Determination of Need and Containment of Hospital Costs

To the Editor: In her article in the August 11 issue, Greenfield* correctly identifies the “twin focus on absolute need and on capital costs” as the major underlying problem constraining the ability of determination-of-need programs to contain health-care costs. Her proposed classification scheme for hospital projects, however, appears to neglect important questions regarding determination-of-need review of applications for new medical technologies, thereby undermining its value in practical use. First of all, there is the question of how to identify and estimate the potential operating costs of emerging technologies, most notably equipment-embodied technologies. The novelty of such innovations frequently precludes accurate…