Unfortunately, decision makers often lack the scientific evidence on effectiveness that would help them judge the relative value of alternative health technologies. One result of our shortage of scientific evidence is our health care system's wide variation in use of services. Often, this occurs when there is ambiguity on the effectiveness of the procedure or service. There is also variation in what services are covered. For example, a recent study on laser therapy demonstrated that there is substantial variation in coverage on new technologies.
Variation also exists in medical practice among states and local jurisdictions.
Health services research has shown that these differences can be attributed in large part to a lack of knowledge regarding the efficacy and effectiveness of medical technologies. Another consequence of inadequate evidence on effectiveness is that old technologies linger even when they have been surpassed by better ones. In 1989, I published a study that examined old and new technologies in hospitals and found that new technologies did not replace older technologies, but were simply added to the hospital regimen. Technology and the Cost of Medical Care Mr. Chairman, let me make two points at the outset. These small-cost technologies can add up to big expenses.