Comparisons of medical technology in Canadian, German, and U.S. Hospitals.

One strategy proposed to constrain our health costs is to regulate the acquisition of and to centralize the availability of tertiary care services. American hospitals provide significantly more sophisticated equipment per million persons than is available either in Canada or Germany in six of seven expensive medical technologies studied (radiation therapy being the exception). The regionalization of tertiary care resources should be stimulated by the fiscal incentives inherent in managed care and capitated payment, additional shortfalls in Medicare and Medicaid reimbursement, and hospitals, physicians, and insurance companies' organizing health networks. These trends could eventually force an increasing number of community hospitals to eliminate their expensive sophisticated services.