Effects of federal policies on extracorporeal shock wave lithotripsy Page: 75
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devices at once in order to negotiate a group dis
count (76). The marketing center purchases CT
scanners for other government agencies such as
DOD, enabling the center to combine purchases
and negotiate quantity discounts from manufac
turers.
In June 1983, the Chief Medical Director in the
VA central office formed a High Technology
Assessment Group to "determine what course the
VA should follow with respect to acquisition of
major new technology in the future" (168). At the
first meeting of this group in 1984, the group was
presented with data supporting the purchase of
a Dormier lithotripter (102). These data, collected
from a survey by the central office's Office of Sur
gical Services, indicated that 4,800 veterans un
derwent treatment for upper urinary stones in
1984, that the VA could support the purchase of
several lithotripters (102). The Office of Surgical
Services has requested two devices to be pur
chased in fiscal year 1986 and intends to request
a third in fiscal year 1987. These lithotripters
would be placed in VA hospitals serving a high
proportion of spinal cord injury patients, possi
bly the facilities in Hines, Illinois; Long Beach,
California; and Memphis, Tennessee (102).
Meanwhile, arrangements to establish an ESWL
facility at the VA hospital in New York City are
already in place. This facility is an example of
shared provision and use of lithotripsy. A Dor
nier lithotripter is being purchased by the Para
lyzed Veterans of America and donated to the VA
hospital. The hospital is providing the facility and
funding renovations; a nearby private hospital is
funding the staff to run it. The private hospital
will refer patients to the facility, although VA pa
tients will have first priority use. The facility is
scheduled to become operative by the end of 1986
(102).
VA is a self contained system that plans and
purchases its own equipment and is on a finite
budget. This can lead to a small number of ESWL
machines at the facilities and in the areas where
they will serve the greatest number of patients.
A side effect of VA's self contained system, how
ever, is that VA's placement decisions are isolated
from planning decisions made in the community
at large. For example, the first ESWL facility atthe Bronx VA hospital is in an area already served
by one ESWL unit. Of other VA spinal cord in
jury centers in line for a lithotripter, one is in the
Chicago area (where several other facilities are
planned in the community) and a second is in the
Los Angeles area, which also has several units,
There is no routine mechanism through which to
share facilities or purchase services between VA
and non VA patients.
Spouses and unmarried children of certain dis
abled veterans, or survivors of such veterans, are
covered under the Civilian Health and Medical
Program of the Veterans Administration (186).
This health care financing program operates in
an identical manner to the Civilian Health and
Medical Program of the Uniformed Services
(CHAMPUS), described below.
Department of Defense
DOD operates military hospitals for use by per-
sons in the U.S. Armed Services on active duty.
It also operates CHAMPUS, which pays for much
of the health care provided to military families.
CHAMPUS provides payment for medical serv
ices to dependents of active duty personnel and
to Armed Services retirees, their families, and
their survivors. It requires no premiums. All eligi
ble persons may receive any inpatient or out
patient services provided at military hospitals. If
they live near a military hospital (within certain
zip codes), they must first determine whether serv
ices are available for inpatient care at that hospi
tal before seeking care in the community in or
der to be covered by CHAMPUS. Ambulatory
care does not require a predetermination of avail
able services at the military facility. Care at mili
tary hospitals is provided on a space available ba
sis. There is no charge for outpatient services
received at a military hospital; inpatient services
require a very small nominal charge per day (185).
If a CHAMPUS beneficiary does not live near
a military hospital, or if the hospital has affirmed
that the needed service is not available there, he
or she may seek services in the community. In this
case, CHAMPUS covers both inpatient and am
bulatory services unless the beneficiary is also
eligible for Medicare. Inpatient services require
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United States. Congress. Office of Technology Assessment. Effects of federal policies on extracorporeal shock wave lithotripsy, report, May 1986; [Washington D.C.]. (https://digital.library.unt.edu/ark:/67531/metadc39606/m1/76/: accessed April 23, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.