Læknablaðið - 15.09.1982, Síða 36

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LÆKNABLAÐIÐ
6.5 Certificate of need system. Whenever a
medical technology is required by an institu-
tion, justification may have to be given and a
special authority which after examination of
the request, approves or rejects it. This
authority may be seated at national level in
small countries and combined with the natio-
nal medical technology centre but should
whenever possible be regionalized and then
combined with a regional instrument and
equipment centre or committee. The matter
could even be further decentralized but the
local authority has to rely on regional or
national centres, as it would not be rational to
build-up expertise and data at the peripheral
level.
6.6 Technical recommendations at national or
regional levels. Some countries have deve-
loped a system of technical assessment of a
more or less limited range of medical equip-
ment through specialized institutes. The re-
sults are then collated and diffused to the
interested institutions on a regular basis. This
procedure is particularly useful in countries
having organized a national health service.
6.7 Guidance of industry. Apart from design-
ing, promoting and servicing medical equip-
ment, industry should be guided to develop
new equipment and devices according to the
real needs of the health professions. When this
guidance is lacking, new industrial develop-
ments may follow wrong lines and thus after
an expensive evolution, the product may not
be accepted by testers and consumers. In
other instances a single successful technology
may have to support financially other unsuc-
cessful ones and then be very expensive.
6.8 Manpower training policy. The trend to-
ward medical specialization is linked directly
with the availability and use of specific medi-
cal technologies. It follows that policies that
influence the number and speciality distribu-
tion of physicians can be expected to have a
direct impact on the use of medical technolo-
gies. This is particularly true of the high
capital (i.e., CT scanners) and high labour (i.e.,
gastrointestinal endoscopy) technologies that
tend to be restricted to specialists, and less
true of the low capital, high volume technolo-
gies that apply to all categories of physicians.
While the specialist-to-generalists balance is a
factor regulating high cost technology use, the
overall supply of physicians is an important
determinant of the use of low cost technolo-
gies. The need for a greater proportion of
primary health care physicians not only for
overall health reasons but also for an appro-
priate use of the necessary technologies is to
be emphasized.
6.9 Physician education. The current training
of new physicians in most universities of the
Region heavily emphasizes the use of the
latest procedures and equipment. Even per-
sons being trained as primary care physicians
attend the same medical schools as the future
specialists, institutions where »the practice of
medicine« is epitomized by the best-equipped,
around-the-clock diagnostic and treatment
facilities. This leaves the new graduate in a
difficult situation when he is left on his own in
a remote area.
The teaching of the choice and utilization of
medical technologies according to the real
needs of patients and community should be an
essential part of all curricula not only for
undergraduate, post-graduate and refresher
training of physicians, but should also be
incorporated in the programmes destined to
other health care personnel. General practitio-
ners should be well-informed about the values
and limitations of all available technologies.
This is considered as one of the most effective
measures in cost-containment.
6.10 Consumer education. Under this appro-
ach, consumers would be educated about the
costs of the health care they receive. As they
do not always receive a hospital bill, they
often have no idea what services and supplies
were furnished. If patients received adequate
information and copies of their bills, they
would become more aware of the cost of the
services they demand and would perhaps
question their necessity.
The media could also be better used to
publicize the need for second opinions, the
existence of unnecessary operations and tests
and the limitations of certain procedures. If
patients were enlightened about some of the
uncertainties, the costs, and the risks, some
behavioural changes may take place.
6.11 Coordinated Research policy. This may
be an important contributing factor in cost-