Innovations:
between hi-tech and economic viability
By Professor Maximilian F Reiser, director of the Institute of Clinical Radiology at the University Clinic, Munich, Germany
In European countries the in-patient length of stay has decreased considerably. Consequently, from 1990 to 2001 the number of hospital beds shrank by 19% although 20% more patients were treated. This efficiency increase could be realised - not entirely but to a great extent - due to modern imaging diagnostics and minimally invasive radiological procedures. Fast and precise diagnostics, which puts little stress on a patient, enables us to start an effective and targeted therapy briefly after the patient has been admitted to hospital. In these diagnostic procedures radiological equipment such as CT and MRI play a crucial role.
Often, medical technology is held responsible for the explosion of costs in healthcare. However, the facts tell a different story: In Germany (for example) major medical technology equipment accounts for only 1% of annual health expenditures and only 0.2% is spent on investments.
These facts notwithstanding, re-investment and modernisation have become ever more difficult. In Germany, over 50% of the radiological equipment in use is more than 10 years old, which means it is outdated, requires high-maintenance and thus, in the end, it is no longer economical. Even health politicians understand that 10 to 12.5 billion euros need to be earmarked for investments in healthcare annually, but only five billion euros are available. As a result, during the last years, an investment backlog of 25-35 billion euros has accumulated.
This development is, at least in Germany, a direct consequence of the structure of the public healthcare system. Public budgets are in dire straits, which makes urgently needed re-investments impossible - notwithstanding the fact that, as has been proved, innovative medical technology contributes significantly to cost reductions and quality improvement.
It has to be taken into consideration that we are currently witnessing a change of paradigm within radiology which may well lead to a further efficiency boost - for example via whole-body imaging with state-of-the-art MRI systems, PET/CT and multislice CT. Instead of a sequence of diagnostic steps, the entire body is scanned in one go, which further avoids delays. Moreover, interventional radiological procedures, such as radio frequency ablation and vertebroplasty, are highly effective and help reduce treatment costs.
But how can we realize these cost-efficient and doubtlessly useful innovations in a situation characterised by scarce resources? It is not enough for the radiologists to make demands and then complain if those demands are not met. Rather, we must make every effort to reduce operating costs by improving organisation and workflow. New financing models must be developed by partnerships between hospital administration and industry - however, such public-private partnerships require mutual trust. Particularly promising seems to be a ‘Pay per use’ model, which allows a hospital to avoid high initial investments but at the same time guarantees long-term budgeting, and is integrated into a strategic investment plan. Hospital and industry partners share risks, as well as profit, and both partners have a vested interest in the economic success of the project.
Radiologists and hospital managers should make every effort to convince financial decision makers that investment in medical technology and in IT infrastructure can improve the quality of healthcare and at the same time reduce costs. The one-sided orientation and support for pharmaceutical research and development has long been proven as an expensive error.