International Evolution of the use of advanced medical technology.

Title:

Advanced medical technology: an international comparison.

Background:

Technological innovations continuously appear within the field of medicine, which are subsequently incorporated into regular medical practice. However, there has been no examination of the difference between countries and the evolution of the use thereof over time, or whether the new technologies have replaced those previously applied or been added thereto.

Objectives:

1)To produce updated, homogeneous, consistent and valid information on the diffusion of 10 advanced medical technologies (AMT) in 47 countries.

2)To describe the difussion of AMT over time (longitudinal) and between countries cross sectional by means of descriptive models which include socioeconomic and health care variables.

3)To describe the replacement or complementary effect of alternative technologies.

4)To define explanatory hypotheses based on the descriptive and contrasting findings emerging from case studies.

Methodolgy:

The diffusion of AMT on an international level was described, and specific cases were studied in countries selected on the basis of descriptive findings. The study considered the use of advanced medical technology in 47 countries, including the 24 countries of the OECD.

The 10 technologies considered to be advanced medical technology (AMT) were: computer axial tomography ( CAT); magnetic resonance (MRI); conventional vascular radiology (CVR); digital substraction angiography (DSA); cardiac catheterization laboratories (CCL); cobalt units (CU); linear accelerators (LINAC); extracorporeal shock-wave lithotripsy (ESWL); gamma cameras (GC); and mammography units (MAM).

Data were collected regarding the number of units installed: 1) at the end of 1990 for 5 technologies (CAT, MRI, CU, LINAC, ESWL) in the 24 OECD countries plus 4 countries with low wealth indices and 2) at the end of 1994 for 7 technologies (CAT, MRI, CU, LINAC, CCL, GC and MAM) in 19 OECD countries. The variations between countries with regard to distribution of AMT were analysed in terms of population, number of physicians, gross domestic product (GDP) and health care expenditure.

The information on AMT was obtained from multinational industries, the Health Ministries and international agencies for technology assessment. The data on social, economic and health care variables were obtained from international and national bodies.

Participants, in collaboration with the Scientific Department of the Kovacs Foundation:

Health Care Service Research Unit, Carlos III Institute of the Ministry of Health, and RAND Europe. Jointly funded by Rand Europe and the Health Care Research Fund of the Spanish Ministry of Health.

Results:

The aspects of the project as a whole or with regard to some of the advanced medical technologies have been published in:

Lázaro P, Fitch K. Economic Incentives and the Distribution of Extracorporeal Shock Wave Lithotripters and Linear Accelerators in Spain. Int J Tech Ass Health Care 1996; 12:735-744.

Lázaro P, Fitch K. The distribution of "big ticket" medical technology in OECD countries. Int J Tech Assess in Health Care 1995; 11:552-570.

Lázaro P, Fitch K. A comparison of different measures of medical technology intensity. In: Proceedings of the 11th Annual ISTAHC Meeting. Stockholm, Sweden, 1995: 168.

Monteagudo JL, Lázaro P. Modeling the spatio-temporal diffusion of health technology: the case of MRI in Spain. In: Proceedings of the 11th Annual ISTAHC Meeting. Stockholm, Sweden, 1995: 173.

Lázaro P. The diffusion of medical technology. In: Paine, editor. Hospital Management International 1994. London. International Hospital Federation, 1994:356-357.

Lázaro P. High cost medical technology: a method for international comparison. Economy and Health 1993; 13:8.

Lázaro P. Magnetic resonance and linear accelerators: Are they a complement or substitute of computed tomography and cobalt units? In: Proceedings of the 9th Annual ISTAHC Meeting. Sorrento, Italy, 1993:122.

In summary, the results show that there is a high rate of variation between countries and within one single country for all indices analyzed. Health expenditure explains part of the variability in the distribution of CAT, MRI, CU and LINAC, but not in ESWL. The association is lower in the case of GDP and no association exists with the number of physicians. MRI and CAT are complementary technologies, whilst LINAC is spread as substitutory technology for CU. In 1990 Spain has a disproportionately high number of lithotrity units and low of linear accelerators compared to other OECD countries, which is associated with monetary incentives to suppliers of private services to the public sector.