Managing the diffusion of medical technologies
The aim of the study was to understand how and why medical technologies (devices, pharmaceuticals and surgical procedures) are produced (innovated and developed) and consumed (adopted and utilised).Medical technologies are linked to the expansion of health care provision and costs. Policy makers encourage technology assessment to ensure the value of medical technologies (absolute technological efficacy and relative cost effectiveness). This policy, which is underlain by a model of technological determinism, may be ineffective if other factors influence decision making.Three international (UK and USA) comparative case studies were undertaken, analysing the innovation, development and diffusion of specific medical technologies. Annual statistics were gathered on adoption and utilisation rates of Magnetic Resonance Imaging (a device), Laparoscopic Cholecystectomy (a surgical procedure) and Prozac (a drug). Literature review supported interviews with parties involved in decision making processes.The widespread adoption of Magnetic Resonance Imaging has been motivated by professional and institutional competition, despite its often inappropriate utilisation, uncertain efficacy and extremely high costs.Laparoscopic Cholecystectomy (keyhole surgery for gallbladder stones) has diffused rapidly, being driven by general surgeon's concerns over their control of the gallbladder. The ease of the surgery has enabled total surgical volumes to almost double.The diffusion of Prozac (an expensive antidepressant) was influenced by high profile uncertainties regarding its safety and efficacy. Subsequently its range of applications have grown, but many of these are unproven, whilst its long term safety profile is unknown.The study concludes that the decision making surrounding the innovation and diffusion of medical technologies is only vaguely related to their clinical efficacy or their cost effectiveness. lntra professional competition is central to the production and diffusion of medical technologies. Technology assessments, being largely reactive, and dependent on clinical reports, are unlikely to prove effective in achieving cost effectiveness. This finding has significant implications for future health care policy making.