The objective of this article is to describe and analyze the decision-making process and its consequences for medical technology transfer in China. Data were obtained in 1987 from 35 elite teaching hospitals affiliated with 13 medical universities, directly supervised by the Ministry of Health in the People's Republic of China. This article focuses on three kinds of diagnostic equipment: computerized tomographs, ultrasonic diagnostic units, and high-power x-ray diagnostic apparatuses. Decision-making on the transfer of medical technology in China is decentralized. Most hospitals rely on foreign medical sales representatives and medical exhibits, and their decisions on the acquisition of equipment rely more on the services available than on the price of the product. Chinese hospitals also encounter serious infrastructure problems when buying medical equipment. A number of alternatives are suggested for improving the efficiency of medical technology transfer in China.

Many people believe that cost-effectiveness (CE) and cost-benefit (CB) analyses require different assumptions. However, when CE analysis supports decisions to use medical resources, it makes the same assumptions that CB analysis requires. They are mathematically equivalent. Differences between CE and CB hinge more on reporting style than on fundamental assumptions.

The use of 53 different technologies was studied in 82 patients in a neonatal intensive care unit. Using a coefficient of similarity based on the utilization pattern of these technologies, it was possible to identify five clusters of patients that can be correlated with the primary diagnostic groups and such other variables as birth weight (BW), gestational age, length of stay (LOS), and weight gain. Four interdependent models were identified by multiple regression analysis. The number of different therapeutic technologies applied to these patients can be explained (r = 0.67) by their Apgar scores, gestational age, and an index of severity of illness based on the diagnostic group. The number of different diagnostic technologies used is directly related to the number of therapies delivered (r = 0.63) and, jointly with BW, determines LOS (r = 0.73). Finally, weight gain is explained by LOS and BW (r = 0.65).

In a pretest-posttest panel survey of 595 eligible Maryland physicians practicing family or general medicine, internal medicine, cardiology, or nephrology, perceptions of consensus reports designed to alter medical practice are examined. On a 7-point scale, physicians reported positive or neutral views of descriptors, most favorably rating credible (mean = 2.25) and reliable (mean = 2.41), and least favorably rating biased (mean = 3.79). In a regression analysis of factors influencing changes in practice behavior congruent with consensus recommendations before and 1 year after the release of a consensus report on hypertension (8), these perceptions were not significant determinants. The strongest predictor of congruent practice behavior a year after the report was published was congruent practice behavior just prior to the report's release, and the second strongest predictor was perceived influence of the report's sources/sponsors.

This article discusses and identifies the weaknesses of approaches to assessing computerized decision support (CDS) systems, examining the design of two CDS systems, “DXplain” and the “Problem Knowledge Coupler” (PKC). It suggests that the inadequate assessment of CDS technologies will promote a conservative orientation toward their diffusion.

The dream of artificial blood has existed since the 1960s. Disease-free hemoglobin solutions will be commercially available in 1991. A willingness-to-pay (WTP) survey was undertaken to assess the tangible and intangible benefits to the public from this new product. The positive results suggest that third-party payers should cover this benefit and assist the diffusion of this new technology. From the perspective of industrial marketing, results suggest that there will be little consumer price resistance for hemoglobin solutions within the suggested price range of $225–300 per unit. Management implications of this new product are discussed.

To maintain high efficacy and cost-effectiveness of health interventions, such as immunization programs and health information, systematic and careful evaluation is necessary. This is particularly relevant when health resources are scarce, as in most developing countries. Whereas vaccines used in immunization programs are generally evaluated for efficacy and safety prior to their application in routine health service, very little attention is paid to continuous or operational evaluation.

There are situations where, for many reasons, an innovation considered revolutionary in several respects is widely accepted by those whose ways of doing things are transformed by it. The innovation represents a “winning combination” in that it combines such attractive elements that each party, for its own reasons, will desire its adoption and work toward that common goal. In France, and particularly in the Assistance Publique de Paris and in the Hospices Civils de Lyon, such has been the case with the German-made Dornier extracorporeal lithotriptor, an innovation that makes it possible to destroy kidney stones without surgery.