Frederick C. Robbins Dean, Case Western Reserve University, School of Medicine 2119 Abington Road Cleveland, Ohio 44106 (216) 368-2820 Gerald Rosenthal, Ph.D. Director, National Center for Health Services Research, DHEW Center Building, Room 8-50 3700 East-West Highway Hyattsville, Maryland 20782 (202) 436-6944 Blair L. Sadler, J.D. Vice President and Director, Hospital and Clinics Scripps Clinic and Research Foundation 10666 North Torrey Pines Road La Jolla, California 92037 (714) 455-9100, ext. 1500 Charles Sanders, M.D. General Director Massachusetts General Hospital Fruit Street Boston, Massachusetts 02114 (617) 726-2000 Steven Schroeder, M.D. Associate Professor of Medicine School of Medicine, Health Policy Program University of California 1326 Third Avenue San Francisco, California 94143 (415) 666-1836 Anne A. Scitovsky Director, Health Economics Division Palo Alto Medical Research Foundation 860 Bryant Street Palo Alto, California 94301 (415) 326-8120 Terry Shannon Special Assistant to the Director Health Resources Administration, DHEW Mitchell Spellman, M.D. Executive Dean Charles R. Drew Postgraduate Medical School (Sun Valley Forum Board Member) 1621 East 120th Street Los Angeles, California 90059 Jonathan Spivak 245 National Press Building Judith L. Wagner, Ph.D. Urban Institute 2100 M Street, N.W. Washington, D.C. 20037 (202) 223-1950 Stanley Wallack, Ph.D. Director, Health Policy Analysis Center Florence Heller Graduate School for Advanced Studies in Social Welfare Brandeis University Waltham, Massachusetts 02154 (61) 647-2914 Jane Sisk Willems, Ph.D. Research Director, Health Program Office of Technology Assessment Washington, D.C. 20510 (202) 224-4142 Foreword The growth of technology in health care has been a phenomenon reflective of both the capacity of modern science and medicine to develop increasingly sophisticated methods to diagnose and treat illness on the one hand, and the American commitment to the health of its people on the other. The rapidly rising costs of health care in the United States has become a critical issue to legislators, policy makers, planners, and researchers alike, and efforts to curb these rising costs must be matched by efforts to understand the complex political, social, and economic factors underlying medical technologies and health care costs. In August 1977, a symposium entitled "Medical Technology: The Culprit Behind Health Care Costs?" was convened by the Sun Valley Forum on National Health, Inc., for the purpose of examining the relationship between medical technology and health care costs. The proceedings of this symposium are comprised by a series of papers that were presented at the conference covering a variety of topics, including statistical evidence of the relationship between health care costs and medical technologies, case studies on the development, introduction and use of technology, and recommendations concerning relevant public policy issues. The National Center for Health Services Research and the Bureau of Health Planning are pleased to publish these proceedings in the hope that the debate contained within them will assist all who are interested and involved in health care in the United States to better understand the issues surrounding a complex topic of immense importance. Gerald Rosenthal National Center for Health Services Research Colin C. Rorrie, Jr., Ph.D. Bureau of Health Planning Dr. Robert J. Blendon-Biographical sketch Dr. Robert J. Blendon is Vice President of the Robert Wood Johnson Foundation. He previously served in the Department of Health, Education, and Welfare, as Special Assistant for Policy Development in Health and Scientific Affairs to both the Assistant Secretary and Deputy Undersecretary of the Department. Dr. Blendon is a graduate of the School of Business, The University of Chicago, with a master's degree in Business Administration. In addition, he holds a doctoral degree from the School of Public Health, Johns Hopkins University, where his principal attention was directed toward health services administration and research. Prior to his HEW appointment, Dr. Blendon served as Assistant Director for Planning and Development, Office of Health Care Programs, Johns Hopkins School of Medicine; and Assistant Professor, Department of Medical Care and Hospitals, at the School of Public Health. Stuart H. Altman-Biographical sketch Stuart H. Altman, Dean of The Florence Heller Graduate School at Brandeis University, is an economist whose research interests are primarily in the area of Federal health policy. Between 1971 and 1976, Dr. Altman was the Deputy Assistant Secretary for Health Planning and Evaluation, Department of Health, Education, and Welfare. While serving in that position, he was one of the principal contributors to the development and advancement of the Administration's National Health Insurance proposal. From 1973 to 1974, he was also Deputy Administrator at the Cost of Living Council where he was responsible for developing the Council's program on cost containment. He is currently advisor to the Office of Technology Assessment, the Josiah Macy Foundation, and the Health Care Financing Administration, HEW. He is a member of the Institute of Medicine and serves on the board of the Robert Wood Johnson Foundation's Clinical Scholars Program. Dr. Altman is chairman of the board of the University Health Policy Consortium located at Brandeis University. Dr. Altman has an M.A. and Ph.D. degree from UCLA (1964) and taught at Brown University (Associate Professor, 1966-1970) and the Graduate School of Public Policy (University of California, Berkeley, 1976-77). Contents 10. Perspectives on the growing debate over the Robert J. Blendon and Thomas W. Moloney 24. Technology on trial-Is it the culprit behind rising health costs? The case for and against Stuart H. Altman and Stanley S. Wallack Different types of technology Possible cost control policies 166. Assessing the consequences of biomedical research Frederick C. Robbins 178. The dynamics of medical technology use: Analysis and policy options Steven A. Schroeder and Jonathan A. Showstack 213. Regulatory and nonregulatory strategies for controlling health care costs Alain Enthoven and Roger Noll 235. Biomedical research and its technological products in the quality and cost problems of health practices Paul A. Marks 242. Controlling health technology Clifton R. Gaus and Barbara S. Cooper 253. Regulating the cost of health care: A discussion and a proposal Richard A. Berman and Thomas W. Moloney 262. Controlling health technology: A public policy dilemma Robert M. Heyssel 273. Observations on health care technology: measurement, analysis, and policy Herbert E. Klarman 292. Report of the symposium |