McClellan M
Department of Economics, Stanford University, CA 94305-6072, USA.
Proc Natl Acad Sci U S A. 1996 Nov 12;93(23):12701-8. doi: 10.1073/pnas.93.23.12701.
Whether the U.S. health care system supports too much technological change-so that new technologies of low value are adopted, or worthwhile technologies become overused-is a controversial question. This paper analyzes the marginal value of technological change for elderly heart attack patients in 1984-1990. It estimates the additional benefits and costs of treatment by hospitals that are likely to adopt new technologies first or use them most intensively. If the overall value of the additional treatments is declining, then the benefits of treatment by such intensive hospitals relative to other hospitals should decline, and the additional costs of treatment by such hospitals should rise. To account for unmeasured changes in patient mix across hospitals that might bias the results, instrumental-variables methods are used to estimate the incremental mortality benefits and costs. The results do not support the view that the returns to technological change are declining. However, the incremental value of treatment by intensive hospitals is low throughout the study period, supporting the view that new technologies are overused.
美国医疗保健系统是否支持了过多的技术变革——以至于采用了低价值的新技术，或者有价值的技术被过度使用——这是一个有争议的问题。本文分析了1984年至1990年期间老年心脏病发作患者技术变革的边际价值。它估计了可能最先采用新技术或最密集使用新技术的医院进行治疗的额外收益和成本。如果额外治疗的总体价值在下降，那么此类密集型医院相对于其他医院的治疗收益应该下降，并且此类医院的额外治疗成本应该上升。为了考虑可能使结果产生偏差的各医院患者组合中无法衡量的变化，采用工具变量法来估计死亡率的增量收益和成本。结果并不支持技术变革回报正在下降的观点。然而，在整个研究期间，密集型医院治疗的增量价值都很低，这支持了新技术被过度使用的观点。
