LEADER 05225nam 2200649 450 001 9910220091803321 005 20231108003917.0 010 $a0-8330-8549-2 010 $a0-8330-8547-6 035 $a(CKB)3710000000108683 035 $a(EBL)1684540 035 $a(SSID)ssj0001216878 035 $a(PQKBManifestationID)11836996 035 $a(PQKBTitleCode)TC0001216878 035 $a(PQKBWorkID)11197744 035 $a(PQKB)10803063 035 $a(Au-PeEL)EBL1684540 035 $a(CaPaEBR)ebr10867874 035 $a(OCoLC)879551018 035 $a(MiAaPQ)EBC1684540 035 $a(EXLCZ)993710000000108683 100 $a20140517h20142014 uy 0 101 0 $aeng 135 $aur|n|---||||| 181 $ctxt 182 $cc 183 $acr 200 00$aRedirecting innovation in U.S. health care $eoptions to decrease spending and increase value /$fSteven Garber [and six others] 210 1$aSanta Monica, California :$cRAND Corporation,$d2014. 210 4$dİ2014 215 $a1 online resource (135 p.) 300 $aDescription based upon print version of record. 311 $a0-8330-8546-8 320 $aIncludes bibliographical references. 327 $aCover; 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 327 $aU.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 327 $aSources 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 327 $aCase 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 327 $aLimited 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 327 $aTreatment Creep Can Substantially Affect Incentives for Innovators 330 $aNew 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. 606 $aMedical care$zUnited States 606 $aMedical care, Cost of$zUnited States 606 $aMedical innovations 615 0$aMedical care 615 0$aMedical care, Cost of 615 0$aMedical innovations. 676 $a362.10973 700 $aGarber$b Steven$f1950-$0910138 702 $aGarber$b Steven 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910220091803321 996 $aRedirecting innovation in U.S. health care$92885267 997 $aUNINA