This article describes and explains the impact of the National Health Service bureaucracy on the diffusion of medical technology in the United Kingdom. Through case studies of six medical technologies, the author demonstrates how health care authorities may exercise significant control by using the central financing system to dampen the general diffusion of technology. However, the United Kingdom has less control in specific cases due to the absence of a bureaucratic body to coordinate the evaluation and introduction of new technology.

The authors provide a detailed overview of how the national and provincial health systems of Canada exercise control over the diffusion of medical technology. In particular, they examine the diffusion of CT scanning and the adoption of non-ionic radio contrast media. While the nature of the parliamentary system theoretically aflows the government, especially the executive, to exert more control over its policy agenda than in the United States, the authors believe that effective control is hampered by a lack of political will and insufficient “teeth” in the Ministry of Health' mandate and policy. The authors also conclude that the manipulation of reimbursement systems to encourage or discourage the diffusion of various medical technologies is not always effective, and that political clout often triumphs over rational decision making.

This article begins by sketching out the constitutional arrangements in Italy for the distribution of powers among different levels of government. The more important characteristics of the health system are then examined in some detail, the aim being to provide a sufficient basis for understanding the analysis of technology policy which follows later. The mechanisms used for funding medical technology are next described, after which data available on the diffusion of medical equipment are illustrated. Medical technology policies at the national and regional level are examined and an attempt made to appraise their effectiveness. The article concludes with a brief analysis of the possible role played by private medicine in the diffusion of medical technology in ltaly.

This article argues that while health care and government authorities in the Netherlands in the last decades have attempted to rationalize the diffusion of medical technology, much work remains to be done. The authors contend that though a mix of direct government regulation and economic incentives will be needed, regulation by incentive is more effective than regulation by directive in achieving cost effective use of technology. Generally, bureaucratic structures provide only limited opportunities for tight control of the diffusion of medical technologies. The article offers possible future strategies for directing the adoption and use of medical technologies and stresses the importance of reliable infor mation culled from comprehensive technology assessments.

This article provides a comprehensive analysis of the social, cultural and economic factors which have led to the present pattern of technology utilization in Japan. It is divided into five sections. The first provides the historical framework; the second, an overview of the health care delivery context and its economic incentive structure; the third, an analysis of the various contenders involved in the process of resource allocation; the fourth, a description of the technology areas which have been emphasized in Japan; and the fifth, an examination of future issues.

This article presents a survey of the public and private agencies and institutions providing health care in Israel and examines the degree and nature of the control that these bodies exercise over medical technology. The author demonstrates that while the Israeli government is highly centralized, the Ministry of Health is able to exercise only limited practical influence and is neutralized because of its circumscribed control of government funds. In addition, the Ministry of Health lacks standardized procedures for the assessment of prospective or existing technologies. The author notes that there has been a clear move toward a system to oversee the rational diffusion of technology and outlines several proposals for the future.

This paper reviews the evolution of U.S. policy toward medical technology in areas such as cost containment, regulation of devices and drugs, and third party reimbursement. In addition the authors chronicle the diffusion of major medical technologies, procedures, and organizational innovations in the United States. Finally, the article provides tentative observations on the effect of recent policy changes and concludes with some recommendations for the future.

This paper describes a content analysis of the statements of 24 Consensus Development Conferences conducted by the Office of Medical Applications of Research (OMAR) of the National Institutes of Health in the years 1979–1983. The goal was to understand the potential influence of the consensus statements by identifying characteristics that might determine whether and how physicians become aware of their findings and adopt their recommendations. Three characteristics emerged, each suggestive of a different style of consensus statement: discursiveness, didacticism, and scholarliness. Variations in style among consensus statements may affect their acceptance by the medical profession

The different models of consensus development conferences (CDC5) are analyzed in relation to democratic technology assessment. In some countries CDCs are mainly concerned with influencing the quality of clinical practice and thus are dominated by medical experts. In other countries, CDCs are directed towards the public and the decision makers on the political and administrative level. The Danish experience demonstrates that CDCs may be a forceful social technology with a strong potential to influence decisions about medical as well as non-medical technology

This paper presents data on the diffusion to dentists of information from the May 1981 American Dental Association conference and December 1983 National Institutes of Health (NIH) conference on pit and fissure sealants. A mail survey was sent to 521 (72.2¼ returned) randomly selected dentists in general practice and all 47 (76.6¼ returned) pedodontists in the State of Washington. Approximately 70¼ of the dentists were aware that the conferences had taken place and a little over 50¼ were aware of the conference recommendations. Awareness was related to: being a pedodontist, number of continuing education hours taken, number of refereed journals read, and being an officer in a dental organization

Through the postmortem examination, pathologists offer the ultimate clinico-pathologic assessment of the efficacy of medical care. Similarly, pathologists can offer a clinico-pathologic assessment of the efficacy of health care technology. Assessment by pathologists has diagnostic authority because it draws on the resources of the laboratories of surgical and necropsy pathology. In this essay we argue for enhancing the accuracy of medical device and biomaterials technology assessment by systematically collecting pathology-oriented data. We recommend the establishment of a pathology-based medical device registry to assess implantable medical device technology by accumulating reports routinely issued by pathology departments throughout the country. We further suggest the establishment of a university-based, industry-supported Medical Device and Biomaterials Pathology Institute to operate the registry, collect recovered, used health care devices, and generate definitive, pathology-based, primary data for he lth care technology assessment