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Technology Acquisition in Canada: control in Regulated Market

Published online by Cambridge University Press:  10 March 2009

Raisa B. Deber
Affiliation:
University of Toronto
Gail G. Thompson
Affiliation:
University of Toronto
Peggy Leatt
Affiliation:
University of Toronto

Abstract

The authors provide a detailed overview of how the national and provincial health systems of Canada exercise control over the diffusion of medical technology. In particular, they examine the diffusion of CT scanning and the adoption of non-ionic radio contrast media. While the nature of the parliamentary system theoretically aflows the government, especially the executive, to exert more control over its policy agenda than in the United States, the authors believe that effective control is hampered by a lack of political will and insufficient “teeth” in the Ministry of Health' mandate and policy. The authors also conclude that the manipulation of reimbursement systems to encourage or discourage the diffusion of various medical technologies is not always effective, and that political clout often triumphs over rational decision making.

Type
Special Section: Health Care Systems and the Diffusion of Technology, Part I
Copyright
Copyright © Cambridge University Press 1988

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References

REFERENCES

Banta, H. D., Behney, C. J., & Willems, J. S.Toward rational technology in medicine. New York: Springer, 1981.Google Scholar
Banta, H. D., & Sanes, J. R. How the CAT got out of the bag. In Egdahl, R. H. & Gertman, P. M. (eds.) Technology and the quality of health care. Germantown, MD: Aspen Systems Corporation, 1978, 175190.Google Scholar
Biles, B., Schramm, C. J., & Atkinson, J. G.Hospital cost inflation under state rate-setting programs. The New England Journal of Medicine, 1980, 303, 664667.CrossRefGoogle ScholarPubMed
Boadway, A. L., & Brown, M. E.Kingston General reviews the use of CMGs as a management tool. Dimensions in Health Service, 1987, 64, 2426.Google ScholarPubMed
Bolton, C. F., Dinsdale, H. B., Paty, D. W., & Pryse-Phillips, W. E. M.Canadian Neurological Society: Statement on diagnostic imaging techniques. Canadian Journal of Neurological Sciences, 1984, 11, 8687.Google Scholar
Bunker, J. P., Barnes, B. A., & Mosteller, F. Costs, risks, and benefits of surgery. New York: Oxford University Press, 1977.Google Scholar
Calabresi, G., & Bobbitt, P.Tragic choices. New York: W. W. Norton, 1978.Google Scholar
Cook, K., Shortell, S. M., Conrad, D. A., & Morrisey, M. A.A theory of organizational response to regulation: The case of hospitals. Academy of Management Review, 1984, 8, 193205.Google Scholar
Deber, R. B.Your money and your life: The limitations of “business-like” approaches in health care. Health Management Forum, 1985, 6, 2531.Google Scholar
Deber, R., & Heiber, S. Freedom, equality, and the Charter of Rights: Policy and legal aspects of regulating physician reimbursement. Paper prepared for presentation at the Canadian Political Science Association Meeting, 06, 1987, Hamilton, Ontario.Google Scholar
Deber, R. B., & Leatt, P. Technology acquisition in Ontario hospitals: You can lead a hospital to policy, but can you make it stick? Paper prepared for presentation at the Third Canadian Conference on Health Economics, 05 29–30, 1986, Winnipeg, Manitoba.Google Scholar
Deber, R. B., & Vayda, E. The environment of health policy implementation: The Ontario Canada example. In Knox, G. (ed.), Oxford textbook of public health vol. III, investigative methods in public health. Oxford: Oxford University Press, 1985, 441461.Google Scholar
Detsky, A. S., Abrams, H. B., Ladha, L., & Stacey, S. R.Global budgeting and the teaching hospital in Ontario. Medical Care, 1986, 24, 8994.Google Scholar
Detsky, A. S., Stacey, S. R., & Bombardier, C.The effectiveness of a regulatory strategy in containing hospital costs: The Ontario experience, 1967–1981. The New England Journal of Medicine, 1983, 309, 151159.Google Scholar
Evans, R. G. The fiscal management of medical technology: The case of Canada. In Banta, H. D. (ed.), Resources for health: Technology assessment for policy making. New York: Praeger, 1982.Google Scholar
Evans, R. G., & Stoddart, G. L. (eds). Medicare at maturity: Achievements, lessons & challenges. Calgary: University of Calgary Press, 1986.Google Scholar
Evans, R. G., & Wolfson, A. D. Moving the target to hit the bullet: Generation of utilization by physicians in Canada. Paper prepared for presentation at the National Bureau of Economic Research Conference on the Economics of Physician and Patient Behavior, 01 27–28, 1978, Stanford, California.Google Scholar
Evans, R. W. Some thoughts on advances in medical technology. Paper prepared for presentation at the Economic Council of Canada Colloquium on Aging with Limited Health Resources, 05 5–6, 1986, Winnipeg, Manitoba.Google Scholar
Evens, R. G.Computed tomography – a controversy revisited. The New England Journal of Medicine, 1984, 310, 11831184.CrossRefGoogle ScholarPubMed
Feeny, D.Neglected issues in the diffusion of health care technologies: The role of skills and learning. International Journal of Technology Assessment in Health Care, 1985, 1, 681692.Google Scholar
Feeny, D., Guyatt, G., & Tugwell, P.Health care technology: Effectiveness, efficiency & public policy. Montreal: The Institute for Research on Social Policy, 1986.Google Scholar
Fineberg, H. V., & Hiatt, H. H.Evaluation of medical practices: The case for technology assessment. The New England Journal of Medicine, 1979, 301, 10861091.CrossRefGoogle ScholarPubMed
Fried, B. J., Deber, R. B., & Leatt, P.Corporatization and deprivatization of health services in Canada. International Journal of Health Services in Canada, 1987, 17, 567583.CrossRefGoogle ScholarPubMed
Fuchs, M., & Deber, R. B.Technology acquisition in a selected sample of Ontario hospitals. Part I: The technology acquisition survey. Part II: suggestions for improving technology acquisition in hospitals, Dimensions in Health Service, 1987, 64, 6, 1720. Dimensions in Health Service, 1987, 64, 7, 30–32.Google Scholar
Goel, V., & Deber, R. B. Radio-contrast media: How much can we pay? Case study, Department of Health Administration, University of Toronto, 1987.Google Scholar
Greer, A. L.Adoption of medical technology: The hospital's three decision systems. International Journal of Technology Assessment in Health Care, 1985, 1, 669680.Google Scholar
Hastings, J. E. E, & Vayda, E. Health services organization and delivery: Promise and reality. In Evans, R.G. & Stoddart, G. L. (eds.), Medicare at maturity: Achievements, lessons & challenges. Calgary: University of Calgary Press, 1986, 337384.Google Scholar
Heiber, S., & Deber, R.Banning extra-billing in Canada: Just what the doctor didn't order. Canadian Public Policy/Analyse de Politiques, 1987, 13, 6274.CrossRefGoogle Scholar
Iglehart, J.Health policy report: Canada's health care system (first of three parts). The New England Journal of Medicine, 1986, 315, 202208.Google Scholar
Iglehart, J.Health policy report: Canada's health care system (second of three parts). The New England Journal of Medicine, 1986, 315, 778784.CrossRefGoogle Scholar
Iglehart, J.Health policy report: Canada's health care system (third of three parts). The New England Journal of Medicine, 1986, 315, 16231628.CrossRefGoogle Scholar
Institute of Medicine. Assessing medical technologies. Washington, DC: National Academy Press, 1985.Google Scholar
Lomas, J., & Barer, M. L. And who shall represent the public interest? The legacy of Canadian health manpower policy. In Evans, R. G. & Stoddart, G. L. (eds.), Medicare at maturity: Achievements, lessons & challenges. Calgary: University of Calgary Press, 1986, 221–286.Google Scholar
McNeil, B. J., & Cravalho, E. G. (eds.). Critical issues in medical technology. Boston: Auburn House, 1982.CrossRefGoogle Scholar
Metropolitan Toronto District Health Council. Specialized Services Committee Task Force on CAT Scanners. A planning document on CA Tscanners in Metropolitan Toronto. 12 1981.Google Scholar
Ministry of Health. Report of the Task Force on the Placement of Instruments for Computerized Axial Tomography, Toronto, Ontario, 02 26, 1976.Google Scholar
Moloney, T. W., & Rogers, D. E.Medical technology–a different view of the contentious debate over costs. The New England Journal of Medicine, 1979, 301, 14131419.Google Scholar
National Academy of Sciences. Medical technology and the health care system: A study of the diffusion of equipment-embodied technology. A report by the committee on Technology and Health Care, Assembly of Engineering, National Research Council and Institute of Medicine. Washington, DC: National Academy of Sciences, 1979.Google Scholar
National Institutes of Health. Computed tomographic scanning of the brain. Consensus development conference summary, 1982, 4.Google Scholar
Needleman, J. The management of medical technology in Canada. In Banta, H. D. & Kemp, K. B. (eds.), The management of health care technology in nine countries. New York: Springer, 1982, 2859.Google Scholar
Nove, A.The Soviet economic system. London: George Allen & Unwin Ltd., 1977.Google Scholar
OCATH Research and Information Office. The funding of capital equipment in Ontario teaching hospitals. 02, 1983.Google Scholar
Office of Technology Assessment. Strategies for medical technology assessment. Washington, DC: U.S. Congress, Office of Technology Assessment, 1982.Google Scholar
Ontario Council of Health. Interim report of task force on diagnostic imaging. 05, 1980.Google Scholar
Ontario Council of Health. Proceedings: Consensus development conference, diagnostic imaging. 05, 25–26, 1980.Google Scholar
Ontario Council of Health. Final report. Part I: Task force on diagnostic imaging. 11 18, 1980.Google Scholar
Ontario Ministry of Health. Hospital statistics 1983 /84. Toronto: Ontario Ministry of Health.Google Scholar
Rosenthal, G. Anticipating the costs and benefits of new technology: a typology for policy. In Altman, S. H. & Blendon, H. (eds.), Medical technology: The culprit behind health care costs? Proceedings of the 1977 Sun Valley Forum on National Health. Washington, DC: DHEW Publication No. (PHS) 79–3216, 1979, 7787.Google Scholar
Ruth, S., & Miller, L. S.The volunteer/government/provider relationship. Health Management Forum, 1985, 6, 1824.Google Scholar
Taylor, M. G.Health insurance and Canadian public policy: Seven decisions that created the Canadian health insurance system. Montreal: McGill-Queen's University Press, 1978.Google Scholar
Thompson, C., Youmans, J., & LeTouze, D.Hospital capital shows signs of old age, Part 1. Dimensions in Health Service, 1984, 61, 3436.Google ScholarPubMed
Thompson, C., & LeTouze, D.Hospital capital shows signs of old age, Part 2. Dimensions in Health Service, 1984, 61, 1922.Google Scholar
Thompson, G. G., Deber, R. B., & Fuchs, M. Technology acquisition in Ontario hospitals: Hospital process. Paper prepared for meeting of Canadian Health Economics Research Association, 06 22, 1987, Halifax, Nova Scotia.Google Scholar
UTHA. Report of the Sub-committee on Computerized Axial Tomography Scanners. 01, 1977.Google Scholar
Van, Loon R. J., & Whittington, M. S.The Canadian political system: Environment, structure and process. Toronto: McGraw Hill-Ryerson, 1987.Google Scholar
Vayda, E., & Deber, R. B.The Canadian health care system: An overview. Social Science and Medicine, 1984, 18. 191197.Google Scholar
Weller, G. B., & Manga, P. The development of health policy in Canada. In Atkinson, M. & Chandler, M. (eds.), The politics of Canadian public policy. Toronto: University of Toronto Press, 1983, 223246.Google Scholar
Wennberg, J. E., McPherson, K., & Caper, P.Will payment based on diagnosis-related groups control hospital costs? The New England Journal of Medicine, 1984, 311, 295300.CrossRefGoogle ScholarPubMed
Wildavsky, A. Doing better and feeling worse: The political pathology of health policy. In Knowles, J. (ed.), Doing better and feeling worse: Health in the United States. New York: W. W. Norton and Co., 1977.Google Scholar
Zuckerman, A. M. Diagnosis related groups: Applications for Canada. Health Management Forum, 1983, 6679.Google Scholar