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Index A Aaronson, William, 1~17 Acceptance of new technology, 3-4, 7, 9 Acquired immune deficiency syndrome (AIDS), 6 ALZA Corporation, 142-144 Angioplasty, 10, 56, 116, 131-132 Appropriate care payments review, 130 Appropriate Technology International, 30 Artificial organs, 57 Auto analyzer, 13-16 B Bioengineering Research Panel, 51-52, 6~61 Biomaterials, 54 Biomechanics, 53-54 Biomedical engineering artificial organs, 57 biomaterials, 54 biomechanics, 53-54 biosensors, 5~55 federal funding, 57-60 183 innovation proposal, 152 metabolic imaging, 55-56 minimally invasive procedures, 56 neural protheses, 53 systems physiology and modeling, 52-53 Biosensors, 54-55 Blood supply testing, 6 Blue Shield of California, 116 C Cardiac pacemakers, 10, 24-29, 98, 104-105 Centralization of skills and facilities, 115-116, 134 Chardack, William C., 24, 2~28 Chemical analysis, see Auto analyzer Clinical management, 135 Company size, role in innovation, 42-47 Comprehensive accident compensation plans, 83 Computed tomographic (CT) scanning, 7, 132-133, 153, 159

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184 Coronary artery disease, 9-10 Cost containment practices, 109-112 centralization of skills and facilities, 115-116, 134 interim coverage policies, 115-118 and managed care providers, 108, 110, 129-130 rationing health care resources, 111-112, 13~135 D Diagnosis-related groups (DRGs), 94-95, 97-100, 10~108, 111, 117-119, 130-132 Diagnostic procedures, 7-8 Dialysis, 9, 57-58 Diffusion of technology, 116, 133, 159, 171-172 Disabled persons, independent living movement, 29-30 E Endoscopy, 7 F Federal funding, 111, 155-159 for biomedical engineering, 57-60 see also specific agency names Fiber-optic endoscopy, 7 Financing strategies auto analyzer, 14 pneumatic extradural intracranial pressure monitor, 19 wheelchair project for Nicaragua, 30 Food and Drug Administration (FDA), 4~45, 74-76, 79-82, 84-86, 89-90, 114, 140, 14~148, 169 For-profit health care enterprises, 109 Funding, see Federal funding; Private investment decisions INDEX G Gage, Andrew, 24, 26 Government role in financing care, 156-157 in public safety, 157 in reconciling conflicting interests, 15~163 in research, 155-156 see also specific agency names Greatbatch, Wilson, 24-29 H Health care costs, 3-4, 10-11, 170-171; see also Cost containment practices; Hospital finances; Medicare; Prospective Payment Assessment Commission (ProPAC); Prospective payment system (PPS) Health Care Financing Administration, 9~99, 107- 108, 118-119, 132, 161-162 Health Industry Manufacturers Association, 148-149 Health maintenance organizations, see Managed care providers Heart transplants, 112, 116 Hospital finances, 10~103, 130-136 Hospital market share decisions, 134 Hospitals and technology development, 127-136 I ICP monitor, see Pneumatic extradural intracranial pressure monitor Imaging technology, see Computed tomographic (CT) scanning; Magnetic resonance imaging Independent living movement for the disabled, 29-30

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INDEX Informed consent, 141-143 Innovation factors, 152 company size, effect of, 42-47 market considerations, 66-68 stages of innovation, 35-38, 145-150, 165-167 technical considerations, 63-66 user versus manufacturer innovations, 38-41 see also Food and Drug Administration (FDA) Institute of Medicine, 121, 162, 171-173 Interim coverage policies, 115-118 International Classification of Diseases, 117 Intracranial pressure monitor, see Pneumatic extradural intracranial pressure monitor Intrauterine devices (IUDs), 142-143 Intravenous therapy, 133 L Labeling products, 140 Lithotriptor, 9, 132 M Magnetic resonance imaging, 7, 55-56, 99, 110-111, 116, 159 Mammography, 6-7 Managed care providers, 108, 110, 129-130 Marketing strategies, 6~68 auto analyzer, 14-15 cardiac pacemaker, 27-28 pneumatic extradural intracranial pressure monitor, 19 retinoscope, 24 Medical Device Amendments of 1976, 65, 73-75 Medicare, 93-94, 111-112, 116-117; see also Prospective payment system (PPS) 185 Metabolic imaging, see Magnetic resonance imaging Minimally invasive procedures, 56 Mortality data, 161 N National Academy of Engineering, 171-173 National Center for Health Care Technology, 116 National Institutes of Health, 58-60, 155-156 National Science Foundation, 58-60 Neural prostheses, 53 Nicaragua wheelchair project, 29-34 o Outdated technology, identification of, 119-12() p Pacemakers, see Cardiac pacemakers Penile prostheses, 99-100 Plasmapheresis, 16-17 Pneumatic extradural intracranial pressure monitor, 17-19 Preferred provider organizations, see Managed care providers President's Science Advisory Committee, 127-128 Preventive medicine, 9-10 Private investment decisions, 62-70, 167-168 market considerations, 66-68 technical considerations, 63-66 Product liability and regulation compensation board, proposal for, 86-89 comprehensive accident compensation plans, 83 data deficiencies, 151-152 inconsistencies between, 79-81

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186 informed consent, 141-143 and insurance premiums, 78 labeling, 140 limits of, 7~79, 170 Medical Device Amendments of 1976, 65, 73-75 prosecutions, proposed federal role, 89-90 punitive damage awards, 78 reform framework, 81-90 strict liability interpretation, 77-78 and tort law, 75-79, 170 see also Food and Drug Administration (FDA) Prospective Payment Assessment Commission (ProPAC), 94-103, 108, 1 16-1 19 Prospective payment system (PPS), 94-103, 106-108, 117-118, 130, 150~151, 159-160 Public participation in payment coverage decisions, 119 R Rationing health care resources, 1 1 1-1 12, 134-135 Regionalization of skills, see Centralization of skills and facilities Regulations, see Food and Drug Administration (FDA); Product liability and regulation Rehabilitation procedures, 11-12 Renal disease, 9, 57-58 Research and development INDEX financing decisions, 62-70, 155-156 Retinoscope, 19-24 Risk/benefit analysis and responsibilities, 139-144, 152-154, 169 S Screening procedures, ~7 Self-insurance by large employers, 109 Siting decisions, 4 Skeggs, Leonard, 13-14 Specialized medicine, 128-129 Stethoscope, 4, 7 Systems physiology and modeling, 52-53 T Technicon Corporation, 13-16 Technology assessment for policy decisions, 113-115 Therapy procedures, ~11 Thomas, Lewis, 8-10, 127-128, 136 Tort law, see Product liability and regulation U United Kingdom yellow-card program, 140 Utilization review mechanisms, 109-1 10 W Wheelchairs, 29~34