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 (...

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