Chapters in medical management - Parameters for allocation of expensive medical devices (EMD) as a national regulatory mechanism

Background: In an ever-growing environment of health expenditure, governments should consider methods to contain costs, for example: professional guidelines, appropriateness criteria, preauthorization mechanism and regulations. Certificate of Needs (CON), although controversial, was also considered as a tool to lower health costs by limiting the supply of health services. Therefore, expenditures on costly medical devices require the special attention of the Ministry of Health or regulatory authorities. Aims: To define the relative importance of significant parameters in the decision-making model for the allocation of expensive medical devices in Israel. Methods: A survey, using a structured questionnaire, was conducted among 50 participants from the Ministry of Health (medical technology assessors, and health economists), researchers in health policy and sociology of health, psychologists, epidemiologists, physicians (radiologists and general physicians), nurses and members of the "Health Parliament". Discussion: Limiting the number of special devices and raising the device utilization levels constitute basic tools in the fight to restrain growing costs in the health system. The Certificate of Need methodology is a means of limiting health expenditures. Relevant allocation criteria include parameters of varying importance. Our study revealed that certain parameters are of greater importance in the decision-making process. These parameters include: emergency function of the institute, extent of activities, alternatives available and examination mix. Parameters of mediocre importance (utilization, geographic distribution, number of hospital beds, and specialized departments) and parameters of least importance (population characteristics, training and policy considerations) have a low impact. Conclusion: Defining the weight for these parameters can be translated to a model that assists in determining appropriate needs for expensive devices as a regulatory tool balancing health outcomes and resources.