health expenditures and technology in the treatment of heart attacks

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Finally, treatment of AMI and the resulting patient outcomes is a multifactorial process ofwhich technology is one component. Other risk factors such as smoking, cholesterol levels,blood pressure, and physical inactivity need to be taken into account. More research is thereforerequired if technology is to be conclusively eliminated as a major driver of expenditure inflation.Expenditure-Technology Relationship in the Treatment of Other DiseasesTreatment of heart attacks was predominantly comprised of hospital care. Funding ofhospital care, in turn, is determined exogenously. Hence technology facilitates changes intreatment mix based on decisions made by the relevant decision-makers in response togovernmentally determined budgets. In other words, the decision-makers use of technology isconstrained by a fixed budget. Control of physician expenditures and medications is not astightly controlled. Treatment of diseases with a greater proportion of physician and medicationexpenditures therefore would lead to different conclusions. Further examination of theeffectiveness of capitating total physician expenditures should be examined. Also, the role ofcost containment measures in prescribed medications for the elderly and indigent with respect tospecific diseases should be explored.Implications for Predicting Health ExpendituresThe ability to predict future expenditures on health is constrained by the inability to predictdecisions made on the basis of political factors. Intermittent infusions of cash into the Albertahealth care system following precedent-setting reductions are an example of the results ofpolitical pressures. The ability of the province to respond to these pressures is constrained due toits reliance on resource revenues. One could therefore conclude that models of health careexpenditures include supply and demand factors of the market for crude oil! However,examination of the incentives facing and decisions made by actors in the health care systemprovide insight into the relative effectiveness, efficiency and equity of levels of healthexpenditures. And although the importance of technology as a significant cost driver has notbeen established, its continued monitoring and regulation may be warranted on the basis of itspotential to significantly impact future expenditures.38 Institute of Health Economics Working Paper 00-14
REFERENCES1. Alberta Health. Alberta Ministry of Health Annual Report.: 1997-1998. 1998.2. Alberta Health. Rates per Thousand and expenditure charts for Alberta individuals bydiagnostic groupings over a five year period. Provincial Medical Consultant’s Office.1991.3. Alberta Health. Patterns of Hospital Morbidity in Alberta – A Statistical Compendium.1993.4. Alberta Health. Alberta Health Heart Survey. 1991.5. AHW. Alberta Health and Wellness News Release, Health Funding Increased toImprove Access to Services, Edmonton, March 9, 1999.6. Fassbender K, Hailey D, Saunders LD, Teo K. “Determinants and Consequences ofTechnological Change in Health Care: Acute Myocardial Infarction (AMI) in Alberta,Canada” in A Global Analysis of Technological Change in Health Care: Heart Attacks;Editors, Mark McClellan and Daniel Kessler. Health Policy and Management Series.Ann Arbor, MI: University of Michigan Press, 1998.7. Fassbender K, Connolly, M. An empirical review of health expenditures and technology.Edmonton: Institute of Health Economics and Alberta Heritage Foundation for MedicalResearch, November 19998. Harstall.C Technologies used for managing and preventing acute myocardial infarction.Edmonton: Institute of Health Economics and Alberta Heritage Foundation for MedicalResearch, August 19999. Health Canada. Canadians and Heart Health: Reducing the Risks; Canadian Heart HealthSurveys. 1995.10. Heart and Stroke Foundation of Canada. Heart Disease and Stroke in Canada. Ottawa,Canada, 1997.11. Hornbrook MC, Hurtado AV, Johnson RE. Health care episodes: definition, measurementand use. Med Care Rev 42(2): 163-218, 1985.12. IMS (Intercontinental Medical Statistics) Canada. Canadian Disease and TherapeuticIndex, Year Ending 1994. 1994.13. IMS (Intercontinental Medical Statistics) Canada. Compuscript. 1996.14. Jacobs P. Fassbender K. Bay K. Lave JR. “The Impact of Case Mix Funding in Ontarioand Alberta, 1989 – 1993.” Unpublished. Presented at the Australian Case-MixConference in September 1995.Institute of Health Economics Working Paper 00-14 39
Page 1 and 2: HEALTH EXPENDITURES AND TECHNOLOGYI
Page 3 and 4: TABLE OF CONTENTSEXECUTIVE SUMMARY
Page 5 and 6: TABLE 15 ..........................
Page 7 and 8: EXECUTIVE SUMMARYPurposeThe purpose
Page 9 and 10: INTRODUCTIONThis paper is the third
Page 12 and 13: INCENTIVES FOR TECHNOLOGICAL CHANGE
Page 14 and 15: Figure 1: Funding of Health Care Se
Page 16 and 17: In 1986 physician fees were determi
Page 18 and 19: Services (established in June 1998)
Page 20 and 21: Table 3: Inclusion and Exclusion Cr
Page 22 and 23: Table 4: Number, Age and Gender of
Page 24 and 25: Increased consumption of health car
Page 26 and 27: Table 8: In-Hospital Length of Stay
Page 28 and 29: Table 10: Crude Percutaneous Transl
Page 30 and 31: Changes in Low-Tech CareLow-tech ca
Page 32 and 33: Table 15: Most Frequent Physician S
Page 34 and 35: use of cardiac drugs but a 50% incr
Page 36 and 37: with respect to each health encount
Page 38 and 39: Table 19 also includes limited priv
Page 40 and 41: DISCUSSIONHealth reform has been su
Page 42 and 43: of resources consumed on a per diem
Page 46: 15. Jacobs P. Hall EM. Lave JR. Gle

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