http://www.docomo-usa.com/vision2010/streaming/Vision_2010_256k.wmv

1. http://www.docomo-usa.com/vision2010/streaming/Vision_2010_256k.wmvhttp://www.docomo-usa.com/vision2010/streaming/Vision_2010_256k.wmv Chapter 6 - - Health Care Technology

2. How technology affects costs depends on the technology, where it is used, and—above all—on how the concepts of costs and benefits are defined. Indeed, that is the challenge.It affected on national health care expenditures: $27 billion in 1960, $1.1 trillion in 1998, $2.2 trillion in 2008.

3. Medical Technologies…p272 • Diagnostic: CT scanner, Fetal monitor, Computerized electrocardiography, Automated clinical labs, MRI, Ambulatory blood pressure monitor • Survival (lifesaving): Intensive care unit, Cardiopulmonary resuscitation(CPR), Liver transplant, Autologous bone marrow transplant • Illness management: Renal dialysis, Pacemaker, PTCA (angioplasty), Stereotactic cingulotomy (psychosurgery)

4. Medical Technologies…p272 • Cure: Hip joint replacement, Organ transplant, Lithotripter • Prevention: Implantable automatic cardioverter-defibrillator, Pediatric orthopedic repair, Diet control for phenylketonuria(PKU) • System management: Medical information systems, Telemedicine

5. History and Background..p273 • The technology of modern allopathic (western) medicine can be traced to the end of the 19th century and the advent of efficacious surgery. • Acute care hospitals are especially quick to add technology. • The magnetic source imaging (MSI) provides important supplemental information. • Ex. MRI (none in 1984, 10.6% hospitals; a MRI cost $1.5 million to buy, $200,000 to install)

6. Type of Technologies..p274 • Definitive (Curative, Preventive) • Vaccines or antibiotcs , monitoring and screening programs – inexpensive • Surgical intervention – expensive • Halfway (Add-on) technologies • Feeding (N-G) tube – inexpensive • Lower mortality reflects primarily changing incidence or early detection • Transplants and grafts improve the health status of a new individuals but add considerably to costs

7. Type of Technologies..p274 • Deferral technologies • Slow the progression of disease and improve a patient’s condition • Coronary artery bypass grafting (CABG) – expensive, p’t repeated every 5~7 years • The coronary angioplasty provided a simple, less invasive procedure costing a fraction of bypass surgery. It is thought that after repeat angioplasties, bypass surgery is needed anyway.

8. Type of Technologies..p275 • Competing technologies • Technologies that compete may have similar results but very different costs. • Two thrombolytic agents (streptokinase, tissue plasminogen activator) • Cost-Saving technologies • Few new technologies prevent disease either for individual or populations. • They replace more costly treatment or those of lesser quality, the result will be lower costs and better outcomes for the patient and the health services system

9. Forces affecting development and diffusion of technology..p277 • Medical Education and Practice • It is generally believed that a ratio of two thirds primary care physicians to one third specialists is desirable • Specialization meant that physicians were trained to use technology • Reimbursement • Third-party Payment • Diagnosis-Related Groups • Health Care Financing Administration • The Public • Competitive Environment

10. Responses to diffusion and use of technology..p281 • Public Sector Activities • Food and Drug Administration • PSROs and PROs • Certificate of Need • Private Sector Activities • Joint Commission • ISO 9000 • Tort Law: demanding liability standards

11. 貳、 醫療儀器業特色

12. 一、支援性及關聯性產業成熟技術之應用 • 就使用方式及生產質材而言，醫療儀器和其他產業幾無差異，雷射光學工業、聲納〈超音波〉產品開發的主要關鍵則為如何在設計上融入醫療行為。

13. 二、產品價格昂貴 • 在技術應用與產品設計上與其他產業完全相同，其間價格相差仍以數倍甚至數十倍計。

14. 三、同類機種數量少但型號多 • 例如，呼吸機從單純的氧氣幫浦供給到複雜的潮氣容積控制、肺壓控制等訓練病人用呼吸機都有。

15. 四、市場具全球性 • 就產業經濟而言，量大、經濟規模大，方可壓低成本。

16. 五、適合中小企業發展 • 醫療儀器在生產上具有這種少量多樣化之特性，特別適合靈活且機動性高的中小企業發展。

17. 六、產品品質管制嚴格 • 各國之衛生主管機關對於醫療儀器之開發、製造、品質保證、銷售等過程，均有嚴密審核控制之標準。並在商品化之前，一定得經過臨床試驗的證實，以保障使用者(醫護人員)和直接消費者(病患)。

18. 七、消費者不具購買決定權 • 直接消費者(病患)少有個人偏好選擇之餘地(居家護理除外)，所以醫療儀器業之市場交易行為多發生在醫療院所機構，其購買決定因素牽涉到更多更複雜的層面，此亦是醫療儀器業交易行為之特色。

19. 八、具有明顯的市場進入障礙 • 醫療儀器因與生命健康息息相關，故有豐富臨床基礎之儀器設備廠牌很容易被接受，而新興之廠牌則很難建立其市場佔有率，價格戰也甚少激烈發生在此一行業。

20. 九、產品行銷管道特殊 • 大部分醫療儀器的最終使用者為專業醫師，而這些醫師基於過去的使用經驗、品牌偏好、醫療專業，以及受到醫療行政單位採購政策之影響，形成特殊的行銷管道，製造商往往需要透過經驗豐富或特殊管道的代理或經銷商，產品才能打進醫院市場。

21. 十、研究開發之投資大而回收慢 • 大多數醫療儀器與侵入人體的醫療器材等產品開發，必須以科技整合的方式來進行。 • 需要長時間及相當大的投資才有可能成功，因此在研發方面除具雄厚財力與技術之大型企業外，往往得仰賴國家研究機構的輔導與經費的支持。

22. 十一、產業內各據山頭 • 醫療儀器產品範圍涵蓋紡織、家具、造紙、化學材料、化學製品、橡膠、塑膠、金屬、機、電子、運輸、工具、精密器械等各製造業，產品之間的替代性或生產技術之間的類似性都不高，因此醫療器材業具有破碎型產業（fragmented industry）之特色。

23. 十二、產業內貿易盛行 • 醫療器材產品種類繁多項目龐雜，產品差異化程度大。即使是同一類型的產品，加以不同安全、功效、性能與可靠度的要求，生產技術層次不同。

24. 十三、政府政策之影響大 • 有關醫療保險支付之政策，影響此醫療儀器業之研究發展方向和行銷策略甚大。

25. 十四、較不受經濟景氣循環影響 • 應用在生老病死之醫療儀器業，相較於其他電子機械產業較不受經濟蕭條之影響。