“In the long run, it is the development and adoption of new medical technologies and practices which drive trends in health costs. Other factors, such as the aging population and increased obesity, play a role, but their importance is secondary. The U.S. has led the world in spending growth because it has been quick to adopt more expensive technologies and practices — in many cases, even if there is no evidence that they lead to improved outcomes. For example, the U.S. is the world leader in the use of expensive robotic surgery techniques, even though there is no evidence that robotic surgery has major benefits compared to conventional surgery. In the U.S., a significant fraction of Medicare spending also goes to intensive hospital care for the elderly, despite studies finding that the benefits are minor.
As I have previously explored this blog, in every industry but healthcare, technological advances generally lead to reduced costs over time. In healthcare, however, technology creates additional cost.
While this alone is problematic, even more concerning is the institutional failure within the industry to assess the effectiveness of new technologies. As Holmes explains:
“Further cost control will require changing the way the U.S. rewards innovators in the medical sector. In other sectors, from airlines to computing, technology growth is often associated with reduced costs as companies compete to lower prices…As long as the U.S. continues to adopt and utilize those high-cost technologies that provide little to no marginal benefit to patients such as proton beam therapy, robotic surgery, and intensive end-of-life care for elderly patients, growth in the cost of healthcare will continue to define the next generation.”
To be fair, the argument isn’t as simple as it sounds on the surface. For one, comparative effectiveness testing of new treatments is time consuming and costly, and could create delays in treatment availability (or, at least, coverage).
Additionally, restricting treatment options, even when supported with evidence, goes against a long-held belief in our country about healthcare: When suffering, everyone should have access to any possible treatment that could alleviate that suffering, even if its chances of working (or outperforming current treatment options) are low, and its costs high.
While proton beam treatment of certain cancers hasn’t been shown to be more effective than less costlier treatments, you can be sure the first insurer(s) who refuse to cover it will face a public relations nightmare.
Yet, despite these challenges, our nation must better rein in our use of costly new medical technologies that don’t stand up to comparative testing. The prosperity of our nation for the next generation relies on it.
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