What information and decisionmaking processes determine how and whether an experimental medical technology becomes accepted and used? Adopting New Medical Technology reviews the strengths and weaknesses of present coverage and adoption practices, highlights opportunities for improving both the decisionmaking processes and the underlying information base, and considers approaches to instituting a much-needed increase in financial support for evaluative research. Essays explore the nature of technological change; the use of technology assessment in decisions by health care providers and federal, for-profit, and not-for-profit payers; the role of the courts in determining benefits coverage; strengthening the connections between evaluative research and coverage decisionmaking; manufacturers' responses to the increased demand for outcomes research; and the implications of health care reform for technology policy.
Annetine C. Gelijns and Holly V. Dawkins, Editors; Committee on Technological Innovation in Medicine, Institute of Medicine
1 FRONT MATTER; 2 PART I: SETTING THE STAGE; 3 1. INTRODUCTION; 4 2. THE NATURE OF TECHNOLOGICAL CHANGE: INCENTIVES MATTER!; 5 3. THE IMPACT OF TECHNOLOGY ASSESSMENT ON DECISIONS BY HEALTH CARE PROVIDERS AND PAYERS; 6 PART II: PROVIDER DECISIONMAKING; 7 4. ROLE OF THE HOSPITAL IN THE ACQUISITION OF TECHNOLOGY; 8 5. PHYSICIAN; 9 PART III: THIRD PARTY PAYER COVERAGE DECISIONS; 10 6. DECISIONMAKING IN THE HEALTH CARE FINANCING ADMINISTRATION; 11 7. BLUE CROSS AND BLUE SHIELD ASSOCIATION INITIATIVES IN TECHNOLOGY ASSESSMENT; 12 8. KAISER PERMANENTE; 13 9. AUTOLOGOUS BONE MARROW TRANSPLANTATION: A MICROCOSM OF THE U.S. HEALTH CARE SYSTEM; 14 10. TECHNOLOGY ASSESSMENT, BENEFIT COVERAGE, AND THE COURTS; 15 PART IV: INCREASING THE RATIONALITY OF COVERAGE DECISIONMAKING; 16 11. STRENGTHENING THE CONNECTION BETWEEN EVALUATIVE RESEARCH AND COVERAGE DECISIONMAKING; 17 12. MANUFACTURER; 18 13. PAYING FOR EVALUATIVE RESEARCH; 19 14. HEALTH CARE REFORM: SOME REFLECTIONS ON TECHNOLOGY; 20 APPENDIXES; 21 A. WORKSHOP AGENDA; 22 B. CONTRIBUTORS; 23 INDEX