Seymour Perry

Abdominal Adhesiolysis: Inpatient Care and Expenditures in the United States in 1994☆

BACKGROUND Adhesion formation represents a major complication after lower abdominal operations. It is postulated that a shift in surgical practice in recent years toward the use of less invasive techniques, such as laparoscopy, may be associated with a reduction in the incidence of intraperitoneal adhesions and in the rate of adhesiolysis procedures. Using an attributable-risk methodology, this cost-of-illness study was designed to estimate the hospitalization rate and expenditures for adhesiolysis in the United States in 1994 and to examine changes in attributable expenditures since 1988. STUDY DESIGN A national hospital discharge data base was used to identify all abdominal adhesion procedures performed in the United States in 1994. Total hospitalization expenditures were based on Medicare payment rates for adhesiolysis hospitalizations and physician services, which were applied to the total number of inpatient days attributed to adhesiolysis. The results were compared with published rates and expenditures attributed to adhesiolysis in 1988. RESULTS Adhesiolysis was responsible for 303,836 hospitalizations during 1994, primarily for procedures on the digestive and female reproductive systems. These procedures accounted for 846,415 days of inpatient care and

A history of ISTAHC: A personal perspective on its first 10 years

1.3 billion in hospitalization and surgeon expenditures. CONCLUSIONS Although the adhesiolysis hospitalization rate has remained constant since 1988, inpatient expenditures have decreased by nearly 10% because of a 15% decrease in the average length of stay. The increased use of laparoscopy during this 6-year period does not appear to be associated with a concomitant reduction in the adhesiolysis hospitalization rate, suggesting that the causes of adhesion formation warrant further research.

The status of health technology assessment worldwide. Results of an international survey.

This reflection on the history of the International Society of Technology Assessment in Health Care is an effort to describe the creation of the Society and its first 10 years of activity. Without analyzing the forces that spurred the growth of technology assessment internationally or linking events, policies, and changes in the various countries, this essay focuses on the persons and events that surrounded the birth and growth of the Society in the past decade.

Healthy Children: Investing in the Future Office of Technology Assessment

Health technology assessment (HTA) has increasingly become a valuable tool to examine effectiveness, quality of care, patient outcomes, and cost-effectiveness of health care technologies. In 1994 and 1995, a survey was conducted to document the scope of worldwide HTA activities; 103 organizations from 24 countries responded. This paper summarizes the results of this international survey, including a description of each countrys program, types of technologies assessed, methodologies used, and dissemination approaches. Results for Canada, the United States, and European and other countries are presented separately.

The Appropriate Use of High-Cost, High-Risk Technologies: The Case of Total Parenteral Nutrition

Despite many gains, the United States could do better in preventing health problems in infants and young children, says the congressional Office of Technology Assessment (OTA) in its new report, Healthy Children: Investing in the Future . Rep. Henry Waxman (D-Calif.), Chairman, Subcommittee on Health and the Environment, Committee on Energy and Commerce, released the report at a hearing.

Evaluation of Health Care Technologies in the United States Compared to Canada and European Countries

An assessment of total parenteral nutrition (TPN), a high-cost, high-risk technology, is used to illustrate the importance of technology assessment to quality assessment. A review of the literature suggests that TPN is only sometimes effective and that it actually produces measurable harm by increasing complication rates in certain groups of patients. However, there are strong advocates for its use. The economic and ethical implications of TPN for the quality of care are also discussed at the levels both of the individual and of society. Continuous assessment of health care technologies, particularly those that are high-cost and high-risk, is critical to the overall quality of health care.

REPORT FROM THE HEALTH COUNCIL OF THE NETHERLANDS

This paper presents the results of the first comprehensive international survey to catalogue health technology assessment (HTA) activities. By 1995, there were formal HTA programs in 24 countries, established mostly in the late 1980s and early 1990s. European countries generally have one or two federal or provincial HTA programs each. Canada has an extensive network of federal and regional organizations coordinated by a central body, and the US has 53 HTA organizations, the vast majority of which are in the private sector. While the commitment of the US government to HTA has been erratic, the private sector has been witness to an expansion of HTA activities by insurance companies, hospitals, medical/device manufacturers, consulting firms, and health professional societies. In contrast to other developed countries, the current state of technology assessment in the US is decentralized, fragmented, and duplicative. We conclude by discussing the importance of a US HTA agency at the national level.

The Management of Clinically Localized Prostate Cancer

The Health Council of the Netherlands (Gezondheidsraad) is the scientific advisory body on health and health care to the Dutch government. Its recommendations cover fields that relate to the health of the population, such as clinical medicine, public health, environmental protection, food and nutrition, and occupational hygiene. Independent multidisciplinary committees draw up the Councils advisory reports. The Councils 1997 Executive Summaries booklet is now available. The reports are: