This article chronicles the adoption of medical technology in twentieth-century Korea. The author suggests that the structure of the present health care delivery system has relied predominantly on small clinic practice and has resulted in a shortage of highly capitalized hospitals and a maldistribution of modern technology. In addition, the author argues that medical practice in small unconnected clinics and hospitals isolate physicians from academic medicine and hamper research. Finally, the highly decentralized structure of Korean medicine is a weak basis for controlling the diffusion of medical technology and leaves most acquisition judgments in the hands of individual hospital owners.

This article reviews the diffusion of western medical technology in China since 1978. The author demonstrates how medical organization and financing at both the national and hospital levels have contributed to a relatively rapid diffusion. The example of the CT scanner is used to evaluate the financing, distribution, and utilization of medical technology in China. The author concludes with an examination of the policy implications and practical impact of current trends.

The authors of the paper argue that Norway's national health service, despite public perceptions, is both inexpensive and technologically advanced. Norway has a highly regulated medical system at both the national and local levels, and many distribution issues take the form of political debate. As a result, the authors believe that medical care and equipment is equitably distributed, but perhaps over-densely, throughout the country. Although the overall picture is optimistic, there is some concern that technologies, health care priorities, and decision-making processes should be more carefully examined by consensus conferences, advisory groups, and experts in technology assessment.

This article surveys attempts by the Finnish government to plan and budget health care since the Primary Health Care Act of 1972. A national board of health allocates approved resources to local authorities who develop plans for preventative and primary health care and hospital services. The acquisition of expensive technologies are debated at the national level. The author presents studies which suggest that there is a considerable need for expansion of both diagnostic and therapeutic technologies in Finland. These adjustments will be necessary to meet the needs of an economically, socially, and demographically changing country.

The author describes how France has attempted to reconcile its ethos of optimum health care for all with a belief in free enterprise, with increasing medical costs and complex technological innovations, and with a traditional distrust of widespread regulation. Effective oversight of the diffusion of technology is further hampered by the shared responsibilities of several government agencies. Although France has enacted a fee schedule for physicians, created national procedures for evaluating equipment, and exercised some control over hospitals, the general sentiment is anti-bureaucratic and third-party insurers will most likely play an important role in limiting the diffusion of technology in the future.

This article contends that the German social and economic situation is conducive to the rapid diffusion of innovative medical technology. While there is public control over hospital facilities, the pluralistic health care system and decentralized government responsibilities contribute to an essentially laissez faire regulatory environment. There is perfunctory planning and regulation for major medical expenditures, but the essential constraints are financial. This is no comprehensive program for the assessment of diagnostic technologies and the effective imposition of guidelines depends on the cooperative effort of various financing organizations, professional interests, and public pressure groups.

The author examines the Australian health care system by surveying the financing techniques, physical organization, and government activity. He explains the impact of the public and private sectors and comments on the effectiveness of current evaluation procedures. While the author believes that the system is relatively healthy and cost effective, he recognizes a need for more comprehensive and scientific oversight. Using regression analysis and focusing on the installation of medical technology in hospitals, the author attempts to determine the specific factors that influence technology diffusion. He concludes by stressing that further studies analyzing the actual use of specific technologies are vital.

The author contends that the diffusion and use of modern medical technologies has had a profound impact on the hospital environment, the doctor-patient relationship, and the humanity of the patient. On these grounds the author argues for a rigorous, comprehensive, and ongoing assessment of diagnostic and therapeutic technologies. He stresses the importance of developing standards by which to judge the human and economic impact of particular technologies. These studies would decrease the inappropriate use of medical technology and would provide guidelines to improve current use.

This study compares the cost-effectiveness of mitral valve reconstruction and replacement. Published clinical data were used to determine the effectiveness of each procedure. Both direct and indirect costs were calculated. The findings indicate that reconstruction has lower costs per year of life extended than replacement due to better outcomes. Changing outcome probabilities and discount rates did not alter these results. Cost savings in excess of 40% may be achieved by early reconstruction for suitable patients. These results suggest that the prevailing practice of delaying surgery until replacement is needed should be reconsidered, especially for patients who could benefit from reconstruction.