International Journal of Technology Assessment in Health Care

General Essays

A Comparison of the Investment in Hospital-Based Obstetrical Ultrasound in Wales and Washington State

Roger A. Rosenblatta1, Andrew J. Dawsona2, Eric H. Larsona3, Carolyn J. Tresslera3, Anthony Jonesa4, L. Gary Harta5 and Thomas S. Nesbitta6

a1 University of Washington School of Medicine

a2 Neville Hall Hospital

a3 University of Washington School of Medicine

a4 University of Wales College of Medicine

a5 University of Washington School of Medicine

a6 University of California at Sacramento


The purpose of this study was to examine differences in the way Britain and the United States invest in and deploy a new medical technology. We used structured interviews to obtain information on the technical sophistication and approximate replacement value of all hospital-based obstetrical ultrasound machines in every maternity hospital in Washington state and Wales. The supply of hospital-based ultrasound machines—approximately two machines per 1,000 births—was similar in both countries. Wales had fewer advanced ultrasound machines than Washington state, and they were based exclusively in high-volume district general hospitals; there were no obstetric ultrasound machines in the private sector. In Washington state, the majority of advanced machines were in small and medium-sized hospitals, and many private offices had ultrasound machines. The approximate replacement value of hospital-based machines was three times as high per birth in Washington state as in Wales. In the case of obstetrical ultrasound, centralization of facilities, a relatively small private sector, and global budgeting lead to lower expenditures per patient within the National Health Service without compromising access to care.