Since 1992, the NextMed/MMVR conference has gathered researchers who create tools that improve medical care and education. Engineers, clinicians, scientists, educators, industry, military, and students come to share, learn, evaluate, and nurture progress. Their mission is to improve healthcare outcomes and efficiency through computing and networking technologies—products of the IT industry.

These researchers also participate in the healthcare crisis that the United States and, to a lesser extent, other developed countries now face: how to meet the public's high expectations of care when costs are precariously high.

Multiple factors have elevated these expectations. Baby Boomers are entering retirement after a lifetime of viewing ads that promise them “golden years” invigorated by science. Competition for affluent patients means hospital ads never admit a tacit truth: “Yes, our experienced doctors treat people with fancy machines, but some still die or never improve”. The media glowingly report on patients saved by dedicated physicians, and people believe they can buy miracles with sufficient talent and technology. Meanwhile, a convoluted reimbursement system obscures the true cost of care, individually and collectively.

The cost of care is steadily increasing, too. In the United States, the chronically ill of all ages—five percent of the population—consume half of all healthcare spending. Many of these patients suffer from lifestyle diseases that proliferate in synch with modernization. Aging Boomers will exacerbate this increase as they approach the inevitable during the next decade or so. Granted, human nature compels us to fight illness by any means possible—without weighing the financial toll beforehand. (If a TV medical drama included accountants in the ER who tabulated invoices while doctors saved lives, it would morph into a dark comedy that's not too far from reality.) However, when we extend lives with innovative therapies but don't completely heal, the economic burden can accumulate impressively.

And unfortunately, the American public's return on investment—healthier lives per dollars spent—is poor. Again, several factors are at play. Opaque and monopolistic healthcare pricing obstructs comparison between providers, so inefficiencies stand uncorrected. In addition, the insurance industry takes a large cut of healthcare spending without actually providing any care. Furthermore, American culture tends to underrate prevention, but value dramatic interventions. (How many cardiac stents and insulin pumps could we eliminate with better dietary education?) And when the public expresses discontent and asks the government to improve the current system, the methods to effect change become stubbornly politicized. Naturally, players already making a lot of money protect their advantage; political expediency influences how healthcare profits remain private and losses become socialized.

Caregivers, hospitals, drugs, and devices are limited and valuable resources that merit significant investment. In order to protect these resources and improve our investment, though, we need to resolve the key issue at hand: how much more can the public pay for care without damaging the rest of the economy? Clearly, we require greater efficiency.

Scientists and engineers also form part of the relationship between healthcare invention, patient expectations, and increasing expenditure. They tackle healthcare problems focusing chiefly on scientific solutions. But science is also a business, so following successful discovery and regulatory approval, corporations must recoup R&D and fund future research. Their aggressive marketing of new products maximizes sales, and pricing reflects what the market will bear, yet FDA approval doesn't guarantee that a new therapy is the most cost-effective option available. Return on investment—from the public's standpoint—appears to be an afterthought.

Although the technologies shared at NextMed/MMVR capitalize on the increasing capabilities and decreasing costs pioneered by the IT industry, researchers can further help patients by aiming for not just a cure, but a cure patients can afford. No one wants to dampen ingenuity, but could researchers take into account the future costcompetitiveness of the investigated solution?

Can engineers and scientists, for example, collaborate with healthcare providers (including those ER accountants tabulating in the background) to understand what patients need, clinically and economically? Can their differing perspectives reduce misguided efforts and improve the economic viability of the cure? At NextMed/MMVR, we believe they can. In fact, interdisciplinary collaboration has been a conference objective since 1992, and it remains as important as ever.

To the many researchers who contributed papers for this volume, thank you for the tremendous effort and ingenuity you have invested in improving healthcare, and for presenting your work at this conference.

Acknowledgment

Many thanks to Dr. Patrick Cregan, a member of the NextMed/MMVR Organizing Committee, for sharing his enthusiasm for healthcare economics and some useful references on the topic.

James D. Westwood

Aligned Management Associates, Inc.