Ruby G, Banta H D, Burns A K
J Health Polit Policy Law. 1985 Spring;10(1):141-55. doi: 10.1215/03616878-10-1-141.
One possible approach to containing Medicare costs involves explicit changes in Medicare's coverage policy with respect to medical technology. This paper first describes the development and diffusion of medical technology in general and then describes how technologies are identified, assessed, and approved for payment by Medicare. Currently, cost is neither a criterion nor an explicit issue in coverage decisions, although coverage policy is an integral part of payment policy. A combination of policies to reduce the rates of adoption and use of certain technologies is needed--including cost considerations in technology assessments for coverage decisions, limiting diffusion of technology to certain providers and sites, limiting utilization to certain indications, and tightening administrative processes. Finally, the interaction between coverage policy and DRG payment needs to be explored more thoroughly.
控制医疗保险成本的一种可能方法涉及对医疗保险在医疗技术方面的覆盖政策进行明确调整。本文首先总体描述医疗技术的发展与传播，然后阐述医疗保险如何识别、评估技术并批准其纳入支付范围。目前，成本在覆盖决策中既不是一个标准，也不是一个明确的问题，尽管覆盖政策是支付政策的一个组成部分。需要采取一系列政策组合来降低某些技术的采用率和使用率，包括在覆盖决策的技术评估中考虑成本、将技术传播限制在某些医疗机构和场所、将使用限制在某些适应症范围内以及收紧行政程序。最后，需要更深入地探讨覆盖政策与诊断相关分组（DRG）支付之间的相互作用。
