High cost technology in health care: a benefit or a burden?

The influence of high cost technology goes beyond its consequences for the selected patient groups that benefit from its application. Past and future technological developments have a variety of social, economic and ethical implications which have to be taken into account when balancing its costs and benefits to society. Departing from an economic perspective we describe a number of mechanisms underlying the emergence of high cost technology which help us to understand some of the characteristics of high cost technology, such as its focus on quality enhancement rather than on economy. To assess the actual performance of high cost technology in terms of efficiency and equity is difficult as there may be debate about the perspective guiding such assessment and as there still is scarce information on high cost technology in terms of these economic indicators. The increasing technological opportunities have triggered a wider debate on the desired evolution of our health care systems. In some countries there is a tendency to diminish government involvement in health care and emphasize private (for profit) enterprise as a reaction to not being able to finance all new high cost technology. The risks of such strategies are discussed briefly. We conclude that the main actors in health care should adjust their behaviour in order to accomplish the introduction of more cost-effective technologies and to achieve a more socially efficient distribution of their benefits.