[Economic analysis of the dissemination of a medical innovation: prenatal diagnosis by early amniocentesis as an example. Part 1. Epidemiologic, medical and socioeconomic bases. The dissemination of a diagnostic innovation].

The article offers a detailed analysis of the characteristics of the supply and demand of prenatal diagnosis by amniocentesis in order to identify the major problems that must be faced in formulating a policy designed to diffuse the use of this technique. The data collected for the whole of France made it possible to evaluate exhaustively the increase in the number of prenatal diagnoses during the years 1972-1981; to determine the number and geographic distribution of the diagnostic centers; to identify the medical criteria justifying the examinations. A comprehensive survey covering all examinations performed in the Ile de France (Paris region) in 1979--which constituted 46.5% of all the prenatal diagnoses performed in France that year--made it possible to determine the predominant socioeconomic characteristics of the women who took this examination, revealing, particularly, the significant inequalities of access, with an underrepresentation of the least privileged socioprofessional categories. The confirmation of the influence of socioeconomic status on access to this medical innovation is further reinforced by the fact that usage rates vary widely according to place of residence; furthermore, it adds to the financial barriers implicit in any policy of having reimbursement of the examinations dependent upon Social Security conventions. A public health policy regulating the diffusion of this innovation must take into account the discriminatory aspects of the first phase of diffusion, as analyzed here.