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Health Care Technology and Its Assessment in Eight Countries

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Health Care Technology and Its Assessment in Eight Countries Health Care Technology and Its Assessment in Eight Countries February 1995 OTA-BP-H-140 GPO stock #052-003-01402-5 Recommended citation: U.S. Congress, Office of Technology Assessment, Health Care Technology and Its Assessment in Eight Countries, OTA-BP-H-140 (Washington, DC: U.S. Government Printing Office, February 1995). For sale by the U.S. Government Printing Office Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328 ISBN 0-16 -045487-5 Foreword n 1980, when OTA examined the management of health care technology in 10 countries, we stated that “international literature in the area of eval- uating and managing medical technologies is sparse. ” The richness and variety of experiences in 1994, captured for eight countries in this back- Iground paper, is evidence that major changes have occurred. Technology as- sessment in health care was just emerging in the United States at the earlier date, and in other countries it was largely a new concept whose role had not yet been defined. Today, it would take a volume bigger than this one to fully de- scribe technology assessment just in the United States. In each of the other countries studied—Australia, Canada, France, Germany, the Netherlands, Sweden, and the United Kingdom—technology assessment organizations also have become part of the health care landscape. It is easy to catalog health care technology assessment organizations and their work in each country but difficult to discern how the adoption and use of technology has been affected by those efforts. In this background paper the ex- periences of each country with six technologies (or sets of technologies)—in- including evaluation and management efforts and how the technologies dif- fused—are presented and compared. The six areas are: 1 ) treatments for coronary artery disease, 2) imaging technologies (CT and MRI scanning), 3) laparoscopic surgery, 4) treatments for end–stage renal disease, 5) neonatal in- tensive care and 6) breast cancer screening. This background paper is part of a larger study on International Differences in Health Care Technology and Spending, which consists of a series of back- ground papers. lnternational Health Statistics: What the Numbers Mean for the United States was published in November 1993, and International Com- parisons of Administrative Costs in Health Care appeared in September 1994. An additional background paper will report on lessons for the United States from a comparison of hospital financing and spending in seven countries. The country chapters of this background paper were written by experts in those countries, and the entire effort was guided by David Banta of the Nether- lands. It was greatly assisted by the advisory panel for the overall study, chaired by Rosemary Stevens of the University of Pennsylvania. In addition, many other individuals helped in various ways and OTA acknowledges gratefully the contribution of each one. As with all OTA documents, the final responsibility for the content rests with OTA. ROGER C. HERDMAN Director .,. Ill Advisory Panel Rosemary Stevens, Chair Ellen Immergut University of Pennsylvania Massachusetts Institute of Technology Philadelphia, PA Boston, MA Stuart Altman Lynn E. Jensen Brandeis University American Medical Association Waltham, MA Chicago, IL Jan E. Blanpain Bengt Jonsson Leuven University, Belgium Stockholm School of Economics Leuven, Belgium Stockholm, Sweden Harry P. Cain II Kenneth G. Manton Blue Cross and Blue Shield Association Duke University Washington, DC Durham, NC Thomas W. Chapman Edward Neuschler The Greater Southeast Healthhcare System Health Insurance Association of America Washington, DC Washington, DC Louis P. Garrison, Jr. Jean-Pierre Poullier Syntex Development Research Organisation for Economic Co-operation and Palo Alto, CA Development Paris, France Annetine Gelijns Columbia University Mark Schlesinger New York, NY Yale University New Haven, CT John Iglehart Health Affairs Bethesda, MD Note: OTA appreciates and is grateful for the valuable assistance and thoughtful critiques provided by the advisory panel members. The panel does not, however, necessarily approve, disapprove, or endorse this background paper. OTA assumes full responsibility for the background paper and the accuracy of its contents. iv Preject Staff Hellen Gelband ADMINISTRATIVE STAFF CONTRACTORS Project Director Beckie Ericksonl Martha Cooley Health Program Office Washington, DC Clyde J. Behney Administrator Assistant Director A. Mark Fendrick Health, Education, and Louise Staley2 University of Michigan Environment Health Program Office Ann Arbor, MI Administrator Sean R. Tunis Claudia Steiner Health Program Director Charlotte Brown Johns Hopkins University Word Processing Specialist Baltimore, MD Daniel B. Carson PC Specialist Carolyn Martin Word Processing Specialist Carolyn Swarm PC Specialist 1 Until September 1994. 2 From September 1994 — contributors H. David Banta Egon Jonsson Netherlands Organization for Applied Scientific Karolinska Institute and Research Swedish Council on Technology Assessment in Leiden. The Netherlands Health Care Stockholm, Sweden Renaldo N. Battista Conseil devaluation des Technologies de la Sante' Stefan Kirchberger du Quebec and Landesversicherungsanstalt Sachsen and McGill University University of Muenster Montreal, Canada Leipzig, Germany Michael Bos Jackie Spiby Health Council of the Netherlands Bromley Health The Hague, The Netherlands Hayes, Kent, United Kingdom Hellen Gelband Sean R. Tunis Office of Technology Assessment Office of Technology Assessment U.S. Congress U.S. Congress Washington, DC Washington, DC David Hailey Caroline Weill Australian Institute of Health and Welfare National School of Public Health Canberra, Australia Saint–Maurice, France Matthew J. Hedge Montreal General Hospital Montreal. Canada Robert Jacob Quebec Ministry of Health and Social Services Quebec, Canada vi Acknowledgments Rob Carter Naarilla Hirsch National Centre for Health Program Evaluation Australian Institute of Health and Welfare Melbourne, Australia Canberra, Australia Bernard Cohen Guido Persijn Eurotransplant Foundation Eurotransplant Foundation Leiden, The Netherlands Leiden, The Netherlands Dell Cowley Diane Telrnosse Australian Institute of Health and Welfare Conseil devaluation des Technologies de la Sante Canberra, Australia du Que'bec Montreal, Canada Bernard Crowe Australian Institute of Health and Welfare Gabriel ten Velden Canberra, Australia Health Council of the Netherlands The Hague, The Netherlands Wolodja Dankiw Australian Institute of Health and Welfare Canberra, Australia Yvonne van Duivenboden Health Council of the Netherlands The Hague, The Netherlands vii — contents 1 Health Care Technology as a Policy Issue 1 The Diffusion of Health Care Technology 2 Content of This Report 2 Treatments for Coronary Artery Disease—CABG and PTCA 4 Medical Imaging (CT and MRI) 6 Laparoscopic Surgery 8 Treatments for End-Stage Renal Disease (ESRD) 9 Neonatal Intensive Care 11 Screening for Breast Cancer 12 Interpretation of the Cases 13 References 13 2 Health Care Technology in Australia 19 Overview of Australia 19 Health Status of the Population 20 Controlling Health Care Technology 25 Health Care Technology Assessment 29 Case Studies Treatments for Coronary Artery Disease 39 Medical Imaging (CTand MRI) 42 Laparoscopic Surgery 44 Treatments for End-Stage Renal Disease (ESRD) 47 Neonatal Intensive Care 49 Screening for Breast Cancer 51 Chapter Summary 53 References 55 3 Health Care Technology in Canada (with special reference to Quebec) 61 Overview of Canada 61 Health Status of the Population 64 The Canadian Health Care System 64 Controlling Health Care Technology 67 Health Care Technology Assessment 75 . Vlll Case Studies Treatments for Coronary Artery Disease 79 Medical Imaging (CT and MRI) 82 Laparoscopic Surgery 86 Treatments for End-Stage Renal Disease (ESRD) 88 Neonatal Intensive Care 90 Screening for Breast Cancer 92 Chapter Summary 95 References 96 4 Health Care Technology in France 103 Overview of France 103 The French Health Care System 105 Controlling Health Care Technology 110 Health Care Technology Assessment 114 Case Studies Treatments for Coronary Artery Disease 120 Medical Imaging (CT and MRI) 122 Laparoscopic Surgery 124 Treatments for End-Stage Renal Disease (ESRD) 126 Neonatal Intensive Care 129 Screening for Breast Cancer 131 Chapter Summary 132 References 134 5 Health Care Technology in Germany 137 Overview of Germany 137 Health Status of The Population 138 The German Health Care System 139 The Cost Containment Debate 144 Controlling Health Care Technology 147 Regulation of Placement of Services and Quality Assurance 151 Case Studies Treatments for Coronary Artery Disease 154 Medical Imaging (CT and MRI) 155 Laparoscopic Surgery 158 Treatments for End-Stage Renal Disease (ESRD) 160 Neonatal Intensive Care 162 Screening for Breast Cancer 164 Chapter Summary 165 References 167 ix 6 Health Care Technology in the Netherlands 171 Overview of the Netherlands 171 Health Status of the Population 173 The Dutch Health Care System 173 Controlling Health Care Technology 178 Health Care Technology Assessment 183 Case Studies Treatments for Coronary Artery Disease 188 Medical Imaging (CT and MRI) 191 Laparoscopic Surgery 197 Treatments for End-Stage Renal Disease (ESRD) 198 Neonatal Intensive Care 201 Screening for Breast Cancer 203 Chapter Summary 205 References 207 7 Health Care Technology in Sweden 209 Overview of Sweden 209 Health Status of the Population 211 The Swedish Health Care System
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