On Tue, 4 Feb 1997 09:31:54 -0500 Sam Lanfranco
<[log in to unmask]> wrote:


> Most involve people trying to get their heads
> around what are the issues - at multiple levels - and where does all this
> information and communiction technology fit in. A consultant to a major
> institution recently offered the following - which I paraphrase -
>
>    Health Informatics for developing counties is a good idea since it
>    will promote the U.S. export of diagnostic and information mangement
>    systems, helping the balance of payments, and the longer production
>    runs will bring down costs in the U.S. reducing the U.S. health care
>    crisis.


This statement can be dissected and discussed from a number
of perspectives. We could be horrified at the blatant
chauvinism of it, or we can marvel at the cynicism it
implies about public policy. We could also be concerned at
the development of dependency on a drip feed of high tech
goods that impacts on the balance of trade of developing
nations. We could also wonder why anyone finds it
remarkable that the dynamics of a capitalist economy
dictate that export orders be sought in the developing
world.

I would like to challenge the notion that exporting
health informatics will lead to a decrease in costs in US
health care.

The main reason being that the above view implies a static
analysis of the US economy, especially the high tech area.
It is highly unlikely that any extra profits would be
passed on to the US health industry in the form of lower
unit costs because that assumes that systems are in place
for a significant period of time and that these systems are
replaced same with same.

Unfortunately obsolescence and complexity drive the
informatics industry to produce higher tech solutions that
in turn absorb the profits of off-shore sales in Research
and Development, costs that are passed onto the health
industry as they forge ahead implementing "later and
greater" "solutions" that in turn prove to have higher
capital and maintenance costs. A vicious cycle with
increasing frequency.

There may in fact be some benefit to the US economy with
high-tech offshore sales but that benefit will not be
passed on to the health sector and is somewhat marginal. If
anything the adoption of high-tech informatics etc in
health care seems to have been paralleled by a continuous
increase in cost - the so-called productivity paradox.

For further discussion of some of these ideas I would
recommend: Why Things Bite Back: Technology and the Revenge
of Unintended Consequences*, by Edward Tenner (New York:
Alfred A. Knopf, 1996).  Hardcover, 341 pages, $26.

There is also an excellent synopsis and analysis of this
book in Netfuture #37.



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Craig Silva, Electronic Outreach Program Officer
Victorian Health Promotion Foundation, Melbourne Australia
e-mail: [log in to unmask], Tel: 61 3 9345 3211
Post: PO Box 154, Carlton Sth Victoria. 3053. Australia
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