A COMPARISON OF THE INVESTMENT IN HOSPITAL-BASED OBSTETRICAL ULTRASOUND IN WALES AND WASHINGTON-STATE

The purpose of this study was to examine differences in the way Britai n 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 Washin gton state and Wales. The supply of hospital-based ultrasound machines -approximately two machines per 1,000 births-was similar in both count ries. Wales had fewer advanced ultrasound machines than Washington sta te, and they were based exclusively in high-volume district general ho spitals; there were no obstetric ultrasound machines in the private se ctor. In Washington state, the majority of advanced machines were in s mall and medium-sized hospitals, and many private offices had ultrasou nd machines. The approximate replacement value of hospital-based machi nes 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 co mpromising access to care.