Benefits and risks of affordable technologies in healthcare

Despite and perhaps because of the advances in biomedicine over the past few decades, chronic diseases, like heart disease, stroke, and diabetes are now rising in many places of the world and more worryingly they impose their heaviest burden on the poor and disadvantaged populations.

For example, poorer people are likely to suffer a heart attack about five to 10 years earlier than their affluent citizens. And their chances of surviving such events are lower. We know that simple medical therapy delivered on time can halve the risk of future heart attacks and strokes. But in many places of the world we are far away from reaching these targets.

Evidence suggests that it takes poorer people about twice as long to present to hospital after a heart attack than their affluent citizens; a delay in presentation that often decides over life and death.

The reasons behind such disparities are complex but one major barrier to the more widespread use of effective therapies is that many of them remain unaffordable for the poor. Catastrophic health expenditures and shortfalls in household incomes are now considered a major driver of poverty and inequalities in many regions of the world. Indeed, surging healthcare costs are not just a problem of the poor. There is hardly a country in the world that is immune to the growing healthcare costs.

In response to this challenge, there has been a growing interest and demand for investment in low-cost frugal health technologies. For example, some of the major health technology industries in China have been successfully working on the development and distribution of affordable diagnostics and therapeutics. The George Institute for Global Health is also devoting a major programme of research and development to frugal innovation.

But there is a common misconception about frugal technologies. Healthcare costs are determined not only by price of technologies but also by the volume of care. And it is the volume of care, ie. the amount of care that each patient receives that often derives the total expenditure.

Experience elsewhere shows that lowering the price per unit of technology will not have much impact on the overall spending. In fact, in most industries cheaper technologies have led to higher spending.

So, affordable health technologies are important and necessary but they are not sufficient. They will not have much impact on the surging healthcare costs unless we do also something about the quantity of care. However, the problem with quantity of care is that it is much harder to understand and control. What we have learned in the Western societies is that quantity of care does not correlate well with the quality or value of care.

The growth in healthcare is often chaotic and leads to rise in effective care as well as ineffective or potentially harmful care. What we commonly encounter is that underuse of effective therapies persists. In parallel, there is a rise in treatments such as vitamin supplements, traditional medicines or more expensive high-tech diagnostics, where there is little evidence for their value.

So increased access to healthcare is a double blessing. The lack of a rational growth means that it could worsen disparities in care because poorer people will then start spending more on healthcare compared to poor people in areas where per capita spending is less. So the solution is neither a simple rise nor a cut in quantity of care, but approaches that increase the value of care to patients.

Solutions need to make better use of new and affordable technologies as well as human resources to make knowledge, not healthcare, more accessible to consumers. Such a strategy promises an increase in the capacity of our health systems to better respond to the growing number of people with chronic conditions.