Unhealthy Technology Race

August 06, 1991

It is encouraging to see federal officials taking a hard look at the costs versus benefits of extensive use of new health-care technologies. No one can deny the long-term results of new insights from new tools such as positron emission tomography scanners, but does every ailment require the machine's penetrating exactitude?

Such questions were asked in the late 1970s, when state health regulators began to doubt the need for computer tomography scanners in hospitals with small patient loads. Computer tomography revolutionized X-ray exams, showing doctors pictures never before seen, but many said they couldn't interpret what they were getting. It made far more sense to locate such machines in larger medical centers, which saw many illnesses for which scanners were needed, with other hospitals referring patients -- but doctors would not hear of it. CAT scanners, which cost more than $1 million each and up to $500 for each use, proliferated.

The scenario was repeated when magnetic resonance imaging appeared in the mid-1980s. Health regulators in some states tried to require certificates before hospitals could buy new equipment and pass the bill to patients, but medical entrepreneurs made an end run. Private imaging centers sprang up, evading the certificate requirements but making handsome profits for their owners.

Once Medicare agreed to pay for magnetic imaging examinations, the machines swept across the country, with doctors saying they had to have them and hospitals saying they couldn't recruit without them and patients fearful something would be missed if they didn't get scanned.

Now there are 2,000 magnetic resonance imagers, costing $1 million to $2 million each. Studies say more than 5 million MRI scans were made in the United States in 1990, at a cost $600 to $1,000 each. In other words, magnetic imaging adds $5 billion to the U.S. health bill each year, even though some insurance studies show many scans were inappropriate for the complaints patients brought to doctors.

Positron scanners, costing $5 million or more each and $1,500 to $2,500 for each use, come on-line at a time the nation is sensitized to the medical-care bill. That's healthy. Doctors have to be the final arbiters of what is needed for proper care. But the public, which eventually pays the bill, has a right to good explanations for the tests and examinations being ordered. Meanwhile, the ethical conflicts that promote doctors who own X-ray or ultrasound machines to order four to 4.5 times as many tests as physicians who refer patients to outside radiologists cannot continue. The country simply can no longer afford it.

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