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INTERNATIONAL COMPARISON OF THE DISTRIBUTION OF HIGH COST MEDICAL TECHNOLOGY

Title.

Medical technology: an international comparison.

Background.

Technological innovations in the medical field appear constantly and are constantly being included into routine medical practice. However, the differences among countries and the evolution of their use over time have never been studied systematically. It is also not known whether the new technologies replace the previously existing ones or are added to them.

Objectives.

1. To produce up-to-date, homogeneous, consistent and valid information on the diffusion of 10 examples of current medical technology (ATecMed) in 47 countries.

2. To describe the diffusion of medical technology in time (longitudinal) and among countries (cross-sectional) by means of descriptive models that include socio-economic and health variables.

3. To describe the effect of replacing or adding the alternative technologies to those already existing.

4. To formulate explanatory hypotheses on the basis of the descriptive findings and to contrast them by means of a study of cases.

Methodology.

The diffusion of medical technology was described in an international context and concrete cases were studied in selected countries as a result of the descriptive findings. The study considered the use of high cost medical technology in 47 countries, including the 24 OECD countries.

The 10 medical technologies considered high cost technology were: computerized axial tomography (CAT); magnetic resonance imaging (MRI); conventional vascular radiology (CVR); digital substraction angiography (DSA); laboratories of cardiac catheterization (CC); units of cobalt-therapy (CBT); linear accelerators (LA); extracorporeal shock wave lithotripsy (ESWL); gamma-cameras (GAM); and mammography units (MAM).

Information was gathered on the number of units installed: 1) at the end of 1990, for 5 technologies (TAC, MRI, CBT, LA, ESWL) in the 24 OECD countries plus four countries of low wealth indices and 2) at the end of 1994, for 7 technologies (TAC, MRI, CBT, LA, CC, GAM and MAM) in 19 OECD countries. The variations between countries in the distribution of such technology were analyzed in terms of population, number of doctors, Gross national product (GNP) and health spending.

The information on medical technology was obtained from multinational medical technology-industries, Health Ministries and national technology evaluation agencies. Information on social, economic and health variables was obtained from international and national organisms.

Participants, along with the Science Department of the Kovacs Foundation.

Unit of Research in Health Services at the Carlos III Institute of the Spanish Ministry of Health and Consumer Protection, and RAND Europe.

Co-funded by Rand Europe and the Fund for Health Research of the Spanish Ministry of Health and Consumer Protection.

Status.

Aspects of the project referring to its entirety or to some of the high cost medical technologies have been published in:

In short, the results show that there is great variability among countries and within the same country for all of the analyzed indexes. Health costs explain part of the variability in the distribution of CAT, MRI, CBT and LA but not ESWL. The association is lower in the case of the Gross National Product and there is no association with the number of doctors. MRI and CAT are complementary technologies while LA is used as a replacement technology for CBT. In 1990, Spain had a disproportionately high number of units of lithotripsy and a low number of linear accelerators in comparison with other OECD countries, which is associated with monetary incentives to service providers coordinated with the public sector.