Medical innovation and the sustainability of health systems: A historical perspective on technological change in health

Abstract

New medical technology challenges the sustainability of healthcare systems in several countries. Drawing on secondary sources of data, the aim of this article is to generate a better understanding of the historical Research & Development dynamics that have contributed to shape today’s medical innovation ecosystem. We describe key technological achievements along three historical periods – the 1950s, the 1980s and the 2000s – and situate them within their broader political, social, cultural and economic contexts. Our analyses bring forward self-reinforcing dynamics between technology, medical specialization, individualization of disease and the concentration of resources in academic teaching centres. We argue that the way medical innovation has been financed, designed and commercialized since the 1950s has engendered path dependency, which exacerbates the sustainability challenges healthcare systems are now facing. We conclude on the need for innovation design principles that could protect the sustainability of healthcare systems.