Diffusion of diagnostic medical devices and policy implications for India.
OBJECTIVE
This study describes the diffusion of advanced diagnostic devices in India and assess implications for efficiency in resource use and equity.


METHODS
Commodity-level import statistics, household survey data, and interviews with medical device sellers are used to assess the spread of diagnostic devices. Published qualitative evidence, case studies of diagnostic service providers, and cross-country analyses are used to identify the reasons underlying the spread of medical devices in India. Case studies of public and private providers and data from 150 hospitals in one Indian state are used to assess efficiency in resource use and the distributive impacts of diagnostic devices.


RESULTS
High-end medical device inflows rose during the 1990s, with both supply- and demand-side factors influencing this trend. Although our results suggest that the overall quantity of advanced diagnostics in India is not excessive, there is some evidence of inefficiency in public facilities and possibly unethical practices in private diagnostic facilities. The unequal geographical distribution of magnetic resonance imaging facilities, coupled with inefficient use of medical devices in public facilities suggests inequality in access.


CONCLUSIONS
The study points to major regulatory gaps and health system inefficiencies and suggests ways in which these gaps can be addressed.
Mahal
Ajay
A
Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA. amahal@hsph.harvard.edu
Varshney
Anil
A
Taman
Srinivas
S
D019719:Diagnostic Equipment; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D015276:Health Care Rationing / Q000458:organization & administration*; D006291:Health Policy; D006292:Health Priorities / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007194:India; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000458:organization & administration*