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Cost-effectiveness of imaging services in India
Cost-Effectiveness of Imaging Services in India Sudarshan K. Aggarwal, MD
n India i significant advances in imaging science have been paralleled by use of new technology. Unfortunately, this has had an adverse effect on the equitable distribution of the available funds in health care. In siudies of cost-effectiveness, a regional view of the goal of diagnostic rad!ology is almost always taken. If we are to serve patients' needs well, however, it is time we take a global view of this problem of outcome versus diagnostic efficacy. The popular use of any new technology is bound to have a worldwide impact, regardless of need, and industry continues to promote new products without consideration of local needs or socioeconomic conditions. Radiologic services are not available in many parts of rural India, and in cities, where most of the equipment is concentrated, it is grossly misused with total disregard of cost-effectiveness. Lack of funds for maintenance and lack of availability of trained professional and technical staff exacerbate tile difficulties of cost-conscious and ethical use of resources. Money is available and equipment is purchased for nonproductive research purposes, but it is my belief that research is primarily a rich country's privilege and a p o o r country's burden. It is difficult to witness patients without services, w h e n m o n e y is being spent on research that never seems to see the light of day. Solutions to these problems require rational choices and tight control of the purchase of expensive equipment, along the lines of the Australian model. For technology to be used effectively, the likely applications and the availability of trained operators must be taken into consideration, and manufacturers supplying equipment must take the responsibility to do so. Ethical business decisions should be based on the country's need and on its ability to make use of the equipment (i.e., the availability of trained personnel). Boih governmen t and industry need to take it upon themselves to train a sufficient number of radiologists and technicians, so that, in any given clinical setting, it is the radiologist, not tile clinician, w h o is responsible for planning the imaging protocol. An often ignored, but essential element of cost-effective use of equipment is that it be in working order. At tile time of purchase, adequate funds must be set aside for maintenance and upkeep.
I increas~g
S128
From the Diwan Chand Satya Pal Aggarwal Imaging Research Centre, New Delhi, India. Address reprint requests to S. K. Aggarwal, MD, Diwan Chand Satya Pal Aggarwal Imaging Research Centre, 10-B Kasturba Gandhi Marg, New Delhi 110001, India. Acad Radiol 1996;3:$128
9 1996, Association of University Radiologists
n India i significant advances in imaging science have been paralleled by use of new technology. Unfortunately, this has had an adverse effect on the equitable distribution of the available funds in health care. In siudies of cost-effectiveness, a regional view of the goal of diagnostic rad!ology is almost always taken. If we are to serve patients' needs well, however, it is time we take a global view of this problem of outcome versus diagnostic efficacy. The popular use of any new technology is bound to have a worldwide impact, regardless of need, and industry continues to promote new products without consideration of local needs or socioeconomic conditions. Radiologic services are not available in many parts of rural India, and in cities, where most of the equipment is concentrated, it is grossly misused with total disregard of cost-effectiveness. Lack of funds for maintenance and lack of availability of trained professional and technical staff exacerbate tile difficulties of cost-conscious and ethical use of resources. Money is available and equipment is purchased for nonproductive research purposes, but it is my belief that research is primarily a rich country's privilege and a p o o r country's burden. It is difficult to witness patients without services, w h e n m o n e y is being spent on research that never seems to see the light of day. Solutions to these problems require rational choices and tight control of the purchase of expensive equipment, along the lines of the Australian model. For technology to be used effectively, the likely applications and the availability of trained operators must be taken into consideration, and manufacturers supplying equipment must take the responsibility to do so. Ethical business decisions should be based on the country's need and on its ability to make use of the equipment (i.e., the availability of trained personnel). Boih governmen t and industry need to take it upon themselves to train a sufficient number of radiologists and technicians, so that, in any given clinical setting, it is the radiologist, not tile clinician, w h o is responsible for planning the imaging protocol. An often ignored, but essential element of cost-effective use of equipment is that it be in working order. At tile time of purchase, adequate funds must be set aside for maintenance and upkeep.
I increas~g
S128
From the Diwan Chand Satya Pal Aggarwal Imaging Research Centre, New Delhi, India. Address reprint requests to S. K. Aggarwal, MD, Diwan Chand Satya Pal Aggarwal Imaging Research Centre, 10-B Kasturba Gandhi Marg, New Delhi 110001, India. Acad Radiol 1996;3:$128
9 1996, Association of University Radiologists