Redirecting innovation in U.S. health care : options to decrease spending and increase value /
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Author / Creator: | Garber, Steven, 1950- author. |
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Imprint: | Santa Monica, CA : Rand Corporation, [2014] ©2014 |
Description: | xxvii, 105 pages : color illustrations ; 26 cm |
Language: | English |
Subject: | |
Format: | Print Book |
URL for this record: | http://pi.lib.uchicago.edu/1001/cat/bib/10161291 |
Table of Contents:
- Preface
- Figures
- Summary
- Acknowledgments
- Abbreviations
- Chapter 1. Introduction
- Project Goals
- What Determines Value for Health Care Products?
- Chapter 2. 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
- Influencers 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 Techno logy
- Primary Actor and Influencers in Approval of Medical Technologies
- Primary Actors in Adoption of Medical Products
- Physicians
- Hospitals
- Influencers of Providers
- Summary: Context for Medical Product Innovation
- Chapter 3. Methods
- Literature Reviews
- Technical Expert Panel
- Expert Interviews
- Case Studies
- Policy Options
- Chapter 4. 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 Produce 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
- Flow Regulators 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 Elorizons 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
- Chapter 5. 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
- Chapter 6. In Conclusion
- Appendixes
- A. Cost-Effectiveness and Value
- B. An Economic Model of Innovation
- References