The spiraling cost of health care in the United States--due in large measure to the explosive growth of medical technology--is a major national problem. Yet many of these technologies have not been properly evaluated. They may in fact be ineffective or even harmful, but once a technology has become part of accepted practice, the threat of malpractice suits alone tends to mandate its continued use regardless of its actual efficacy. With support from this grant, Dr. Mike is undertaking a case study which examines factors in the introduction and diffusion of a perinatal technology, that of transcutaneous blood gas monitoring (TCM). Her study will include: a literature review concerning the development of scientific evidence in support of TCM; an examination of the available data to establish the pattern of diffusion of TCM; interviews with company managers, bioengineers, and others involved in R&D and marketing; and a review of the role of regulation and reimbursement. In the course of this study, she will identify at each stage the ethical and value dimensions of the process of development and diffusion of this technology. This study of factors outside of the health care community is part of a larger project which will examine diffusion of perinatal technologies. By obtaining clearer insights into the complex diffusion process of these expensive new medical technologies, this case study will aid public discussion and should ultimately contribute to more efficient health care planning for the nation.
