Redirecting innovation in U.S. health care : options to decrease spending and increase value / Steven Garber [and six others].
- Rand Corporation monograph series
- Machine generated contents note: ch. One Introduction -- Project Goals -- What Determines Value for Health Care Products? -- ch. Two The Context for Medical Product Innovation -- Three Stages of Innovation -- Primary Actors in Inventing Medical Products -- Drug and Device Companies -- HIT Companies -- Goals of Medical Product Inventors -- Private Investors -- Financial Incentives of Medical Product Inventors -- Influences of Medical Product Invention -- National Institutes of Health -- U.S. Food and Drug Administration -- U.S. Patent and Trademark Office -- Office of the National Coordinator for Health Information Technology -- Primary Actor and Influences in Approval of Medical Technologies -- Primary Actors in Adoption of Medical Products -- Physicians -- Hospitals -- Influences of Providers -- Summary: Context for Medical Product Innovation -- ch. Three Methods -- Literature Reviews -- Technical Expert Panel -- Expert Interviews -- Case Studies -- Policy Options -- ch. Four Analysis -- Lack of Basic Scientific Knowledge -- Lack of an Adequate Knowledge Base Can Hinder Product Inventors -- Sources of Financial Support for Increasing Basic Scientific Knowledge -- Federal Funding Is Critical to Expanding the Basic Scientific Base -- Case Study Summary: Haemophilus influenzae Type B (Hib) Vaccine -- How Scientific Uncertainty Affects Medical Product Invention -- Costs and Risks of FDA Approval -- Could the FDA Ensure Safety with Quicker and Less Costly Processes? -- Delays Entail Both Health and Financial Costs -- Case Study Summary: A Cardiovascular Polypill -- Unpredictability and Ineffective Communication Complicate the Approval Process -- FDA Caution May Be a Root Cause of Regulatory Delay -- Case Study Summary: Avastin for Metastatic Breast Cancer -- Regulatory Risk Figures Prominently in Investment and Invention Decisions -- How Regulatory Uncertainty Affects Investment and Invention -- Limited Rewards for Medical Products That Could Lower Spending -- Many Patients and Providers-Are Fairly Insensitive to Prices -- Generous Health Insurance Tends to Reduce Consumers' Sensitivity to Price -- Fee-for-Service Payment Also Tends to Reduce Price Sensitivity -- Lack of Price Transparency Also Reduces Price Sensitivity -- Medicare Is Not Allowed to Consider Costs in Coverage and Reimbursement Decisions -- Limited Time Horizons and Fragmented Decisionmaking -- Case Study Summary: Electronic Health Records -- Inadequate Rewards for Products That Decrease Spending -- Implications for Inventors and Investors -- Treatment Creep -- Case Study Summary: Implantable Cardioverter-Defibrillator -- Manufacturers Can Promote Low-Value Use -- Case Study Summary: Prostate-Specific Antigen -- Defensive Medicine Is a Form of Treatment Creep -- Off-Label Use of Medical Products Is Widespread, but Health Effects Are Unknown -- It Is Difficult to Control Undesirable Instances of Off-Label Use -- Treatment Creep Can Substantially Affect Incentives for Innovators -- Medical Arms Race -- The Classical Medical Arms Race -- The New Medical Arms Race -- Expensive and Controversial Medical Equipment Remains Prominent -- Case Study Summary: Robotic Surgery -- What Drives the Medical Arms Race? -- The Medical Arms Race Can Substantially Affect Incentives of Inventors -- ch. Five Policy Options to Improve the U.S. Medical Product Innovation System -- Options to Reduce Costs and Risks of Invention and Approval -- Enable More Creativity in Funding Basic Science -- Offer Prizes for Inventions -- Buy Out Selected Patents -- Establish a Public-Interest Investment Fund -- Expedite FDA Reviews and Approvals for Products That Decrease Spending -- Implementation Challenges -- Options to Increase Market Rewards -- Reform Medicare Payment Policies -- Reform Medicare Coverage Policies -- Coordinate FDA Approval and CMS Coverage Processes -- Increase Demand for Products That Could Decrease Spending -- Produce More and More-Timely Technology Assessments -- Case Study Summary: Telemedicine -- Summary -- ch. Six In Conclusion -- APPENDIXES -- A.Cost-Effectiveness and Value -- B.An Economic Model of Innovation.
- Biomedical Technology—economics
- Costs and Cost Analysis
- Device Approval
- Economics, Medical
- Health Policy
- Medical care, Cost of—United States
- Medical care—Technological innovations—United States—Cost effectiveness
- Medical technology—United States—Cost effectiveness
- Drug approval—United States
- United States
- 9780833085467 (paperback)
- "RR-308"--Page  of cover.
- Bibliography Note:
- Includes bibliographical references (pages 91-105).
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