title: A comparison of the investment in hospital-based obstetrical ultrasound in Wales and Washington state.
abstract: The purpose of this study was to examine differences in the way Britain and the United States invest in and deploy a new medical technology. We used structured interviews to obtain information on the technical sophistication and approximate replacement value of all hospital-based obstetrical ultrasound machines in every maternity hospital in Washington state and Wales. The supply of hospital-based ultrasound machines--approximately two machines per 1,000 births--was similar in both countries. Wales had fewer advanced ultrasound machines than Washington state, and they were based exclusively in high-volume district general hospitals; there were no obstetric ultrasound machines in the private sector. In Washington state, the majority of advanced machines were in small and medium-sized hospitals, and many private offices had ultrasound machines. The approximate replacement value of hospital-based machines was three times as high per birth in Washington state as in Wales. In the case of obstetrical ultrasound, centralization of facilities, a relatively small private sector, and global budgeting lead to lower expenditures per patient within the National Health Service without compromising access to care.
authors.affiliation: University of Washington School of Medicine, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenblatt
authors.forename: A J
authors.initials: AJ
authors.lastname: Dawson
authors.forename: E H
authors.initials: EH
authors.lastname: Larson
authors.forename: C J
authors.initials: CJ
authors.lastname: Tressler
authors.forename: A
authors.initials: A
authors.lastname: Jones
authors.forename: L G
authors.initials: LG
authors.lastname: Hart
authors.forename: T S
authors.initials: TS
authors.lastname: Nesbitt
mesh_terms: D001723:Birth Rate; D002201:Capital Expenditures / Q000706:statistics & numerical data*; D003363:Cost Control; D004059:Diffusion of Innovation; D005260:Female; D006276:Health Facility Size; D017721:Hospital Costs; D006801:Humans; D007449:Investments / Q000706:statistics & numerical data; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics*; D011247:Pregnancy; D011787:Quality of Health Care; D016216:Ultrasonography, Prenatal / Q000191:economics / Q000295:instrumentation*; D014852:Wales; D014861:Washington