Medical imaging and planning

How can we reconcile the impressive progress of medical technologies with the no less impressive problems of health insurance systems. Are policies of imagery diffusion and policies of cost-containment simultaneously compatible. The author, based on a historical and prospective approach, believes they are. Whether we consider the sanitary map (carte sanitaire) in France which is an explicit method of rationing, or global budgeting which is an implicit one, we must revise our present methods of planning because they have become obsolete. The Committee for Assessement of Technological Innovation at the Assistance Publique of Paris (CEDIT) is an example of a more refined mechanism, associated with regional planning within the Plan Directeur of the Paris Teaching Hospitals for the 1985-1989 period. The probable evolution of the health insurance system in France, as well as more competition between the private and public hospitals lead the author to propose greater flexibility in planning for imagery, knowing that it is impossible to know what that particular technology will consist of in thirteen years from now in the year 2000, but it will certainly be the core of the future hospital, whether diagnostic or therapeutic