48 THE FIVE-YEAR OUTLOOK 



DISSEMINATING RESEARCH FINDINGS LEADING TO 

 TECHNOLOGICAL ADOPTION 



The dissemination of research findings with potential 

 usefulness for the development of new and emerging 

 technologies traditionally has not been well coordinated 

 (See Section I-C). In the health area, increased Federal 

 efforts have been begun during the past few years, under 

 such auspices as the Lister Hill National Center for Bio- 

 medical Communications and the National Library of 

 Medicine, to improve mechanisms for tranferring basic 

 research knowledge into practice. Those are beginnings, 

 but additional efforts will be needed to provide truly 

 effective dissemination of such findings in the coming 

 years (HEALTH). 



An example of an innovative transfer mechanism in 

 operation is the "Knowledge Base Program" at the Lister 

 Hill Center. Through this computer-based program, 

 knowledge is synthesized in a particular subject for use by 

 a specified audience, such as those interested in a certain 

 new technology. A prototype of the system, applied to the 

 field of viral hepatitis, was established in 1977 and has 

 been subsequently refined. Similar efforts might be initi- 

 ated for the transfer of basic research knowledge in areas 

 underlying application of emerging health technologies 

 throughout the Federal and State Governments. 



IMPROVING THE ASSESSMENT AND REGULATION OF NEW 

 TECHNOLOGIES 



With the advent of more and more sophisticated tech- 

 nologies to meet specific needs, the possibility of misuse 

 also increases. In an effort to control the use of costly and. 

 at times, inappropriate medical technology, various gov- 

 ernment regulations have been enacted to protect individ- 

 uals and contain the costs of care. Federal regulatory 

 activities, however, have often failed to give the regulators 

 a clear mandate with workable goals (Outlook I). Pairther- 

 more. when billions of dollars hang on compliance deci- 

 sions, intense controversy and delays are inevitable. 

 There is a need, therefore, to improve the process of 

 regulating health care technologies. 



Scientific research can be useful both in assessing the 

 costs and benefits of regulations and in curtailing or en- 

 couraging the use of new technologies (Section 1-E). One 

 problem in applying regulations with respect to costs is 

 that current estimates are almost inevitably based on the 

 costs of existing technology. Such estimates tend to over- 

 state those costs. The longer range risks, too, are some- 

 times either under or over estimated. Through improved 

 methods of cost projection and the use of an expanded 

 base of experience, such estimates could be greatly refined 

 (AAAS-5; see also Section 1-E). Therefore, a greater 

 effort is needed to improve the coordination of research 



findings in both the development and the control of health 

 technologies over the next 5 years. 



Increased efforts to assess the relative costs and benefits 

 of new and emerging technologies also will be needed, 

 both to ensure wider application of cost-efficient tech- 

 nologies by the private and public health sectors and to 

 control the adoption of those technologies that are costly 

 and only marginally effective. Many of the new tech- 

 nologies do promise to contribute to cost containment 

 over time and to improve the quality of care offered 

 Americans. However, only through careful assessment of 

 the costs and benefits of those technologies can an effec- 

 tive policy for their adoption be developed (HEALTH). 



ENSURING ADEQUATE AND APPROPRIATE 

 HEALTH SERVICE DELIVERY TO ALL 

 AMERICANS 



Economic constraints make it especially important that 

 available health resources be used as efficiently as possi- 

 ble. A key consideration in ensuring the availability of 

 adequate and appropriate health services to all citizens 

 continues to be the improved access to appropriate serv- 

 ices for those persons who traditionally have been under- 

 served. Among those groups are Black Americans, the 

 Spanish-heritage population. Asian or Pacific Islanders. 

 American Indians and Alaskan natives, rural Americans, 

 the elderly, and low-income groups. While various popu- 

 lation subsets have both unique attributes and certain 

 common points regarding health status, some ethnic 

 groups are generally not as healthy and do not live as long 

 as do other groups of Americans. 



Several alternate types of health care delivery systems 

 that now exist, or are in the process of being developed, 

 offer increased access and more appropriate health care to 

 underserved populations. The most prevalent of those 

 delivery services is the Health Maintenance Organization 

 (HMO). As of 1978. 199 HMOs were providing health 

 care to more than 7 million Americans. While there are 

 various types of HMOs, the most predominant is the 

 Prepaid Group Practice. Under that model, the families or 

 individuals enrolled agree to pay a set monthly premium 

 to the HMO, whether or not they need medical care. In 

 many cases, the monthly premium is paid by the employer 

 or by the government. The staff of the HMO is thus 

 motivated, at least in theory, to keep people healthy and 

 reduce unnecessary utilization of services. 



Other health care programs aimed at underserved popu- 

 lations include community health centers, maternal and 

 child health services, alcohol and drug abuse centers, and 

 migrant health programs. In addition, the Indian Health 

 Service provides a full range of preventive, primary medi- 

 cal, community health, and rehabilitative services to 



