Understanding the Value of Health Innovation
In a Panel hosted by Research Canada, I was asked whether a major obstacle to a well-thought out integration of health technology into our health care system may be our focus on affordability rather than its desirability. These are terms I used in my book, “The problem of health technology”, which called for a clarification of what we mean by the value of health innovation. Is it something that relates to our purse, or to the purposes behind health technology?
To engage in such a debate productively, we first have to get rid of the current rhetoric according to which public health care systems will no longer be able to absorb technological innovations because the cost of medical technology will necessarily continue rising; that public health care systems will collapse and patients will have to pay directly for medical technology. This rhetoric is highly manipulative and it ignores that fact that private health care systems too cannot absorb each and every health innovation.
Health care systems have been rendered unsustainable because those who have created medical technologies during the past thirty years did not care about sustainability and because the most important driver behind medical innovation during that period have been capacity and willingness to pay. In the 1980s, health care systems were being developed and third-party payers were keen to offer various health care packages. As a result, there was a seemingly ever-expanding market in which it was possible to create innovations that, by design, were complex, costly and which overall increased our dependence upon specialized medicine.
The medical technologies we have today are not the way they are because they have to
Like you, I’ve never seen a technology falling out of the sky. But because I was trained in industrial design, I know that technologies are designed in a certain way by people who make various assumptions about what other people may need, are likely to value, desire, adopt and pay for. For instance, one has to decide whether a given innovation will be used by a nurse, a medical specialist, or a patient. One has to decide whether a given innovation will be used in a tertiary care hospital, a walk-in clinic or a patient’s home. Then, one has to decide how costly a given innovation will be. In other words, a series of decisions are made over the course of technology development —upstream—, which ultimately have a direct downstream impact on health care systems. The problem is that these decisions rarely take the needs and challenges of health care systems into account.
The archetype of such development is medical imaging. Different types of information are generated by various types of device; one does rarely substitute to another and there is a need for constant maintenance and upgrading of each system. Moreover, the real impact of medical imaging devices on patient management is still very much debated. This is an example of a technology where the key end-users are medical specialists and where reinforcing their ability to diagnose, monitor health states and do exciting research becomes paramount. But when the key end-user is the patient, like for instance insulin injection devices and monitoring systems for diabetic patients, the technology rather seeks to support the patient’s autonomy and ability to intervene appropriately. Here, another actor is empowered through medical technology and in a way that may be more compatible with supporting the sustainability of health care systems.
Reconsidering what innovations are for? And for whom?
As argued in my book, it is possible to design technologies in a different way, one that can help health care systems achieve better outcomes. But comparing the respective purpose or social relevance of different health interventions is something we’re not very well equipped to do, both from a research and policy perspectives. It does require making value-laden judgments explicit. From a public health perspective, to define which innovation is more desirable requires understanding what makes some people healthy and others not (see Evans et al., 1994). And this doesn’t have much to do with our genes, or with technological solutions that are in “search of a market.” Beyond a few things that individuals may do or refrain to do in order to live healthy lives, the overall outcome for a population is largely determined by its social structures, e.g., by its capacity to redistribute wealth and create healthy places to live and work in.
So far, the way in which health technologies have been designed has threatened the sustainability of private and public health care systems. It is not the other way around; it is not the systems that are not able to absorb innovations. We have to understand how and when a given technology brings more value to health care when compared to others. And then reconsider what kinds of R&D investments should be made for the future of our health care system, giving priority to those that will generate more significant population health outcomes.
|Author :||Pascale Lehoux, Ph.D.|
Evans, R.G., Barer, M.L., and Marmor, T.R. (Eds) (1994). Why are some people healthy and others not? The determinants of health of populations. New York: A. De Gruyter.
Lehoux, P. (2006). The problem of health technology. Policy implications for modern health care systems. New York : Routledge.