The Relevance of Socioeconomic and Health Policy Issues to Clinical Research: The Case of MRI and Neuroradiology

Abstract

Magnetic resonance imaging (MRI) is a high-cost, new technology with great potential for improving patient care. The lack of a coherent public policy for MRI, or its predecessor computed tomography (CT), has caused considerable problems. Lack of an enunciated public policy has led to inconsistent reimbursement and reimbursement levels that develop in haphazard ways. Furthermore, diffusion has been unpredictable and has led to geographical excesses and deficiencies. Technology assessments of MRI, although numerous, have used inconsistent criteria to rate MRI's clinical efficacy. The lack of methodologically sound studies of MRI severely hampered early evaluation. This article examines these problems and suggests that the medical profession take a stronger leadership role in developing policies for expensive, promising new diagnostic technologies. The profession should promote, demand, and perform rigorous clinical evaluations of new technologies, and help develop a consensus regarding the criteria for what constitutes a clinically valuable advance in diagnostic technology.

Analysis of The National Institutes of Health Medicare Coverage Assessment

“…On the other hand, approval of a new technology by HCFA could legitimize its application and subsequently increase its coverage by other providers. For example, Larson and Kent (5) argue that a decision by HCFA in 1985 to cover MRI contributed to its increased use by other providers and turned it into a profitable technology by 1987. Coverage of a technology by HCFA seems to have a strong impact on spreading its use.…”

Court-Ordered Reimbursement for Unproven Medical Technology

“…"13 In particular, the report spec-ified the lack of evidence for the effec¬ tiveness of thermography as a diagnostic tool for conditions of the nervous system. Case Study 1 The first thermography case we ana¬ lyzed was (2) be based on scientific criteria accept¬ ed by the majority of that peer group; and (3) not be of an experimental or in¬ vestigative nature. The trial court received testimony from numerous medical expert witnesses, both favoring and opposing the use of thermograms in the diagnosis of musculoskeletal disease.…”

Cost effectiveness of magnetic resonance imaging in the neurosciences.

“…The age and sex breakdown mirrors that in the United Kingdom as a whole,27 and the breakdown for all 936 patients imaged was similar to that reported for other patients having magnetic resonance imaging (table III). Over the six months after the (13) 103 (20) 132 (26) 94 (18) 44 (9) 20 (4) 14 (3) 34 (8) 49 (12) 80 (19) 92 (22) 90 (21) 50 (12) 8 (2) 3(<1) 1 (<I) 25 (3) 74 (8) 117 (13) 183 (20) 225 (24) 186 (20) 94 (10) 28 (3) 3(<1) 1 (<1) 647 (4) 1617 (10) 2427 (15) 3074 (19) 3074 (19) 2264 (14) 1941 (12) 971 (6) 162 (1) *Australia 49% female; Coventry 54% female. scan the quality of life score fell, with the average score decreasing by 0 059 to 0-845.…”