Commentary: Why the reservations about medical technology?

Medical technologies could improve patient care in at least three ways by: decreasing costs, increasing quality of care, and increasing accessibility or convenience. Yet, they have come under increasing criticism. First of all, they tend to raise rather than lower costs at a time of much concern about rising costs of medical care. Forces leading to increased costs from medical technology use are numerous and include: 1) protechnology reimbursement biases; 2)medical manpower trends; 3) patterns of technology use; 4) changes in patient characteristics; 5) excess supply of hospital beds; 6) methods of hospital reimbursement and insurance coverage; 7) ethical issues; 8) incentives in medical academia; 9) difficulties in broad technology assessment; 10) malpractice fears; and 11) the news media. While evidence is strong that medical technologies increase cost, it is less clear how much they improve quality, especially if one distinguishes technical improvements from improvements in patient outcomes. There is also increasing concern that medical technologies can "dehumanize" patient care as well as cause direct harm. Finally, it is not clear that medical technologies have as yet improved access to care. The current era of constrained resources means that both developers and users of medical technologies will be held accountable for demonstrating their benefits and justifying their costs.