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The Tension Between Cost Containment and the Underutilization of Effective Health Services

Published online by Cambridge University Press:  10 March 2009

Bernard S. Bloom  and
A. Mark Fendrick
Bernard S. Bloom
Affiliation:
University of Pennsylvania
A. Mark Fendrick
Affiliation:
University of Michigan
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Abstract

One of the common ingredients in all attempts to slow escalating health care costs is to control the utilization of services that provide little or uncertain benefit. To reform existing delivery systems, the organization, provision, and financing of health care need to be evaluated critically. Successful reform requires that more rational methods be used to determine which services to provide. The preferences of physicians, patients, and payers of care do not appear optimal from a societal perspective in choosing health care services. While reducing the use of interventions of little or unknown benefit should save money, a policy to restrict the use of medical services may lead to an unwanted result: the underutilization of interventions of proven clinical benefit. Through the determination of the value—by rigorous assessment of both costs and benefits of available alternatives—in a context sensitive to the unique cultural, political, and economic characteristics of individual nations, the health of the population should be improved and growth of health expenditures constrained. This is the first step in health care reform.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 12 , Issue 1 , Winter 1996 , pp. 1 - 8
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

1.Beasley, R. P.Hepatitus B virus. The major etiology of hepatocellular carcinoma. Cancer, 1988, 61; 1942–56.3.0.CO;2-J>CrossRefGoogle Scholar
2.Beasley, R. P., & Hwang, L. Y. Epidemiology of hepatocellular carinoma. In Vyas, G. N., Dienstag, J. L., & Hoofnagle, J. H. (eds.), Viral Hepatitis and Liver Disease: Proceedings of the 1984 International Symposium on Viral Replication. New York: Grune and Stratton, 1984.Google Scholar
3.Bloom, B. S., Hillman, A. L., Fendrick, A. M., & Schwartz, J. S.A reappraisal of hepatitis B vaccination strategies using cost-effectiveness analysis. Annals of Internal Medicine, 1993, 118, 298–306.CrossRefGoogle ScholarPubMed
4.Cochrane, A. L.Effectiveness and efficiency: Random reflections on health services. London: Nuffield Provincial Hospitals Trust, 1972.Google Scholar
5.Dasbach, E. J., Fryback, D. G., Newcomb, P. A. et al. Cost-effectiveness of strategies for detecting diabetic retinopathy. Medical Care, 1991, 29, 20–39.CrossRefGoogle ScholarPubMed
6.Diabetic Retinopathy Study (DRS) Research Group. Preliminary report on effects of photocoagulation therapy: DRS report number 1. American Journal Ophthalmology, 1976, 81, 383–84.CrossRefGoogle Scholar
7.Doorey, A. J., Michelson, M. D., Topol, E. J.Thrombolytic therapy in acute myocardial infarction: Keeping the unfulfilled promises. Journal of the American Medical Association, 1992, 268, 3108–14.CrossRefGoogle ScholarPubMed
8.Fendrick, A. M., Javitt, J. C., & Chiang, Y. P.Cost-effectiveness of the screening and treatment of diabetic retinopathy. International Journal of Technology Assessment in Health Care, 1992, 8, 684–707.Google ScholarPubMed
9.Fendrick, A. M.,Ridker, P. M., & Bloom, B. S.Improved health benefits of increased and expanded utilization of thrombolytic therapy. Archives Internal Medicine 1994,154,1605–09.CrossRefGoogle ScholarPubMed
10.Ferris, F. L.How effective are treatments for diabetic retinopathy? Journal of the American Medical Association, 1993,269, 1290–91.CrossRefGoogle ScholarPubMed
11.Grimes, D. A.Technology follies: The uncritical acceptance of medical innovation. Journal of the American Medical Association 1993, 269, 3030–33.CrossRefGoogle ScholarPubMed
12.Javitt, J. C., Canner, J. K., & Sommer, A.Cost effectiveness of current approaches to the control of retinopathy in type I diabetes. Ophthalmology, 1989, 96, 255–64.CrossRefGoogle Scholar
13.Jefferson, T., & Demicheli, V.Is vaccination against hepatitis B efficient? A review of world literature. Health Economics, 1994, 3, 25–37.CrossRefGoogle ScholarPubMed
14.Krahn, M., & Detsky, A. S.Should Canada and the United States universally vaccinate infants against hepatitis B? A cost-effectiveness analysis. Medical Decision Making, 1993, 13, 4–20.CrossRefGoogle ScholarPubMed
15.Lairson, D.Cost-effectiveness of alternative methods for diabetic retinopathy screening. Diabetes Care, 1992, 15, 1369–77.CrossRefGoogle ScholarPubMed
16.LATE Study Group. Late assessment of thrombolytic efficacy (LATE): Study with alteplase 6–24 hours after onset of acute myocardial infarction. Lancet, 1993, 342, 759–66.CrossRefGoogle Scholar
17.MMWR Morbid and Mortal Weekly Report,1993, 41,1–74.Google Scholar
18.Moertel, C. G., Fleming, T. R., MacDonald, J. S., & Haller, D. G.An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. Journal of the American Medical Association,1993, 270, 943–47.CrossRefGoogle ScholarPubMed
19.Protection Against Viral Hepatitis: Recommendations of the Immunization Practices Advisory Committee. MMWR Morbid Mortal Weekly Report, 1990, 39, 1–26.Google Scholar
20.Rettig, R. A.Medical innovation duels cost containment. Health Affairs, 1994, 13, 7–27.CrossRefGoogle ScholarPubMed
21.Schieber, G. J., Poullier, J.-P., & Greenwald, L. M.Health spending, delivery, and outcomes in OECD countries. Health Affairs, 1993, 12, 120–30.CrossRefGoogle ScholarPubMed
22.Sussman, E. J., Tsiaras, W. G., & Soper, K. A.Diagnosis of diabetic eye disease. Journal of the American Medical Association, 1982, 247, 3231–34.CrossRefGoogle ScholarPubMed