Technology--quality At What Cost

Although medical technology appears to be the driving force behind the rate of increase of real national health expenditures, market imperfections are of greater concern. The market falls short of efficiently allocating health services because of perverse financial incentives and a lack of consumer and physician understanding of the value of many medical services. Making the best use of new and old technology requires better-informed health care decisions, which can help to counter the market imperfections. Cost-effectiveness analysis is presented as one way to assist decisions that must consider the effect of limited resources. Another approach--medical effectiveness--derives from the lack of knowledge about the impact on patient outcomes of many treatments delivered for specific conditions under the average conditions of care in the community. This lack of knowledge led to the development of the medical treatment effectiveness and technology research activities of the Agency for Health Care Policy and Research. The treatment of medical technologies proposed by health reform legislation and by the National Information Infrastructure initiative is briefly discussed. The paper concludes that wise evaluation of new and old technologies--including information systems--is required to improve our patient outcomes, productivity, and enjoyment of life.