Containing Health Care Costs in Japan

10 High-Cost Technology in Health Care: The Adoption and Diffusion of MRI in Japan

CHAPTER 10 High-Cost Technology in Health Care: The Adoption and Diffusion of MRI in Japan Akinori Hisashige SUM MAR Y The total number of installed magnetic resonance imaging (MRI) and computerized-axial tomography (CAT) units in Japan was 1,048 and 8,963, respectively , in 1991. Not only is the number of CAT units relative to population in Japan the highest in the world, but that of MRI is second only to that of the United States. The diffusion of MRI was slower than that of CAT, as was also the case in the United States, accelerating sharply beginning in 1986 onward. Fiftyfive percent of MRI units were owned by private hospitals. This pattern of diffusion in Japan was mainly determined by the following factors: the technological attributes of MRI, the market situation of the medical engineering industry, the reimbursement system of health insurance, and the sociocultural background. However , the introduction of MRI in Japan was not linked to any fonnal assessment of its effectiveness and efficiency. Introduction New technologies have generally been incorporated into the health care system with enthusiasm by both providers and consumers. This is particularly true in Japan, where the medical care system has quickly embraced sophisticated, hightechnology equipment. For example, the total number of installed MRI and CAT units in Japan was 1,048 and 8,963, respectively, in 1991. Japan is the world leader in the number of CAT units relative to population, and its ratio of MRI to population is second only to that ofthe United States. Moreover, more than halfof all hospitals have ultrasonoscopes and gastro-fiberscopes. One-third ofthem have auto-biochemical analyzers and bronchoscopes (Hisashige, Sakurai, and Kaihara 1991; Hisashige I992b). However, seldom are the effectiveness and efficiency of new health care technologies fully evaluated before their widespread implementation. It has been pointed out that dissatisfaction with many technologies grows over time as they fail in clinical settings to meet claims or expectations for benefits. A technology may fall into disuse as it is replaced by yet another new and incompletely evaluated technology. The most serious, common problem is that the quality ofmedical 106 CHAPTER 10 High-Cost Technology in Health Care: The Adoption and Diffusion of MRI in Japan Akinori Hisashige SUM MAR Y The total number of installed magnetic resonance imaging (MRI) and computerized-axial tomography (CAT) units in Japan was 1,048 and 8,963, respectively , in 1991. Not only is the number of CAT units relative to population in Japan the highest in the world, but that of MRI is second only to that of the United States. The diffusion of MRI was slower than that of CAT, as was also the case in the United States, accelerating sharply beginning in 1986 onward. Fiftyfive percent of MRI units were owned by private hospitals. This pattern of diffusion in Japan was mainly determined by the following factors: the technological attributes of MRI, the market situation of the medical engineering industry, the reimbursement system of health insurance, and the sociocultural background. However , the introduction of MRI in Japan was not linked to any fonnal assessment of its effectiveness and efficiency. Introduction New technologies have generally been incorporated into the health care system with enthusiasm by both providers and consumers. This is particularly true in Japan, where the medical care system has quickly embraced sophisticated, hightechnology equipment. For example, the total number of installed MRI and CAT units in Japan was 1,048 and 8,963, respectively, in 1991. Japan is the world leader in the number of CAT units relative to population, and its ratio of MRI to population is second only to that ofthe United States. Moreover, more than halfof all hospitals have ultrasonoscopes and gastro-fiberscopes. One-third ofthem have auto-biochemical analyzers and bronchoscopes (Hisashige, Sakurai, and Kaihara 1991; Hisashige I992b). However, seldom are the effectiveness and efficiency of new health care technologies fully evaluated before their widespread implementation. It has been pointed out that dissatisfaction with many technologies grows over time as they fail in clinical settings to meet claims or expectations for benefits. A technology may fall into disuse as it is replaced by yet another new and incompletely evaluated technology. The most serious, common problem is that the quality ofmedical 106 High-Cost Technology in Health Care 107 technology is neither evaluated nor assured (Hisashige, Sakurai, and Kaihara 1991; Hisashige 1992b). Moreover, there are no formal mechanisms for monitoring the quality of health care technologies. The increasing adoption of new health...