Health Affairs

Health Affairs, 27, no. 6 (2008): 1566-1576 doi: 10.1377/hlthaff.27.6.1566 © 2008 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

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Medical Devices

Diffusion Of New Technology And Payment Policies: Coronary Stents

Chuck Shih and Elise Berliner

Medicare payment is often cited as a major driver of medical technology diffusion. Stakeholders claimed that beneficiaries would be denied access to stents because Medicare payment did not initially cover the cost of stents. Nevertheless, stents diffused rapidly, including to untested indications. Outcomes with stents improved over time, primarily because of a fundamental property of technology diffusion termed "reinvention," in which new technology is modified by users. The traditional system of regulatory approval and reimbursement does not account for this dynamic process. There has been no incentive for systematic collection of data to determine which modifications are most beneficial.

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