Schroeder S A
J Med Educ. 1981 Aug;56(8):634-9. doi: 10.1097/00001888-198108000-00002.
Diagnostic technologies differ from therapeutic technologies in several ways. Use of a diagnostic technologies is increasing faster than overall medical care. New diagnostic technologies tend to be additive and often have multiple uses. In evaluating their benefits, one should assess marginal, not absolute, utilities and measure clinical as well as financial costs. Although the use of therapeutic technologies is more circumscribed, these technologies tend to be in continuous evolution, especially when new. Comparative evaluations of therapeutic technologies are expensive and time-consuming. Pro-technology reimbursement biases may be the most important of the many factors promoting technology use. Academic medical centers, which have become increasingly clinically specialized, must now compete with their own graduates for specialty patients. At the same time they are urged to respond to contradictory national health policies that favor production of more generalists under a pro-specialty reimbursement system. Suggestions for more appropriate technology use should cover multiple approaches, including the changing of current financial incentives and the use of technology assessment to improve quality of care and education.
诊断技术在几个方面与治疗技术有所不同。诊断技术的使用增长速度快于整体医疗护理。新的诊断技术往往具有叠加性且常常有多种用途。在评估其益处时，应该评估边际效用而非绝对效用，并衡量临床成本和财务成本。尽管治疗技术的使用受到更多限制，但这些技术往往处于不断发展之中，尤其是新技术。治疗技术的比较评估既昂贵又耗时。支持技术的报销偏见可能是促进技术使用的众多因素中最重要的因素。学术医疗中心的临床专业化程度越来越高，现在必须与自己的毕业生竞争专科患者。与此同时，它们被敦促应对相互矛盾的国家卫生政策，这些政策在支持专科报销制度的情况下倾向于培养更多的全科医生。关于更合理使用技术的建议应该涵盖多种方法，包括改变当前的财务激励措施以及利用技术评估来提高医疗质量和教育水平。
