Technological advances are commonplace in healthcare. Whether in pharmaceuticals or diagnostics, most of us have benefited from one of these advances in our lives. However, there is an interesting trend in the world of healthcare technology that runs contrary to most other industries: many advances increase the cost of healthcare, whereas in other industries, technological advances decrease the cost of a good or service. A 2008 CBO report concluded that “roughly half of the increase in healthcare spending during the past several decades was associated with the expanded capabilities of medicine brought about by technological advances.”
Just look at the cell phone. In my lifetime, it has transitioned from being an interpersonal communication device Captain Kirk used to communicate with the Enterprise, through a period of being a bulky communication option for the wealthy, to the present day when it’s no longer considered an option, but a necessity for virtually everyone. Technological advances have made the cell phone so inexpensive that you can buy a disposable one for only a few bucks, and even use it to take pictures with amazing resolution and clarity.
Contrast this with many of the advances in medical imaging. While these technological advances have grown exponentially in the same period as the cell phone, their costs have not gone down. Unlike the “imaging” technologies in your phone, the costs of medical imaging technologies have grown along with the technology itself.
Not all medical technologies result in increased costs; in fact, some actually decrease the cost for the consumer. For example, the Department of Transportation appears to be forever tightening the medical guidelines for passing its physicals. Today, the guidelines call for a sleep apnea screen. If a truck driver is deemed to be at high risk for this condition, a sleep study may be required. In the past, this would have meant an overnight stay at the hospital sleep lab for $4,000 to $5,000. Today, the home sleep study—complete with EEG capabilities and internal patient ID security measures—satisfies the regulatory guidelines, costing just a fraction of the overnight hospital-based diagnostic. It is being trialed in our office today.
The medical field does present one consideration with its technological advances that many others do not. It has to ask the question: “Is the improved assessment or care of the individual with the added cost of the technology worth it?” Many examples exist where life and death can be cited; of these I will steer clear. But in our clinic, a “lighter” example exists in which we said “no” to high-tech: functional lift tests. Many occupational health clinics have traded in the low-tech, “watch-a-potential-worker-lift-a-specified-weight” option for various isometric machines purporting to give the same results. Machines like these have been around for nearly two decades, and to date, no research shows an advantage with the high-tech assessment, only increased costs.
Technological advances will always play a role in medicine and its costs. Accompanying these improvements in technology will always be the same questions: “Is the technology worth it?” and “How do we measure its worth?” iBi
