Doessel D P
Department of Economics, University of Queensland, Australia.
Health Policy. 1991 Jul;18(2):101-18. doi: 10.1016/0168-8510(91)90092-c.
The health sectors in many countries have been increasing in relative size, and medical innovations have been identified by some as a factor contributing to the rise in health expenditures. This paper begins by reviewing the various approaches that economists have employed to determine the connection, if any, between rising health expenditures and new medical technologies. It is then argued that another way to approach the issue is to determine if innovations have substituted for previously existing technologies. Thus this method cannot be applied to product innovations: it is restricted to process innovations. This procedure is applied to the innovation of fibre optic colonoscopy, a procedure for diagnosing diseases/conditions in the lower gastrointestinal tract. The data relate to private medical practice in Australia which operates on a fee-for-service basis. The empirical results indicate no evidence of substitution of the 'new' for the 'old' technology. Thus, there is some reason to believe that this innovation will have contributed to rising health expenditures for diagnosis of the lower gastrointestinal tract. The paper concludes by considering policy options that could address the issue.
许多国家卫生部门的相对规模一直在扩大，一些人认为医学创新是导致卫生支出上升的一个因素。本文首先回顾了经济学家用来确定卫生支出上升与新医疗技术之间是否存在联系的各种方法。然后有人认为，解决这个问题的另一种方法是确定创新是否替代了以前存在的技术。因此，这种方法不适用于产品创新：它仅限于过程创新。这个程序被应用于光纤结肠镜检查的创新，这是一种诊断下消化道疾病的程序。数据涉及澳大利亚按服务收费的私人医疗实践。实证结果表明，没有证据表明“新”技术替代了“旧”技术。因此，有理由相信这一创新将导致下消化道疾病诊断的卫生支出增加。本文最后考虑了可以解决这一问题的政策选择。
