Technological Change in Health Care: A Global Analysis of Heart Attack (Studies In Health Economics & Policy)

Thông tin sách: Technological Change in Health Care: A Global Analysis of Heart Attack (Studies In Health Economics & Policy) (Hardcover, 432 trang) – University of Michigan Press, 2002. Ngôn ngữ: Tiếng Anh.

Evidence from the United States suggests that technological change is a key factor in understanding both medical expenditure growth and recent dramatic improvements in the health of people with serious illnesses. Yet little international research has examined how the causes and consequences of technological change in health care differ worldwide. Seeking to illuminate these issues, this volume documents how use of high-technology treatments for heart attack changed in fifteen developed countries over the 1980s and 1990s. Drawn from the collaborative effort of seventeen research teams in fifteen countries, it provides a cross-country analysis of microdata that illuminates the relationships between public policies toward health care, technology, costs, and health outcomes. The comparisons presented here confirm that the use of medical technology in treatment for heart attack is strongly related to incentives, and that technological change is an important cause of medical expenditure growth in all developed countries. Each participating research team reviewed the economic and regulatory incentives provided by their country's health system, and major changes in those incentives over the 1980s and 1990s, according to a commonly used framework. Such incentives include: the magnitude of out-of-pocket costs to patients, the generosity of reimbursement to physicians and hospitals, regulation of the use of new technologies or the supply of physicians, regulation of competition, and the structure of hospital ownership. Each team also reviewed how care for heart attacks has changed in their country over the past decade. The book will be of enormous importance to health economists, medical researchers and epidemiologists, and policymakers. Mark McClellan is Associate Professor of Economics and of Medicine and, by courtesy, of Health Research and Policy, Stanford University. He is a National Fellow, the Hoover Institution. Daniel P. Kessler is Associate Professor of Economics, Law, and Policy in the Graduate School of Business, Stanford University, and a Research Fellow, the Hoover Institution. Editorial Reviews From The New England Journal of Medicine Technological Change in Health Care: A Global Analysis of Heart Attack analyzes the relation between outcomes and technological change in the treatment of acute myocardial infarction by comparing events that took place over the course of 20 years in 15 countries (United States, Canada, Japan, South Korea, Taiwan, Switzerland, Australia, Israel, Finland, Sweden, Denmark, United Kingdom, Belgium, France, and Italy). The book was developed after a conference held at Stanford University in February 1998. The editors coordinated a collaborative effort involving 18 research teams. The contributing authors are physicians, health economists, epidemiologists, and lawyers, making the book a multidisciplinary effort. The editors begin the book by noting that many studies have documented substantial differences in medical practice among countries but have failed to provide information on how these differences affect outcomes. Technological Change in Health Care attempts to fill that gap. It is a qualitative analysis relating three sets of variables: structural characteristics of the health care system (provider incentives, incentives for technological change, competition, hospital ownership, physician supply, and technology regulation), process variables (change in use of high-tech and low-tech interventions), and outcomes (changes in mortality and expenditures). It does all this by examining one specific disease state: acute myocardial infarction. The chapters are organized identically, with the same headings and variables, facilitating comparisons among the countries. The authors have taken advantage of the phenomenon that mortality from acute myocardial infarction has dropped steadily over time in all 15 of these countries, to a greater or lesser degree. The variation in outcomes (the dependent variable) can then be related to the variation in the structural and process variables (the independent variables) in an attempt to reveal patterns and perhaps allow conclusions to be drawn. The premise here is that variation in changes in technology will lead to variation in changes in outcome. In some cases, the investigators have been able to quantify change in the use of specific interventions, such as angioplasty, coronary bypass surgery, angiotensin-converting-enzyme inhibitors, and aspirin. Other variables, such as the regulation of technology, are less amenable to quantification. At any rate, each chapter represents a nice vignette of these relations in a specific country. The final chapter attempts to draw conclusions: "There is some evidence of significant differences in outcome trends across countries, but the trend differences are much more modest than the differences in treatment trends and further analysis is needed to reach definitive conclusions." This book is a tour de force. I am not aware of any other book that does such a good job of developing this kind of analytic framework. The editors are to be commended for their ability to standardize the approach to the discussion of the various countries. I should point out that it is, however, very dense reading. It is difficult to read every page (and I admit that I did not). Who will find this book useful? Those who wish to research the effect of changes in technology on specific outcomes will, of course, be the first beneficiaries. Policymakers who are interested in determining whether their health care sector is providing good value for the financial investment may also find it useful but will be somewhat disheartened to learn that one cannot really tell whether specific variations in medical practices and structure have helped or hurt. All one can say is that improvements in outcomes are correlated with an increase in the use of technology. Finally, this book will be very useful to graduate students wishing to embark on a doctoral thesis. The economist in me (and in Mark McClellan) imagined an econometric exercise converting each of these characteristics into a quantitative variable and performing a statistical regression. Indeed, there is one paragraph, in the last chapter, pointing the student in this direction. In summary, this book is a must read (or at least a "must skim") for anyone performing health-services research. We should be grateful to its editors and contributors. Allan S. Detsky, M.D., Ph.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. About the Author Mark McClellan is Associate Professor of Economics and of Medicine and, by courtesy, of Health Research and Policy, Stanford University. He is a National Fellow, the Hoover Institution.


Daniel P. Kessler is Associate Professor of Economics, Law, and Policy in the Graduate School of Business, Stanford University, and a Research Fellow, the Hoover Institution.