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Welcoming remarks and introduction
Welcoming Remarks and Introduction Alexander R. Margulis MD, DSc (hc)
It has been 2 years since the First Symposium on Costs and Benefits of Radiology was held at St. John's College in Oxford, England. During this time the practice of radiology in the United States has adapted to managed care and, in many areas, has begun to achieve recognition as cost-effective, even by the administrators of health-care organizations. The process is gradual, and perhaps slower than optimal, in part because a small segment of the public still believes that modern medicine, with all its technologic advances, only prolongs suffering and deprives patients of dignity at the inevitable ending of life. Others hold to a Luddite conviction, asserting that the purpose of medical technology is to make things more complicated and expensive and that it does not contribute to improving the health of individual patients. European health administrators are carefully watching developments in the United States. If the measures adopted in the United States are successful in reducing or stopping the escalation of health-care costs, 'they will likely be modified to suit the local situation in many European countries. A number of issues are common to the practice of radiology in both Europe and the United States, including (a) nonselective cost containment, (b) turf wars related to these cost-containment measures, (c) resultant fragmentation of the specialty, (d) overregulation by governmental agencies, often delaying the application of advances to patient care, and (e) an oversupply of radiologists weakening the specialty as a whole. As a whole, these elements lead to diminished support for teaching and research and an almost total shift of man-
Acad Radio11998; 5(suppt 2):$255 1From the University Office of A d v a n c e m e n t a n d Planning, University of California San Francisco, 3333 California St, Ste 16, San Francisco, CA 94143-0292. Address reprint requests to the author.
agement decision making, from radiologists to administrators. Of the more than $1 trillion spent on health care in the United States in 1996, only approximately 3.5% was attributable to radiology, even taking into account the purchase of over 400 magnetic resonance and 850 computed tomography units. Although the number of conventional radiology examinations has decreased, the number of computed tomography (CT), magnetic resonance (MR), and ultrasound (US) examinations has remained relatively steady or even increased. Even though the cost of equipment in radiology has significantly decreased over the past 10 years, there are more options than ever before. The most sophisticated equipment, of course, carries a higher cost. In terms of economics, the single most important concept for a radiologist who is ordering or approving diagnostic procedures to understand is that a progression of imaging tests from the least expensive to the more costly may well result in an unnecessary waste of time and resources, with higher overall expenditures. Initial performance of more cosily tests, if appropriate and if they lead to a precise diagnosis, are generally more cost-effective. In order to ensure competent recommendations for radiology procedures, it is vital to develop guidelines which can be used to judge the suitability of a given procedure in a given circumstance. Such guidelines must, of course, be modified to reflect individual circumstances and conditions, including availability of equipment and expertise of operators. Technologic advances continue to be made in radiology, and correctly used it can be one of the greatest assets of modem medicine. Radiology is an attractive specialty, which continues to draw the best and the brightest, and it is therefore assured of a successful future.
© AUR, 1998
$255
It has been 2 years since the First Symposium on Costs and Benefits of Radiology was held at St. John's College in Oxford, England. During this time the practice of radiology in the United States has adapted to managed care and, in many areas, has begun to achieve recognition as cost-effective, even by the administrators of health-care organizations. The process is gradual, and perhaps slower than optimal, in part because a small segment of the public still believes that modern medicine, with all its technologic advances, only prolongs suffering and deprives patients of dignity at the inevitable ending of life. Others hold to a Luddite conviction, asserting that the purpose of medical technology is to make things more complicated and expensive and that it does not contribute to improving the health of individual patients. European health administrators are carefully watching developments in the United States. If the measures adopted in the United States are successful in reducing or stopping the escalation of health-care costs, 'they will likely be modified to suit the local situation in many European countries. A number of issues are common to the practice of radiology in both Europe and the United States, including (a) nonselective cost containment, (b) turf wars related to these cost-containment measures, (c) resultant fragmentation of the specialty, (d) overregulation by governmental agencies, often delaying the application of advances to patient care, and (e) an oversupply of radiologists weakening the specialty as a whole. As a whole, these elements lead to diminished support for teaching and research and an almost total shift of man-
Acad Radio11998; 5(suppt 2):$255 1From the University Office of A d v a n c e m e n t a n d Planning, University of California San Francisco, 3333 California St, Ste 16, San Francisco, CA 94143-0292. Address reprint requests to the author.
agement decision making, from radiologists to administrators. Of the more than $1 trillion spent on health care in the United States in 1996, only approximately 3.5% was attributable to radiology, even taking into account the purchase of over 400 magnetic resonance and 850 computed tomography units. Although the number of conventional radiology examinations has decreased, the number of computed tomography (CT), magnetic resonance (MR), and ultrasound (US) examinations has remained relatively steady or even increased. Even though the cost of equipment in radiology has significantly decreased over the past 10 years, there are more options than ever before. The most sophisticated equipment, of course, carries a higher cost. In terms of economics, the single most important concept for a radiologist who is ordering or approving diagnostic procedures to understand is that a progression of imaging tests from the least expensive to the more costly may well result in an unnecessary waste of time and resources, with higher overall expenditures. Initial performance of more cosily tests, if appropriate and if they lead to a precise diagnosis, are generally more cost-effective. In order to ensure competent recommendations for radiology procedures, it is vital to develop guidelines which can be used to judge the suitability of a given procedure in a given circumstance. Such guidelines must, of course, be modified to reflect individual circumstances and conditions, including availability of equipment and expertise of operators. Technologic advances continue to be made in radiology, and correctly used it can be one of the greatest assets of modem medicine. Radiology is an attractive specialty, which continues to draw the best and the brightest, and it is therefore assured of a successful future.
© AUR, 1998
$255