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Biomedical subjects

H D Banta

Publications and source records attributed to H D Banta.

At least 55 records · Page 3Linked to original sources
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

Policy implications of the diffusion and control of medical technology.

Medical technology has become a controversial national policy issue, largely because of rapidly rising national health expenditures and their relation to medical technology. These costs are increasingly viewed in relation to benefits or effectiveness. Attempts to control medical technology, to consider benefits in relation to costs, have largely been regulatory, and have failed to ameliorate cost rises. This failure has stimulated consideration of the reimbursement system as a controlling device. The Medicare program already has developed a rather formal process for making reimbursement decisions based on technology assessments. However, fundamental reform of the reimbursement system seems necessary to counter perverse incentives built into payment. Recent proposals to shift to prospective payment is an example of such a change. However, the basically private nature of the health care system and the limited leverage of the Medicare program limits the power of the federal government to make change.

Communication↗
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↗
PubMed1981

Policies toward medical technology: an international review.

Rapidly rising medical care costs have become an important political issue in industrialized countries during the past decade. Attempts to control the growth in expenditures have focused on the contribution of medical technology to costs. All industrialized countries have begun to experiment with the kinds of mechanisms necessary to effect changes in development, diffusion, and use of medical technologies. This paper describes government policies toward: 1) research and development, 2) evaluation, 3) safety and efficacy regulation, and 4) investment in and use of medical technologies. To clarify how these policies work in practice, policies toward CT scanners, renal dialysis, and coronary bypass surgery are examined. Rapid changes in policies and laws in different countries are attempts to find effective policy mechanisms, but also reflect the difficulties of choosing a realistic policy objective. Until recently, most countries have focused on promoting the development and adoption of new technologies, or increasing the efficiency of their production and use. A few governments have begun to question and test the benefits of medical technologies as an aid to decision making. Finally, with the growing realization that every kind of care that is beneficial cannot be provided, some countries have begun to consider limiting the diffusion of technologies to a level that strikes a balance between the benefits to be gained and the costs of achieving them.

Coronary Artery Bypass↗