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Technology in Healthcare. Amitabh Chandra HARVARD UNIVERSITY. International Comparison of Spending on Health, 1980–2010. Average spending on health per capita ($US PPP). Notes: PPP = purchasing power parity; GDP = gross domestic product. - PowerPoint PPT Presentation
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Technology in Healthcare
Amitabh ChandraHARVARD UNIVERSITY
International Comparison of Spending on Health, 1980–2010
Average spending on healthper capita ($US PPP)
Notes: PPP = purchasing power parity; GDP = gross domestic product.Source: Commonwealth Fund, based on OECD Health Data 2012.
Why?
• Aging?• Obesity and Sickness?• Waste and Inefficiency?• Medical Malpractice?• Technology
Technology in Healthcare
• Challenge: – High fixed-cost, low marginal cost– Heterogenous benefits (large value for some
patients!)– Trials are often done in most appropriate patients– Financial incentives push for overuse in others
A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
J. Bruce Moseley, M.D., Kimberly O'Malley, Ph.D., Nancy J. Petersen, Ph.D., Terri J. Menke, Ph.D., Baruch A. Brody, Ph.D., David H. Kuykendall, Ph.D., John C. Hollingsworth, Dr.P.H., Carol M. Ashton, M.D., M.P.H. and Nelda P. Wray, M.D., M.P.H.
N Engl J MedVolume 347;2:81-88
July 11, 2002
Mean Values (and 95 Percent Confidence Intervals) on the Knee-Specific Pain Scale
Moseley, J. et al. N Engl J Med 2002;347:81-88
Patients Receiving Procedure
0
Benefit from Procedure
100 percent
Rapid Angioplasty within 2 hours of AMI
“Late” Angioplasty within 2 days of AMI
Angioplasty for Stable Coronary Disease
OVERUSE? OVERUSE?
Rapid Stenting: US vs. UK Late Stenting: US vs. UK
Highest Highest PerformancPerformanc
e e
Lowest Lowest PerformanPerforman
ce ce
Source: Chandra, Staiger, Skinner (IOM, 2010)
Rates of All Harms, Preventable Harms, and High-Severity Harms
Landrigan CP et al. N Engl J Med 2010;363:2124-2134.
The Dark Side
• Can technology cause distractions?• Theory of Technology Spillovers
What do Boards do on quality?• Surveyed Board chairpersons from 1000 hospitals• Received 78% response• Oversampled “best” and “worst” hospitals on HQA
processes• Asked about priorities, perceptions, and activities
around quality
Jha and Epstein, Health Affairs, 2010
Perception of Quality Performance
Note: Perception of their hospital’s performance on the TJC/HQA measures compared to typical U.S. hospital
Board’s Attention to Quality
So what’s the bottom line?• Technology growth drives healthcare
spending• New Technologies have ‘high-fixed-cost,
low marginal cost’ profile• New technologies have heterogeneous
benefits– cost effectiveness very hard to do!
• Spending is weakly correlated with outcomes
• Outcomes are affected by professionalism, diligence, and safety culture
• Real cost of technology is that it distracts from safety
• Hard choices ahead– don’t be fooled by prevention as a solution for technology growth