Hillman B J
Health Serv Res. 1986 Dec;21(5):681-711.
The combination of absent financial incentives, aspects of physicians' clinical training, and the uncertainty surrounding the appropriate application of expensive new medical devices have been the most significant factors in promoting their wasteful diffusion and use. This presentation summarizes the forces that have resulted in regulatory and reimbursement initiatives to make more efficient the acquisition and utilization of new medical devices. The case histories of computed tomography (CT) and magnetic resonance imaging (MRI) serve as a paradigm demonstrating why such initiatives have thus far proved ineffectual. More effective would be to abandon distinctions between inpatient and outpatient reimbursement for using new medical devices and to improve the relationship between reimbursement and technology assessment.
缺乏经济激励、医生临床培训的某些方面以及围绕昂贵新医疗设备适当应用的不确定性，这些因素共同作用，成为推动新医疗设备浪费性传播和使用的最重要因素。本报告总结了促使监管和报销举措出台的各种力量，这些举措旨在提高新医疗设备采购和使用的效率。计算机断层扫描（CT）和磁共振成像（MRI）的案例历史可作为一个范例，说明为何迄今为止这些举措被证明是无效的。更有效的做法是摒弃新医疗设备住院和门诊报销之间的区别，并改善报销与技术评估之间的关系。
