Ikegami N, Ikeda S
Keio University.
Int J Technol Assess Health Care. 1997 Winter;13(1):99-110. doi: 10.1017/s0266462300010266.
Analysis of the 1987-91 national outpatient claims data shows that the percentage of patients under going sophisticated diagnostic tests tended to increase and was greater if the hospital was larger, in the public sector, or affiliated with an university. For imaging, the percentage that had CAT scans performed increased, while the percentage undergoing x-rays using contrast medium and other tomography decreased. However, for drugs, newer and more expensive ones tended to be preferred irrespective of the providers' characteristics. Although costs arising from the shift to more expensive and sophisticated technologies have been largely contained by reducing their prices in the fee schedule, this cost-containment strategy faces structural problems. We advocate the establishment of an infra-structure that offers incentives for providers to conduct technology assessment and to use the results.
对1987 - 1991年全国门诊索赔数据的分析表明，接受复杂诊断测试的患者比例呈上升趋势，并且如果医院规模更大、属于公共部门或附属于大学，这一比例会更高。对于成像检查，进行计算机断层扫描（CAT扫描）的比例增加，而使用造影剂进行X光检查和其他断层扫描的比例下降。然而，对于药物而言，无论提供者的特征如何，更新、更昂贵的药物往往更受青睐。尽管通过在收费表中降低价格，向更昂贵和复杂技术转变所产生的成本在很大程度上得到了控制，但这种成本控制策略面临结构性问题。我们主张建立一种基础设施，为提供者进行技术评估并利用评估结果提供激励措施。
