Redirecting innovation in U.S. health care : : options to decrease spending and increase value / / Steven Garber [and six others].

• VerfasserIn: Garber, Steven, 1950-; Garber, Steven,
• TeilnehmendeR: Garber, Steven,
• Place / Publishing House: Santa Monica, California : : RAND Corporation,, 2014.; ©2014
• Year of Publication: 2014
• Language: English
• Physical Description: 1 online resource (135 p.)
• Notes: Description based upon print version of record.

New medical technologies are a leading driver of U.S. health care spending. This report identifies promising policy options to change which medical technologies are created, with two related policy goals: (1) Reduce total health care spending with the smallest possible loss of health benefits, and (2) ensure that new medical products that increase spending are accompanied by health benefits that are worth the spending increases.

Table of Contents

Cover; Title Page; Copyright; Preface; Contents; Figures; Summary; Acknowledgments; Abbreviations; Chapter One: Introduction; Project Goals; What Determines Value for Health Care Products?; Chapter 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; 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 Technology; 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 Three: Methods; Literature Reviews; Technical Expert Panel; Expert Interviews; Case Studies; Policy Options; Chapter 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 Decision making 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