General Conclusions

Abstract

Developing coherent conclusions from such a diverse set of papers from different disciplines and different countries is difficult, but I will try. In his paper, Professor Abel-Smith has drawn attention to the difficulty of accumulating, with sufficient speed, information about the marginal costs and benefits of new technology before investments into it are made. Also a problem are the competing motives of containing health costs and of promoting the health care industry. This was evident to me at a meeting of the Royal Society in London last year when industrialists were complaining about the conservatism of British doctors in not buying equipment as soon as it becomes safe and available; yet, these same doctors are often accused of not being cautious enough before adopting such technology. Dr. Banta has reported the experience of Brazil, where an emerging country with relative wealth has little control over market forces and where the CT scanners are clustered in the private market, leaving the university hospitals without access to them. But South America is only reiterating the scenario that it sees its richer brethren to the north acting out, in which market forces and the entrepreneurial spirit of doctors often manage to outwit efforts at control. An example of this is the 17 CT head scanners in the Bay area around San Francisco, with no scanner available at the San Francisco General Hospital. Yet, this is the hospital to which all head injuries in the area are sent, and head injury is the one condition which everyone agrees benefits from CT scanning.