The diffusion of the computed tomography (CT) scanner in the United States

The rising cost of medical care in the United States is a problem generally familiar to all interested in health care policy. In recent years the contribution of technology to this rising cost has been debated. The computed tomography (CT) scanner has come to exemplify the problem of "technology run wild." The scanner was introduced into the United States in 1973 and has diffused rapidly into virtually every area of the country. However, despite the large number of scanners, they are mal-distributed by institutional setting and geographic location. A number of Federal policies have been developed to deal with medical technology. The case of the CT scanner illustrates the failure of these policies. The CT scanner was not well evaluated before it diffused into practice, and it appears that Federal reimbursement policy facilitated its spread. Federal policies designed to slow diffusion or to assure optimal placement or wise use of scanners have not had demonstrable effects. The case of the CT scanner suggests the need to alter Federal policies toward medical technologies.