In Japan, preventive health services have been heavily concentrated in mass screening. This prioritization is also true in the field of school health. Annual mass health screenings have been provided to 21.3 million children from kindergarten to university level under the School Health Law. In 1973, periodic health examinations were extended to include screenings for renal and heart diseases. This extensive screening program has been introduced without any evidence supporting its effectiveness. Although available data relative to these screenings in Japan were examined, neither the efficacy of the tests nor the effectiveness of the screenings were observed. Moreover, costs for the tests during the initial phase amounted to US $120 million and $65 million, respectively.

Based on an American multicenter study, an economic evaluation of prophylactic misoprostol was undertaken in Sweden. The study included 420 patients with osteoarthritis and nonsteroidal anti-inflammatory drug (NSAID)-associated abdominal pain, but no gastric ulcer at inclusion. The frequency of ulcer development with and without prophylactic misoprostol was assessed at 21.7% and 5.6%, respectively, for a 3-month period. All costs for drugs, ambulatory care, hospital care, loss of production, as well as other factors such as dosage and compliance, were transferred to Swedish conditions. It was concluded that in patients with osteoarthritis and NSAID-induced abdominal pain, prophylaxis with misoprostol is cost-effective in Sweden, which is similar to what is found for other countries. A prerequisite for this result is a frequency of ulcer development of 15%. A patient compliance to prophylactic treatment of more than 60% is also presupposed (79% was observed in the above study). Due to the high age of the osteoarthritis patient population, the cost-effectiveness is influenced to only a minor extent by whether indirect costs are included in the calculation.

The effectiveness of screening to control lung cancer was examined in the German Democratic Republic by analyzing data from a cancer registry and incidence and mortality rates for lung cancer relative to different screening policies, and by two case-control studies. Mortality from lung cancer did not appear to be affected by the screening programs studied. The high cost of mass screening, combined with uncertainty about the benefits of early treatment of lung cancer, outweigh the vague advantages of such screening.

The greatest problem concerning health care technology for developing countries is that they are dependent upon the industrialized world for technology. The only short-term solution to this problem is to improve the choices that are available to them. This goal will require changes in the structure and processes of policy making. A particular difficulty for these countries is the lack of trained personnel in fields related to technology assessment.

This paper examines the diffusion of a “dynamic” innovation—research on the prevention and control of cancer—in a community cancer network. By analyzing the social structures and communication strategies of network members, as well as the attributes of the innovation, the authors explain why this innovation is diffusing more slowly than its “formed” counterpart—research on the treatment of cancer.

This article describes a new group-judgment process, modified from the consensus development approach of the U.S. National Institutes of Health. It is called the “forum” method, a shorthand term for “technology assessment and practice guidelines forum.” This approach is aimed at (a) describing the current state of knowledge of the technology under study; (b) developing practice guidelines for the use of the technology; and (c) providing information for insurers, consumers, policymakers, and others. A pilot study was conducted focusing on total parenteral nutrition. The validity of the process and of the recommendations and their acceptability were evaluated in a survey of participants and a selected group of nonparticipants. Based on the survey results, the forum method appears to be a valuable method for assessing technologies, defining their clinical role, and developing practice guidelines.

To better understand technology diffusion in an ambulatory care setting, we analyzed adult outpatients’ use of magnetic resonance (MR) and computed tomography (CT) imaging in a group-model HMO between 1986 and 1989. The use of MR, but not CT, Increased at a rapid pace with only a small proportion of the scans being accounted for by primary care physicians.

The models and analyses used in this study represent an important step in the continued search for the optimum use of surgery for the treatment of lower back pain. The likelihood of patients who are hospitalized with lower back pain in Massachusetts receiving either laminectomies or spinal fusions or both was increased when any of the following demographic, socioeconomic, or medical characteristics were present: white, male, well insured, young, routine admission, admitted to a medium-sized hospital, admitted to a teaching hospital, admitted to a hospital with a high occupancy rate, and discharged home.

The rapidly changing health care system is still largely organized according to old, and increasingly outdated models. The contemporary demands of patient care and residency training call for an experimental ward, which can develop and test new techniques in hospital organization and the delivery of care in a comprehensive way.

Firms research combines parallel providers of care, ongoing patient randomization, and continuous experimental changes and improvement. This form of efficient research now has a substantial track record of published studies by a growing number of hospitals.

Hospital-based “firms” provide a means for combatting the fragmentation experienced by both patients and caregivers in the modern teaching hospital environment. A “firm” is an academic group practice that includes attending physicians, physician trainees, nurses, other staff, and patients. Each person's relationship with a firm lasts throughout his or her association with a particular institution. This article describes the firm system that was recently implemented on the Medical Service of the Cleveland VAMC. This system incorporates both inpatient and outpatient general medical services and provides for unbiased assignment of patients, physicians, and nurses.

Health care technology assessment is broadly and ambiguously interpreted, diluting its role. It is time to recast the field. We must elucidate it in the contemporary context of health inquiry, explicitly relating it to such pursuits as quality assurance, health services research, effectiveness research, medical informatics, and technological innovation.

A controversial issue in cost-effectiveness analysis is the discounting of gained life-years. What has not been realized, however, is that the different methods used for discounting this measurement provide fundamentally different results. The method used is seldom explicitly stated. In the present article the four main methods for the discounting of gained life-years are reviewed and compared. The conclusion is that if we wish to continue comparing results, researchers must employ the same methodology.