American Journal of Roentgenology, Vol 163, 1289-1293, Copyright © 1994 by American Roentgen Ray Society
Eugene W. Caldwell Lecture. Technology: the key to controlling health care costs in the future
DJ Gibson
University Technology Transfer Corporation, Los Angeles, CA 90025.
The American health care financing system is in a state of crisis. The
rising cost of health care and the progressive difficulty Americans are
experiencing in accessing the system have produced a great national debate
concerning the future of medicine in America. Current health care cost
trends, which are not sustainable, are projected to consume 37% of the
gross national product by the year 2030. The financing system that supports
the health care system is failing. The number of uninsured residents is
growing more than twice as fast as the number with health insurance. The
legitimate concern about the spiraling cost for medicine has focused
attention on seeking root causes. Critics have focused on technology as the
single most important factor in driving the cost trends in medicine upward.
They have concluded that "long-term control of the rate of increase in
expenditures requires that we curb the development and diffusion of
clinically useful technology." These critics have not made their case,
because they base their conclusions on hospital-derived data. These data
are inaccurate because of the phenomenon of "cost-shifting." The critics do
not examine the important issue of productivity and do not have reliable
data on the costs and benefits of new technologies. Finally, the critics do
not take into account the issue of use and abuse of technology. This is
particularly important in the ambulatory environment. To break the health
care cost spiral, radiologists, as the keepers of new technology, must
commit themselves to at least four fundamental initiatives. The current
American hospital-based health system must be replaced with an ambulatory
system; productivity must be the primary business goal for radiologists;
pricing of new services should reflect actual resources consumed, not the
in-patient services displaced; and radiologists must reassert their role as
doctors' doctors. The health care cost spiral is a real national crisis.
The mission for radiology is to introduce the minimally invasive,
ambulatory system of the future. The costs for delivering care within the
new system will be a fraction of former costs. My assignment is to present
a perspective on the role radiology must play in introducing new imaging
technology to medicine. One of the distinguishing features of American
society is its fascination with technology. It is only natural that the
American health care system reflects this orientation.
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