURGICAL PROCEDURES CALCULABLE? -- THE COST-EFFECTIVENESS OF INNOVATION -- THE CASE OF GALLSTONES -- THE SYNERGISM OF NEW TECHNOLOGY -- THE DYNAMICS OF INNOVATION -- SUMMATION -- References -- Part VII Concluding Observations -- 15 Summing Up: Reflections on Medical Innovation and Health Care Reform -- Appendixes -- A Workshop Agenda -- The Changing Health Care Economy: Impact on Physicians, Patients, and Innovators -- B Contributors -- Index.