Related Experiment Videos
Supporting future surgical innovation. Lung transplantation as a case study
K Reemtsma1, A C Gelijns, J E Sisk
1Habif Center for Surgical Studies, Columbia University, College of Physicians and Surgeons, New York, NY.
Annals of Surgery
|October 1, 1993
Summary
Limited funding hinders surgical innovation, particularly for lung transplantation. Provisional coverage within research protocols may ensure timely assessment of new procedures and safeguard innovation.
Area of Science:
- Medical innovation
- Health economics
- Surgical advancement
Background:
- Lung transplantation has seen significant advancements since the 1980s, yet faces challenges in national health policy and cost containment.
- The Health Care Financing Administration (HCFA) has not established a national coverage policy for lung transplants, leaving decisions to regional contractors.
- The development of innovative clinical surgery is increasingly pressured by cost-containment measures.
Purpose of the Study:
- To address the challenge of supporting innovative clinical surgery amidst cost containment pressures, using lung transplantation as a case study.
- To evaluate the coverage landscape for lung transplantation by major insurers and government programs.
- To assess the sources of funding for clinical research and development in surgical innovation.
Main Methods:
- Surveyed major commercial insurers and the Blue Cross Blue Shield Association regarding lung transplant coverage.
- Examined coverage decisions by Medicare intermediaries for lung transplantation.
- Interviewed the National Heart, Lung, and Blood Institute and industry partners on clinical research support.
Main Results:
- Government and industry funding for lung transplant development were limited.
- Academic institutions primarily financed lung transplant development through cross-subsidization.
- Major private payers and Blue Cross Blue Shield initiated coverage in the early 1990s, but Medicare intermediary coverage showed significant variability.
- The lack of a specific diagnosis-related group for lung transplants resulted in payments below mean costs in all-payer states.
Conclusions:
- A growing gap exists between the need for outcomes data on new procedures and available resources for their development and assessment.
- Failure to address this resource disparity could jeopardize surgical innovation and the acquisition of timely outcomes data.
- Provisional coverage within defined research protocols is proposed as a viable mechanism for assessing new procedures before widespread adoption.