In the United States, the complex process of getting health care technologies into practice takes place in

a competitive health system that is driven by technological innovation. Federal, state, and local
governments’ roles in the diffusion process are limited. In low-income countries, where competitive
markets are not as prominent, diffusing medical innovations requires an alternative understanding of
how new technologies are adopted.

in low-income countries, the lack of functioning markets serves as a barrier to the transfer of necessary
health technologies

governments must act as stewards in promoting technologies there.

In the absence of organized markets, health technologies require a steward to promote diffusion.

THE ADOPTION OF NEW HEALTH TECHNOLOGY in the United States is largely dependent on features of
the technology itself, the ways in which communication is channeled, the reimbursement environment,
the features of organizations within which the technologies are used, and the attitudes and skills of
physicians. In this framework, as long as a new technology presents an improvement over an existing
one, it is likely to be diffused into practice because the health system functions without substantial
constraints. Because theoretical and empirical studies of technology diffusion have often focused on the
United States and other developed countries, the tendency has been to apply a similar model to low-
income countries. This paper addresses the need to develop an alternative understanding of the barriers
to the transfer of necessary health technologies in low-income countries, and the need for governments
to act as stewards in promoting technology diffusion in these systems.

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The U.S. and the U.K. have been the technological leaders over the last two centuries. Most of the major
technologies invented over the last two centuries have been invented either in the U.S. or in the U.K.
They also have adopted new technologies much faster than the rest of the world. The shorter adoption
lags have surely contributed to their high levels of productivity and per capita income.

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Rapid technological progress in developing countries has helped to raise incomes and reduce the share
of people living in absolute poverty from 29 per cent in 1990 to 18 per cent in 2004.

Despite these gains, the technology gap between rich and poor countries remains enormous and the
capacity of developing economies to adopt new technology remains weak

Nevertheless, developing countries have a long way to go, given that the level of technology that they
use is only one quarter of that employed in high-income countries.

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The United States has been the world leader in the commercialization of biotechnical knowledge,
although Germany, the

United Kingdom, and Canada appear to be beginning to close

the gap (Cooke, 2001). The main reasons for the United States’

success appear to be:

1. the existence of a large stock of human capital and research institutions

2. government support for basic research

3. well-enforced patent protection

4. historically generous insurance (third party) payers

5. extensively subsidized employer-based private insurance for the majority of its citizens

6. physicians and hospitals that are motivated to use the

highest technology available (Johnson-Lans, 2004)

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The availability of technology has a profound effect on thehealthcare costs and the availability of
medical care.Technologies such as drugs, medical devices, and proceduresmay offer cost savings or
higher quality services.

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Four stages are associated with the development and diffusion of medical technology. According to the
National Science Foundation, the first stage, basic research, is defined as research for the advancement
of knowledge without commercial motivations. Basic research produces new medical knowledge about
areas in biomedical sciences, for example. In the second stage, applied research, the basic knowledge is
applied to yield solutions for the prevention, treatment, or curing of diseases. At the clinical
investigation and testing stage, new medical technologies are tested on human subjects—the benefits
and safety of the technologies are tested at this point. The final stage, diffusion or imitation, involves the
commercial introduction, adoption, and spreading of medical technologies (Johnson-Lans, 2004).

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Health policy analysts have expressed concern that theunconstrained healthcare markets result in
medical technologies that offer low benefits at high costs (Aaron, 1991). To control costs, many
countries have adopted policies to eitherdirectly or indirectly control the adoption and diffusion
ofmedical technologies. Public control can be found at any oneor all four stages associated with the
invention and diffusion ofmedical technology (Banta and Kemp, 1982).

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