Technological Change in Health Care

A Global Analysis of Heart Attack
Mark B. McClellan and Daniel P. Kessler, Editors
Illuminates the causes and consequences of technological change in health care in the developed world


Evidence from the United States suggests that technological change is a key factor in understanding both medical expenditure growth and recent dramatic improvements in the health of people with serious illnesses. Yet little international research has examined how the causes and consequences of technological change in health care differ worldwide. Seeking to illuminate these issues, this volume documents how use of high-technology treatments for heart attack changed in fifteen developed countries over the 1980s and 1990s. Drawn from the collaborative effort of seventeen research teams in fifteen countries, it provides a cross-country analysis of microdata that illuminates the relationships between public policies toward health care, technology, costs, and health outcomes.

The comparisons presented here confirm that the use of medical technology in treatment for heart attack is strongly related to incentives, and that technological change is an important cause of medical expenditure growth in all developed countries. Each participating research team reviewed the economic and regulatory incentives provided by their country's health system, and major changes in those incentives over the 1980s and 1990s, according to a commonly used framework. Such incentives include: the magnitude of out-of-pocket costs to patients, the generosity of reimbursement to physicians and hospitals, regulation of the use of new technologies or the supply of physicians, regulation of competition, and the structure of hospital ownership. Each team also reviewed how care for heart attacks has changed in their country over the past decade.

The book will be of enormous importance to health economists, medical researchers and epidemiologists, and policymakers.

Mark McClellan is Associate Professor of Economics and of Medicine and, by courtesy, of Health Research and Policy, Stanford University. He is a National Fellow, the Hoover Institution.

Daniel P. Kessler is Associate Professor of Economics, Law, and Policy in the Graduate School of Business, Stanford University, and a Research Fellow, the Hoover Institution.

Praise / Awards

  • "The only thing worse than rising medical care spending would be spending that did not increase because new health-improving technology failed to emerge. The superb cross-national study reported here shows that new technology improved outcomes from heart attacks, but also provides definitive evidence on the role of institutions and incentives in affecting the relationship between global technology and local outcomes. We know from this study that improvements in technology can improve health, often (though not always) to such an extent that they offset higher costs; we also know much better than before how economic influences modify the key cost-benefit tradeoff."
    ---Mark Pauly, Wharton School, University of Pennsylvania
  • "I know of no similar work. . . . the comprehensiveness of this volume, its adherence to a specific framework, and the mass of original data make this contribution unique."
    ---Michael Chernew, The University of Michigan
  • "This is an original contribution to the field of health economics as one of the first studies to take a truly global (or at least OECD) view of the factors affecting technological change for a given condition."
    ---Stephen T. Parente, Carlson School of Management, The University of Minnesota
  • "This landmark study in health services research provides valuable substantive findings about technological change in AMI treatment. It also vividly illustrates the problems and the potential of international comparative research."
    ---Victor R. Fuchs, Henry J. Kaiser Jr. Professor Emeritus, Stanford University
  • ". . . a tour de force. I am not aware of any other book that does such a good job of developing this kind of analytic framework. . . . [T]his book is a must read . . . for anyone performing health-services research. We should be grateful to its editors and contributors."
    ---Allan S. Detsky, University of Toronto, New England Journal of Medicine, June 12, 2003

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Copyright © 2002, University of Michigan. All rights reserved.

Product Details

  • 6 x 9.
  • 432pp.
  • 146 drawings, 64 tables.
Available for sale worldwide

  • Hardcover
  • 2002
  • Available
  • 978-0-472-11128-2

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  • $99.95 U.S.