Innovation under Federal Health Care Reform
1994; Project HOPE; Volume: 13; Issue: 3 Linguagem: Inglês
10.1377/hlthaff.13.3.82
ISSN2694-233X
Autores Tópico(s)Global Health Care Issues
ResumoPrologue: The pace of health system reform has intensified since the election of President Bill Clinton in 1992. This has been a mixed blessing for those interested in health care innovation, however; some analysts fear that increasingly strict cost controls do not bode well for the future of technological innovation. Indeed, as Leighton Read and Kenneth Lee report in their DataWatch on medical innovation in this volume, “It is widely believed in the industry that health care reform has slowed investment in biotechnology, because of the uncertainty that President Clinton's early proposals cast over the entire health care economy.” In this paper Jane Sisk and Sherry Glied evaluate the three leading approaches to reform—managed competition (including the Health Security Act), single payer, and insurance market reform—regarding their implications for technological innovation. Sisk and Glied emphasize the heterogeneity of innovation and the effects of reform proposals. Expanding the people and services covered could spur innovation in prevention and other primary care. At the same time, spending constraints and uncertainty could deter development of expensive procedures and innovations with longer lead times. Jane Sisk is a professor in the Division of Health Policy and Management, Columbia University School of Public Health. She received her doctorate in economics from McGill University in Montreal. She previously served as senior associate and project director at the congressional Office of Technology Assessment. Sherry Glied, an assistant professor of public health and economics at Columbia's School of Public Health and Department of Economics, received her doctorate in economics from Harvard. She was senior economist for health care at the President's Council of Economic Advisers and participated in the task force that produced the Clinton administration's Health Security Act in 1992–1993. Abstract: Health care reform, which seeks to expand coverage and control spending, contains mixed messages for innovators. Policies that advance reform goals are likely to shift resources away from hospitals, specialists, and expensive procedures and toward areas such as prevention and primary care where innovation may yield greater health improvements per dollar spent. The size of these effects depends critically on the extent of cost containment achieved. Constraining spending will be politically difficult because it requires that consumers forgo some possible health benefits in return for lower costs. In a climate of cost containment, systematic evaluation of new technology is vital to identify and expand coverage to worthwhile innovations and to assure a fair hearing for innovators.
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