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38670 results in Cambridge Textbooks

Page 1519 of 1934

  • Focus on Value

  • Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
  • Book:
    Biodesign
    Published online:
    11 May 2018
    Print publication:
    02 February 2015, pp 1-6

  • Summary

    What do we mean by “value” and why is it so important?

    The escalation of healthcare costs is one of the major economic and political issues of our time. The problem is most apparent in the United States, where healthcare as a share of the economy has more than doubled over the past 35 years. Spending on health accounted for 7.2 percent of the nation's gross domestic product (GDP) in 1970, expanded to 16 percent in 2005, and is projected to be as high as 20 percent of GDP by 2015.

    Simply put, the US economy cannot sustain this spending trajectory, which has outpaced GDP growth for years (see Figure V1). The problem is not just straining the federal budget: state and local governments have been forced to reduce support for education, infrastructure, and other critical expenditures as they struggle to fund Medicaid and other health programs. In the private sector, the cost of employment-based health insurance is one of the main reasons workers have seen their wages stagnate.

    Despite the fact that the US spends two-and-a-half times more per capita on health than most developed countries, it does not necessarily provide the best care to its citizens. In 2000, when the World Health Organization ranked the health systems of its 191 member states for the first time ever, the US found itself in 37th position. In a more recent study that compared the US to Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom on measures of quality, efficiency, access to care, equity, and the ability of citizens to lead long, healthy lives, America occupied last place. As the report pointed out, “While there is room for improvement in every country, the US stands out for not getting good value for its healthcare dollars.”

    Against this backdrop, economists, researchers, and policy makers alike have pointed to medical technology as a dominant factor driving increased health expenditures in the US.

  • China

  • Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
  • Book:
    Biodesign
    Published online:
    11 May 2018
    Print publication:
    02 February 2015, pp 14-17

  • Summary

    Background

    China is perhaps the most impressive economic development story in modern history. Sustaining annual growth rates upwards of 9 percent for more than two decades, the country's gross domestic product (GDP) reached US$8 trillion in 2012 (second only to the United States at US$16 trillion). This remarkable expansion has lifted hundreds of millions of Chinese out of poverty and created a new middle class that is larger than the entire US population.

    With more than 1.35 billion people, China has the largest citizenry in the world. In 2011, the country's urban population surpassed its rural population for the first time, with close to 700 million people living in China's cities. Population growth in China has decreased steadily over the last 20 years due to the controversial one-child policy (from approximately 1.2 percent to less than half of one percent) and is expected to continue to decline. The country's median age is just 35 years, compared to nearly 40 years in more developed countries. However, as a whole, the population is aging rapidly; senior citizens will account for as much as 35 percent of the Chinese people by 2053.

    One of the most important challenges facing China in the twenty-first century is how to allocate healthcare resources for its massive population. Despite progress in the country's economic transformation, China significantly lags the developed world in its ability to provide even basic health services to the vast majority of its people. The Chinese government spent approximately 5 percent of GDP on healthcare in 2011, compared to roughly 18 percent spent in the US and 9 percent on average in the OECD countries. Per capita spending on medical technologies is just US$ in China versus US$399 in the US.

    China's centrally planned economy provides health insurance coverage to approximately 90 percent of the population under three primary programs (an employer-based system, one for urban residents, and another covering the rural population). These insurance schemes are largely inadequate to cover basic care but rather focus on protecting patients from catastrophic health events. As a result, the Chinese typically pay for basic health services out-of-pocket, causing many individuals to delay diagnosis and treatment until they are critically ill.

  • India

  • Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
  • Book:
    Biodesign
    Published online:
    11 May 2018
    Print publication:
    02 February 2015, pp 23-27

  • Summary

    Background

    South Asia is generally considered to include Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Over the past 20 years, the region has experienced robust economic growth, averaging 6 percent per year. As a result, poverty rates have declined, with the percentage of South Asians living on less than US$1.25 per day decreasing from 61 percent to 36 percent between 1981 and 2008. While the region is still home to approximately 44 percent of the developing world's poor, growth and development in South Asia are expected to continue.

    The largest and most influential country in the region is India. With approximately 1.3 billion people, India is the fourth largest global economy by purchasing power parity (PPP). India's gross domestic product (GDP) reached nearly US$2 trillion in 2012, and it is expected to continue increasing at a healthy rate as the country further integrates into the global economy. Growth will also be driven by increased domestic demand as India's burgeoning middle class expands from roughly 50 million in 2007 to almost 600 million people between by 2025.

    India's healthcare system is plagued by low spending levels. Healthcare expenditure per capita was only US$59 in 2011. The country's private and public sector combined spent only about 4 percent of GDP on healthcare in 2011, although the government is planning to increase its share from 1.4 percent to 2.5 percent of GDP over the next five years. In the past half-century, India's public sector has steadily given up market share to the private sector in providing healthcare. Accordingly to one study, the private sector accounted for over 90 percent of all hospitals, 85 percent of doctors, 80 percent of outpatient care, and almost 60 percent of inpatient care.

    Fortunately, India's private sector has been responsible for some remarkable innovations in healthcare delivery. Several major hospital systems in the country are able to deliver high-quality outcomes at a fraction of the cost of care in developed country settings. For instance, one cardiac care center offers open-heart

    surgery for less than US$2,000 per patient, with outcomes similar to those at US-based centers where the price tag can exceed US$100,000.

  • Japan

  • Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
  • Book:
    Biodesign
    Published online:
    11 May 2018
    Print publication:
    02 February 2015, pp 28-31

  • Summary

    Background

    At nearly US$6 trillion, Japan has the third largest gross domestic product (GDP) in the world, after the US and China. Real GDP grew at about 1.9 percent in 2012, and it is projected to expand at roughly one percent per year through 2020. The Japanese economy was badly hit by the global recession in 2008–2009 and the massive tsunami in 2011, and it continues to suffer from persistent deflation. Japan's economy has been led by the advanced manufacturing sector, which generates strong export activity. However, the country is looking to bolster domestic demand in order to drive increased growth.

    The population of Japan, at more than 128 million people, is decreasing about 0.2 percent each year. Trends indicate that the country's total inhabitants will decline by almost 30 percent by 2060 due to a low birth-rate, limited immigration, and an aging population. Approximately 23 percent of the Japanese people were over 65 years of age in 2012; by 2060, more than 40 percent of the population will be senior citizens. As the population ages, cancer, heart disease, and pneumonia have become the country's leading causes of death.

    The Japanese universal healthcare system, known as kaihoken, has been lauded for increasing the quality of life of the Japanese people and is cited as a key reason the Japanese have the longest life expectancy in the world. However, increasing healthcare costs, in combination with the country's rapidly aging population and slow-growth economy, are creating the need for reforms and cost cutting. Japanese patients tend to visit physicians more frequently than their counterparts in the US (13.2 versus 3.9 appointments per person per year). And their hospitals stays are significantly longer (18.8 versus 5.5 days). Japan also has three times as many acute care hospital beds per 1,000 people (8.1 versus 2.7). Moreover, Japanese expenditures on medical devices are the highest in Asia at US$165 per capita, compared to just US$10 per capita in China.

  • Preface

  • Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
  • Book:
    Biodesign
    Published online:
    11 May 2018
    Print publication:
    02 February 2015, pp ix-xiv

  • Summary

    There is no greater satisfaction than seeing a patient being helped by a technology that you've had a hand in creating. And thanks to continuing advances in science and technology, healthcare is more open for innovation than at any time in history.

    Despite this promise, however, medical technology innovators face significant hurdles – especially in the new era of cost containment. If not managed skillfully, patents, regulatory approval, reimbursement, market dynamics, business models, competition, financing, clinical trials, technical feasibility, and team dynamics (just to name a few of many potential challenges) can all prevent even the best idea from reaching patient care.

    So, where should you begin as an innovator? What process can you use to improve your chances of success? What lessons can you learn from the inventors, engineers, physicians, and entrepreneurs who have succeeded and failed in this endeavor before? This book delivers practical answers to these important questions.

    Who should read it and why?

    Biodesign: The Process of Innovating Medical Technologies provides a comprehensive roadmap for identifying, inventing, and implementing new medical devices, diagnostics, and other technologies intended to create value for healthcare stakeholders. It has been written to be approachable for engineering, medical, and business students at both the undergraduate and graduate level, yet comprehensive and sophisticated enough to satisfy the needs of experienced entrepreneurs and medtech executives. For instructors, it provides a proven approach for teaching medical technology innovation that begins pre-idea and extends through preparing for commercialization. It is ideally suited to support team-oriented, project-based learning experiences in academic and industry settings.

    The text describes the biodesign innovation process, which we initially developed to support the biodesign innovation and fellowship programs at Stanford University. Over 13+ years, the process has been built and refined based on:

  • • Presentations and mentoring by more than 200 industry leaders who have participated in our training programs

  • • Our experience advising more than 150 project teams that have applied the process to their work

  • • Feedback from those who have learned the process through our executive education courses, as well as input and suggestions from students, fellows, instructors at other universities, and industry representatives using the first edition of the book

  • • Extensive field-based research

    • Our confidence that the process is effective is based on the results of the students and fellows trained at Stanford and through our university-based partnerships in India and Singapore.

  • Global Perspectives

  • Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
  • Book:
    Biodesign
    Published online:
    11 May 2018
    Print publication:
    02 February 2015, pp 7-9

  • Summary

    A world of opportunity …

    Although the United States and Europe remain global leaders in medical technology innovation, the story of the medtech sector has become much more diverse in recent years as healthcare has become a global priority. Inventors and companies in countries around the world are playing an increasingly important role in sourcing ideas, designing and developing them into viable products and services, and introducing them into patient care. In parallel, device sales in developing countries are expanding at a rapid pace. As the US and Europe both sustain growth rates in the low single digits, medtech revenues in countries such as India and China are forecast to increase at a compound annual growth rate of 14 percent and 26 percent, respectively.

    The global transformation of the medtech sector has been driven by multiple, interrelated factors. In developed markets, health systems are actively seeking to slow health spending associated with medical technologies as they become more cost conscious and attuned to the value these products deliver. Moreover, as the time, expense, and complexity of developing new solutions in environments like the US continues to increase, innovators are moving offshore and creating new innovation hubs in locations around the world.

    In developing markets, disease profiles are shifting from infectious to chronic conditions, which makes diagnostic and device solutions a more important part of efforts to meet the healthcare needs of patients. Governments and private healthcare providers alike are increasing health-related spending (see Figure G1). And innovators and companies in low-resource settings are becoming leaders in inventing more affordable solutions that enable care delivery in any setting and reduce (rather than increase) its cost.

    Medtech innovators can certainly find compelling opportunities in both environments.

    In developing markets, disease profiles are shifting from infectious to chronic conditions, which makes diagnostic and device solutions a more important part of efforts to meet the healthcare needs of patients.

  • Latin America

  • Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
  • Book:
    Biodesign
    Published online:
    11 May 2018
    Print publication:
    02 February 2015, pp 32-38

  • Summary

    Background

    Latin America includes approximately 20 countries in North, South, and Central America and the Caribbean. In contrast to most of the United States and Canada, Latin languages – mainly Spanish and Portuguese – are primarily spoken in the region.

    While economic growth varies substantially across Latin America, the gross domestic product (GDP) growth in the region as a whole increased by an average of 5 percent from 2000 to 2008, and decreased to closer to 3 percent subsequently. Brazil and Mexico are the largest economies, accounting for roughly 65 percent of region's combined GDP. Globally, Brazil and Mexico have the 7th and 14th largest GDPs, respectively.

    Economic gains have stimulated increases in consumption, population, and longevity, as well as more demand for adequate healthcare by a growing middle class. This, in turn, has led to enhanced opportunities in the public and private healthcare markets and increased investment in healthcare access and infrastructure. Concurrently, Latin America has experienced a rise in the prevalence of chronic diseases across the region. Mortality due to cardiovascular diseases alone is predicted to increase by 145 percent between 1990 and 2020. Healthcare expenditure per capita in the region hovers around US$661, compared to approximately US$8,600 in the United States, suggesting future room for expansion.

    As a whole, Latin America has a medical technology industry valued at more than US$8 billion, which makes it one of the larger global markets. Moreover, medical device sales have been expanding at a rate of more than 10 percent per year in the region. Based on their size, Brazil and Mexico comprise the most important medical device markets in Latin America and, accordingly, will be covered in more detail below. However, Colombia has the fastest growing medtech market, with a projected 2013–2018 compound annual growth rate of 13.3 percent. This market is forecast to reach US$2.2 billion in 2018. Chile and Peru are among the region's top economic performers, but both of these countries represent small markets for medical devices. Argentina and Venezuela have demonstrated a higher demand for medical technologies, yet both countries are experiencing serious macroeconomic challenges that are hindering continued medtech expansion.

Page 1519 of 1934