The Internist: Health Policy in Practice. - periodical reviews

Health Care Financing Review, Winter, 1992

America leads the world in the development of advanced medical technology, but that leadership comes at a price. High-technology care has become synonymous with high-cost care, leading to a renewed examination of the cost effectiveness of new medical technologies. Efforts to tame the technology tiger are explored in the October issue of The Internist: Health Policy in Practice, the magazine of the American Society of Internal Medicine (ASIM).

"High-tech health care does not always clash with cost-containment efforts, " argue the director and the program administrator of the American Medical Association's Department of Technology Assessment. Instead, Sona Kalousdian, M.D., and Andrea L. Schneider believe that it is the inappropriate use of technology that drives up health care costs. Dr. Kalousdian and Ms. Schneider say technology assessment can help health care providers and insurers evaluate the cost effectiveness of new treatments, but they warn that assessment is not a pure science and can be influenced "by the competing needs of cost containment and quality of care."

With at least 70 public and private groups - each with its own agenda - currently involved in technology assessment, many experts are decrying the lack of a nationally uniform approach to assessment. The end result, says Dan Dragalin, M.D., a New York-based physician and consultant, is "inconsistent (insurance) coverage decisions for a wide variety of medical procedures, devices, and drugs." Dr. Dragalin calls for a "coherent and comprehensive national technology assessment process" that would be immune to vested interests.

The public's seemingly insatiable appetite for new medical technology may be fueled, in part, by the news media, says Gary J. Schwitzer, a former medical reporter for the Cable News Network. Schwitzer says medical reporting often touts the benefits of the latest medical technology without examining its cost or effectiveness. Schwitzer talks with internists who recount tales of patients demanding medical miracles based on "the daily bombardment of stories" concerning newer, safer, and cheaper treatments and diagnostic tests.

Equal opportunity for the disabled has always been a good idea, but now it's the law. The ramifications of the far-reaching Americans with Disabilities Act are explained in this month's "Since You Asked." Health law specialist David E. Willett says physicians need to become familiar with the many provisions of the law to ensure that they meet its mandate.