Eugene W. Caldwell Lecture. Technology: the key to controlling health care costs in the future.

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Abstract
The American health care financing system is in a state of crisis. The rising cost of health care and the progressive difficulty Americans are experiencing in accessing the system have produced a great national debate concerning the future of medicine in America. Current health care cost trends, which are not sustainable, are projected to consume 37% of the gross national product by the year 2030. The financing system that supports the health care system is failing. The number of uninsured residents is growing more than twice as fast as the number with health insurance. The legitimate concern about the spiraling cost for medicine has focused attention on seeking root causes. Critics have focused on technology as the single most important factor in driving the cost trends in medicine upward. They have concluded that "long-term control of the rate of increase in expenditures requires that we curb the development and diffusion of clinically useful technology." These critics have not made their case, because they base their conclusions on hospital-derived data. These data are inaccurate because of the phenomenon of "cost-shifting." The critics do not examine the important issue of productivity and do not have reliable data on the costs and benefits of new technologies. Finally, the critics do not take into account the issue of use and abuse of technology. This is particularly important in the ambulatory environment. To break the health care cost spiral, radiologists, as the keepers of new technology, must commit themselves to at least four fundamental initiatives. The current American hospital-based health system must be replaced with an ambulatory system; productivity must be the primary business goal for radiologists; pricing of new services should reflect actual resources consumed, not the in-patient services displaced; and radiologists must reassert their role as doctors' doctors. The health care cost spiral is a real national crisis. The mission for radiology is to introduce the minimally invasive, ambulatory system of the future. The costs for delivering care within the new system will be a fraction of former costs. My assignment is to present a perspective on the role radiology must play in introducing new imaging technology to medicine. One of the distinguishing features of American society is its fascination with technology. It is only natural that the American health care system reflects this orientation.

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