A study of health care technology in Ontario, Canada

The study is by Mehrdad Roham and colleagues:

We find that both the overall volume of services provided per capita and the average cost of these services decreased over our data period, once account is taken of changes in the age distribution of the population (the calculations relate to an age-standardized population) and in prices (all fees are expressed in constant dollar terms, using the consumer price index). However, these decreases are concentrated in services that have low HTI [Health Technology Intensity] and, to a lesser extent, medium HTI; over the same period, the average (age-standardized) number of services for high HTI increased by 55 percent and their share by 7.4 percentage points. We find also that whereas the decreases in the volume and cost of low and medium HTI services took place fairly uniformly across all age groups, the increases in high HTI were concentrated in the middle age groups and, more especially, in the old age groups.

The results suggest two main policy implications. First, technological change and its diffusion within the population are too important to ignore: decision makers (and the policy discussion) should focus on how the delivery of care is changing while, at the same time, accounting for the effects of external changes (such as population aging). Second, health technology assessment should be based on real-life ex-post studies of how health technologies are used by doctors and patients rather than one ex-ante studies of how they should be used. That would help health policy analysts and researchers to gain a better understanding of the relationships between aging populations and the relative distribution of spending on health care for different levels of health technological intensity. Taking into account the observed changes in the use of technology in relation to patient age will also help to produce better predictions of future health care expenditures. However, the important questions of whether the observed changes are warranted, in the sense of leading to better patient outcomes and being cost effective, are ones that we are not able to address. It would be of great analytical and policy interest to have records that include information about patient outcomes following procedures, and not just the procedures themselves.

The bit in bold (added) is a key point that many overlook. Many look to new technologies to cut costs and improve outcomes. That’s how they’re marketed. And, they very well may do so if their use is restricted to the subset of the population for which they’re ideally suited and designed. But what is typical is that technology diffuses more broadly than efficient use would warrant, in part because it’s good business. That ends up turning valuable technology into waste (or, more accurately, valuable for some, wasteful for others). And this is why I’m deeply skeptical of claims that any technology will actually cut costs and improve outcomes, on average, even if it does so for some.


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