The economics of heart transplantation.

RECENTLY there has been much debate about the cost of heart transplantation, often within the context of national health care expenditures and what society can afford to provide in terms of medical care for its citizens. ` Heart transplantation is generally viewed as a costly technology with obvious benefits, although there is not a consensus as to whether the benefits are sufficient given the cost of the procedure.7' This has led to considerable disagreement as to whether heart transplantation is an experimental or a therapeutic procedure.9 Claiming the procedure is the former, both public and private insurers have in the past refused payment, frequently bringing upon themselves the wrath of the medical community as well as patients.4' ' Gradually this nearly intolerable situation has changed, but not without serious reservations." Payers remain concerned that transplant costs will increase as a function of increased donor organ availability, which means already scarce health care resources will be maldistributed to take care of the needs of a small proportion of sick people. 12 It is along these lines, for example, that skeptics argue resources allocated to heart transplantation would be better spent on preventive health care initiatives."15 16 However, the gains reportedly associated with preventive health care measures are by no means clear, and are also controversial. 17 Responding to the need to make a decision about Medicare coverage of heart transplants, then Secretary of the Department of Health and Human Services (DHHS), Patricia Roberts Harris, announced on June 12, 1980, that a major study would be conducted on heart transplantation which would ". . .examine, in general, all aspects of heart transplants, including the scientific, social, economic, and ethical issues, and, in particular, the impact of a possible Medicare decision