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The Changing Economics of Medical Technology
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This volume summarizes the second in a series of Institute of Medicine
workshops whose intent is to examine critically the process by which
biomedical research is translated into actual benefits in medical practice.
Contemporary biomedical research has given us a rich harvest of innovation—
new pharmaceuticals, biotechnology products, medical devices, and clinical
procedures—which in the aggregate essentially define modern medicine. As
always, such success is accompanied by challenges and problems.
Not least among those challenges and problems is the fact that the
economics of medical innovation itself has changed substantially. The cost of
research and development (R&D)—particularly for the regulated medical
technologies such as pharmaceuticals and devices—has escalated dramatically
over the past two decades. Significant factors associated with higher R&D costs
include the shift in research emphasis toward more complex chronic conditions
and, more importantly, demands for more extensive demonstration of safety,
efficacy, and cost-effectiveness. Simultaneously, the economic returns to the
innovator have become increasingly constrained by a host of policies intended
to contain health care expenditures. These policies take varied forms, but not
infrequently they raise barriers to technology adoption, restrict reimbursement,
and force price concessions among technology suppliers. In addition, we see the
emergence of models of "managed care," defined for our purposes to include
various entities ranging from health maintenance organizations to modified fee-
for-service programs that attempt to create incentives for physicians and
hospitals to provide more cost-effective care. These policies will have
implications for technology diffusion as well as for its development
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The Changing Economics of Medical Technology
Nursing
English
National Academies Press
1991
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