Læknablaðið - 15.09.1982, Síða 35

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Fig. 1. The »Shift« in level, emphasis, resources,
responsibilities, integration, technology and training.
Needs

Supplies
Legislation
Fig. 2. Appropriate technology criteria?
environmental and socioeconomic informa-
tion. Any technical service incorporated in a
comprehensive health service has to balance
supply against needs, and, in an ideal setting,
the two may conceivably be equal. However,
concepts of health and, even more so, con-
cepts of health services, are relative and aré
influenced by traditions, culture, expectations,
economy and other factors. Therefore, a
constantly shifting and dynamic relationship:
NEEDS^SUPPLIES in the technical support
services is to be expected. Appropriate tech-
nology criteria such as rationality, acceptance,
access and real use as well as others must be
used to monitor needs and supplies and thus
introduce corrective measures whenever ne-
cessary for improvement of the services (Fig.
2).
6.2 Reimbursementlimitation.This isconsider-
ed as one of the most potent measures
affecting the diffusion of medical technologies.
6.2.1. Hospitals. Applying a limit to the in-
crease in reimbursement would force hospitals
to exercise caution in expanding the technolo-
gies they perform, the equipment they purcha-
se, and the personnel they hire. More cost-
conscious decisions would be made on how to
allocate their potential revenues.
6.2.2. Physicians. If control of medical techno-
logy is to be based, at least in part, on
changing the patterns of physicians’ request-
ing and performing of technological services,
reimbursement mechanisms that now favor
the ordering of these types of services must be
changed. More efforts should be spent in the
area of adjusting physician reimbursement
rates to counteract the built-in incentives to
order unnecessary or inefficient technological
support services.
6.3 Capitai expenditure limitation. This mea-
sure is intended to limit the growth of the cost
of medical care through regulation of expendi-
tures for new services, equipment, or facilities.
This type of regulation is based on the concept
that duplication of services should be discou-
raged and planning for new services be
rationalized. A limitation on the supply of
services will force the health care system to
decide which patients really need to use these
resources.
The answer has recently been sought in
many countries and a functional regionaliza-
tion of services had been proposed. The
primary objective of regionalization is to
coordinate available resources so that they
can be used more efficiently and without
unnecessary duplication to make the services
of the Region’s health establishments availab-
le to all upon demand.
6.4 Market entry licensing and issuing of
standards. This approach would require all
medical equipment and devices to undergo a
procedure of assessment in its widest sense
and approval by a national competent authori-
ty. Although this method may delay or pre-
vent the adoption of many innovations, it
would not curb the use of technology once it
was permitted to enter the market. It could be
effective, however, in preventing the diffusion
of useless or harmful technologies and would
have the potential of providing a rich data
base on risks and benefits.