Developed countries struggle with high healthcare spending, and cost is often cited as a barrier to the introduction of new patient care technologies. The core objective of this review article is to help familiarize medical technology innovators with trends in the health economic environment and the implications for the adoption of new technologies. We review and discuss this topic in language accessible to medical technology innovators. We assess macrolevel developments in healthcare spending and highlight measures already taken to control spending. We discuss practical implications for anyone involved in healthcare innovation. Two observations are central to this discussion: (1) the U.S. spends significantly more on healthcare per capita than any other developed country; (2) across developed countries, healthcare spending has risen steadily over the past two decades. Nevertheless, higher spending has not always led to improvements in health. As a result, innovators need to be prepared to navigate an outcomes-oriented and value-based environment that is being defined by the emerging requirements of various healthcare stakeholders. Practically, new products should aim to improve health outcomes at a cost deemed “good value” and/or reduce cost for one or multiple stakeholders. Opportunities also exist for tools that enable cost/outcomes tracking, which will help demonstrate value to providers, insurers, and patients.

References

References
1.
Hood
,
V. L.
, and
Weinberger
,
S. E.
,
2012
, “
High Value, Cost-Conscious Care: An International Imperative
,”
Eur. J. Intern. Med.
,
23
(
6
), pp.
495
498
.
2.
Sorenson
,
C.
,
Drummond
,
M.
, and
Khan
,
B. B.
,
2013
, “
Medical Technology as a Key Driver of Rising Health Expenditure: Disentangling the Relationship
,”
ClinicoEconomics Outcomes Res.
,
5
, pp.
223
234
.
3.
OECD, 2018, “
OECD Health Database
,” Organisation for Economic Co-operation and Development, Paris, France, accessed Aug. 5, 2018, https://data.oecd.org
4.
Garber
,
A. M.
, and
Skinner
,
J.
,
2008
, “
Is American Health Care Uniquely Inefficient?
,”
J. Econ. Perspect.
,
22
(
4
), pp.
27
50
.
5.
Squires
,
D.
, and
Anderson
,
C.
,
2015
, “
U.S. Health Care From a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries
,”
Issue Brief
,
15
, pp.
1
15
.https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2015_oct_1819_squires_us_hlt_care_global_perspective_oecd_intl_brief_v3.pdf
6.
Anderson
,
G. F.
,
Reinhardt
,
U. E.
,
Hussey
,
P. S.
, and
Petrosyan
,
V.
,
2003
, “
It's the Prices, Stupid: Why the United States is So Different From Other Countries
,”
Health Spending
,
22
(
3
), pp.
89
105
.https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.22.3.89
7.
WHO, 2015, “
World Health Statistics
,” World Health Organization, accessed Feb. 13, 2019, https://www.who.int/gho/publications/world_health_statistics/2015/en/
8.
Nolte
,
E.
, and
McKee
,
M.
,
2011
, “
Variations in Amenable Mortality–Trends in 16 High-Income Nations
,”
Health Policy
,
103
(
1
), pp.
47
52
.
9.
Laugesen
,
M. J.
, and
Glied
,
S. A.
,
2011
, “
Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries
,”
Health Aff.
,
30
(
9
), pp.
1647
1656
.
10.
Kesselheim
,
A. S.
,
Avorn
,
J.
, and
Sarpatwari
,
A.
,
2016
, “
The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform
,”
JAMA
,
316
(
8
), pp.
858
871
.
11.
Whalen
,
J.
,
2018
, “
Why the U.S. Pays More Than Other Countries for Drugs
,” The Wall Street Journal, Washington, DC.
12.
Joyce
,
G. F.
, and
Sood
,
N.
,
2016
, “
Why Medicare Price Negotiation Is the Wrong Prescription for Rising Drug Spending
,”
J. Policy Anal. Manage.
,
35
(
4
), pp.
956
963
.
13.
Wagner
,
J. L.
, and
McCarthy
,
E.
,
2004
, “
International Differences in Drug Prices
,”
Annu. Rev. Public Health
,
25
(
1
), pp.
475
495
.
14.
Himmelstein
,
D. U.
,
Jun
,
M.
,
Busse
,
R.
,
Chevreul
,
K.
,
Geissler
,
A.
,
Jeurissen
,
P.
,
Thomson
,
S.
,
Vinet
,
M. A.
, and
Woolhandler
,
S.
,
2014
, “
A Comparison of Hospital Administrative Costs in Eight Nations: U.S. Costs Exceed All Others by Far
,”
Health Aff.
,
33
(
9
), pp.
1586
1594
.
15.
Reid
,
T. R.
,
2010
,
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
,
Penguin Press
, New York.
16.
Woolhandler
,
S.
,
Campbell
,
T.
, and
Himmelstein
,
D.
,
2003
, “
Costs of Health Care Administration in the United States and Canada
,”
NEJM
,
349
(
8
), pp.
768
775
.
17.
Peterson
,
C. L.
, and
Burton
,
R.
,
2007
, “
US Health Care Spending: Comparison With Other OECD Countries
,” Congressional Research Service Report for Congress, Washington, DC.
18.
Fuchs
,
V. R.
,
1998
,
Who Shall Live? Health Economics, and Social Choice
,
World Scientific, Singapore
.
19.
Mattke
,
S.
,
Liu
,
H.
, and
Orr
,
P.
,
2016
, “
Medical Device Innovation in the Era of the Affordable Care Act: The End of Sexy
,”
RAND Health Q.
,
6
(
1
), p.
9
.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158273/?report=classic
20.
Porter
,
M. E.
, and
Kaplan
,
R. S.
,
2016
, “
How to Pay for Health Care
,”
Harv. Bus. Rev.
,
94
(
7–8
), pp.
88
100
.https://hbr.org/2016/07/how-to-pay-for-health-care
21.
Bradley
,
E. H.
, and
Taylor
,
L. A.
,
2013
,
The American Health Care Paradox
,
PublicAffairs
, New York.
22.
Tram
,
L. D.
,
Zimmerman
,
F. J.
, and
Fielding
,
J. E.
,
2017
, “
Public Health and the Economy Could Be Served by Reallocating Medical Expenditures to Social Programs
,”
SSM - Popul. Health
,
3
, pp.
185
191
.
23.
Smith
,
S.
,
Newhouse
,
J. P.
, and
Freeland
,
M. S.
,
2009
, “
Income, Insurance, and Technology: Why Does Health Spending Outpace Economic Growth?
,”
Health Aff.
,
28
(
5
), pp.
1276
1284
.
24.
Neumann
,
P. J.
,
Cohen
,
J. T.
, and
Weinstein
,
M. C.
,
2014
, “
Updating Cost-Effectiveness—The Curious Resilience of the $50,000-Per-QALY Threshold
,”
N. Engl. J. Med.
,
371
(
9
), pp.
796
797
.
25.
Brock
,
D.
,
2004
, “
Ethical Issues in the Use of Cost Effectiveness Analysis for the Prioritization of Health Resources
,”
Handbook of Bioethics
,
G.
Khushf
, ed.,
Springer
,
Dordrecht, The Netherlands
, pp.
353
380
.
26.
James
,
J.
,
2012
, “
Health Policy Brief: Pay-for-Performance
,” Health Affairs Blog, Oct. 11, accessed Feb. 13, 2019, https://www.healthaffairs.org/do/10.1377/hpb20121011.90233/full/
27.
NICE,
2018
, “
The National Institute for Health and Care Excellence
,” accessed Aug. 5, 2018, https://www.nice.org.uk
28.
eunethta,
2018
, “
European Network for Health Technology Assessment
,” accessed Aug. 5, 2018, http://eunethta.eu/
29.
Rosero-Bixby
,
L.
, and
Dow
,
W. H.
,
2015
, “
Exploring Why Costa Rica Outperforms the United States in Life Expectancy: A Tale of Two Inequality Gradients
,”
PNAS
,
113
(
5
), pp.
1130
1137
.
30.
Zenios
,
S.
,
Makower
,
J.
,
Yock
,
P. G.
,
Brinton
,
T. J.
,
Kumar
,
U. N.
,
Denend
,
L.
, and
Krummel
,
T. M.
,
2015
,
Biodesign: The Process of Innovating Medical Technologies
,
Cambridge University Press
, Cambridge, UK.
31.
Groeneveld
,
P. W.
, and
Dixit
,
S.
,
2017
, “
Cardiac Pacing and Defibrillation Devices: Cost and Effectiveness
,”
Annu. Rev. Med.
,
68
(
1
), pp.
1
13
.
32.
Pietzsch
,
J. B.
,
Garner
,
A. M.
, and
Marks
,
W. J.
, Jr.
,
2016
, “
Cost-Effectiveness of Deep Brain Stimulation for Advanced Parkinson's Disease in the United States
,”
Neuromodulation
,
19
(
7
), pp.
689
697
.
33.
Iribarne
,
A.
,
Easterwood
,
R.
,
Russo
,
M. J.
,
Wang
,
Y. C.
,
Yang
,
J.
,
Hong
,
K. N.
,
Smith
,
C. R.
, and
Argenziano
,
M.
,
2011
, “
A Minimally Invasive Approach Is More Cost-Effective Than a Traditional Sternotomy Approach for Mitral Valve Surgery
,”
J. Thorac. Cardiovasc. Surg.
,
142
(
6
), pp.
1507
1514
.
34.
Santana
,
O.
,
Larrauri-Reyes
,
M.
,
Zamora
,
C.
, and
Mihos
,
C. G.
,
2016
, “
Is a Minimally Invasive Approach for Mitral Valve Surgery More Cost-Effective Than Median Sternotomy?
,”
Interact. Cardiovasc. Thorac. Surg.
,
22
(
1
), pp.
97
100
.
35.
Eaton
,
J.
,
Mealing
,
S.
,
Thompson
,
J.
,
Moat
,
N.
,
Kappetein
,
P.
,
Piazza
,
N.
,
Busca
,
R.
, and
Osnabrugge
,
R.
,
2014
, “
Is Transcatheter Aortic Valve Implantation (TAVI) a Cost-Effective Treatment in Patients Who are Ineligible for Surgical Aortic Valve Replacement? A Systematic Review of Economic Evaluations
,”
J. Med. Econ.
,
17
(
5
), pp.
365
375
.
36.
Russell
,
L. B.
,
2007
, “
Prevention's Potential for Slowing the Growth of Medical Spending
,” National Coalition on Health Care, Washington, DC,
epub
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.485.5410&rep=rep1&type=pdf.
37.
Pashayan
,
N.
,
Morris
,
S.
,
Gilbert
,
F. J.
, and
Pharoah
,
P. D. P.
,
2018
, “
Cost-Effectiveness and Benefit-to-Harm Ratio of Risk-Stratified Screening for Breast Cancer: A Life-Table Model
,”
JAMA Oncol.
,
4
(11), pp. 1504–1510.
38.
Bove
,
A. M.
,
Smith
,
K. J.
,
Bise
,
C. G.
,
Fritz
,
J. M.
,
Childs
,
J.
,
Brennan
,
G. P.
,
Abbott
,
J. H.
, and
Fitzgerald
,
G. K.
,
2018
, “
Exercise, Manual Therapy, and Booster Sessions in Knee Osteoarthritis: Cost-Effectiveness Analysis From a Multicenter Randomized Controlled Trial
,”
Phys. Ther.
,
98
(
1
), pp.
16
27
.
39.
Nelson
,
A. L.
,
Cohen
,
J. T.
,
Greenberg
,
D.
, and
Kent
,
D. M.
,
2009
, “
Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation
,”
Ann. Intern. Med.
,
151
(
9
), pp.
662
667
.
40.
Rizzi
,
M.
,
Messina
,
G.
,
Penner
,
F.
,
D'Ammando
,
A.
,
Muratorio
,
F.
, and
Franzini
,
A.
,
2015
, “
Internal Pulse Generators in Deep Brain Stimulation: Rechargeable or Not?
,”
World Neurosurg.
,
84
(
4
), pp.
1020
1029
.
41.
Aynardi
,
M.
,
Post
,
Z.
,
Ong
,
A.
,
Orozco
,
F.
, and
Sukin
,
D. C.
,
2014
, “
Outpatient Surgery as a Means of Cost Reduction in Total Hip Arthroplasty: A Case-Control Study
,”
HSS J.
,
10
(
3
), pp.
252
255
.
42.
Fearon
,
W. F.
,
Shilane
,
D.
,
Pijls
,
N. H. J.
,
Boothroyd
,
D. B.
,
Tonino
,
P. A. L.
,
Barbato
,
E.
,
Jüni
,
P.
,
De Bruyne
,
B.
, and
Hlatky
,
M. A.
,
2013
, “
Cost-Effectiveness of Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease and Abnormal Fractional Flow Reserve
,”
Circulation
,
128
(
12
), pp.
1335
1340
.
43.
Cameron
,
C.
,
Coyle
,
D.
,
Ur
,
E.
, and
Klarenbach
,
S.
,
2010
, “
Cost-Effectiveness of Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Mellitus Managed Without Insulin
,”
CMAJ
,
182
(
1
), pp.
28
34
.
44.
Ben-Assuli
,
O.
,
Ziv
,
A.
,
Sagi
,
D.
,
Ironi
,
A.
, and
Leshno
,
M.
,
2016
, “
Cost-Effectiveness Evaluation of EHR: Simulation of an Abdominal Aortic Aneurysm in the Emergency Department
,”
J. Med. Syst.
,
40
(
6
), p.
141
.
45.
Kazley
,
A. S.
,
Simpson
,
A. N.
,
Simpson
,
K. N.
, and
Teufel
,
R.
,
2014
, “
Association of Electronic Health Records With Cost Savings in a National Sample
,”
Am. J. Managed Care
,
20
(
6
), pp.
e183
e190
.https://www.ajmc.com/journals/issue/2014/2014-vol20-n6/association-of-electronic-health-records-with-cost-savings-in-a-national-sample
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