When a phone is cheaper than a medical test

In the last 15 years, digital technology has grown, mobile phone charges have dipped, allowing almost everyone to own a mobile phone. This has apparently led to increased availability of cheap and affordable services in almost all sectors of economy, except in medical field.

Looking at it closely, one will realise that the same creativity in digital technology has not been applied in making the provision of medical services affordable. The same technology has rather “failed miserably” in making medicines, medical products and health services cheap.

The cost of most consumer goods that are essentially the products of digital technology (laptops, cameras, DVD players, television sets, video games etc) has remarkably gone down, leading to more people affording them.

But the cost of medical facilities such as ultrasound machines, echocardiography, digital ECG, and others which employ the digital technology that is similar to that of mobile phones, have remained substantially high or have increased in the past decade.

Let’s first look at how Tanzanians own mobile phones, and here, we will apply Moore’s law, an observational law made by Intel co-founder Gordon Moore in 1965.

This law can be used to predict that every two years the cost of computing will fall by half due to new advances in technology—and precisely this is what has been happening throughout the world for the past fifteen years.

According to the data from Tanzania Communication Regulatory Authority (TCRA), in 2000 Tanzania had 110,518 mobile subscribers; this means that each district in Tanzania at that time had 650 residents who owned mobile phones.

Fifteen years later the number of mobile users soared to 39, 808, 419, this is according to TCRA’s report of 2015. This simply means that every person in Tanzania who is above five years of age owns a mobile phone.

Are you surprised? They say numbers don’t lie and that is what the numbers are telling us, the estimated population of Tanzania right now is 47 million and 8 million are children under five years of age that means 39million people are above five years of age which is the exact number of people owning mobile phone in Tanzania right now.

Now the question is: Why are we not seeing the same growth and relief in medical technology?

Well, the main reason is that the consumers of interest to the manufacturing companies in medical technology products are not me and you, but the governments, private hospitals, research institution and regulatory agencies.

Since the purchasers of these products are “institutions” with big shots, it makes the manufacturing companies reluctant to invest in a kind of technology that can make their products affordable. The first-hand buyers (consumers) simply have money.

Most multinational companies that manufacture medical devices are not convinced about the market strategy of producing medical devices to target the market in poor countries.

They do not seem to be inspired by the success story of the cell phone technology. A generous profit margin for every individual item is still the most important strategy used to offset research, development and marketing costs.

These companies are not completely convinced that “economics of scale” with small profit margins for every unit can be applied to their products. They often use similar strategies as they would in developed countries.

Should an ordinary Tanzanian citizen worry that the medical technology costs have struck high? This is a million dollar question, which deserve a million dollar answer but unfortunately there is only one simple answer to it, and that is, “a Tanzanian has to be worried.”

Currently in Tanzania, private hospitals are in some kind of a technological race with the sole purpose of increasing their customer base.

The managers in private hospitals have learned installation of state of art technology in their facilities is the charm which works best.

Truth be told, there is nothing more soothing for doctors like reading a quality x-ray or CT scan film and for this reason it has become a common practice for doctors in public hospitals to refer their patients to private hospitals for investigations even though same investigations can be performed in their public hospitals.

At a small pace public hospitals are also trying to keep up with new technology. Some of the regional and district hospitals for the past two years have started adopting information communication technology system (ICT) in their operations.

The newly established public institute such as the MUHAS academic medical centre, Mloganzila campus and the Benjamin Mkapa Hospital in Dodoma were started with a clear vision of embracing the state of art technology in their operations.

It is certain that medical technologies will results in improvement of patients care, better health and longer life but there is a catch to it, economists and researchers agree the adoption of new technology or intensive use of old one, account for 40-50 per cent of health care costs, in country like Tanzania where health insurance coverage is minimal, all the costs will be reflected to patients and their families.

An ordinary citizen has reasons to get worried because he/she is the one who will pay for the costs of purchasing the technology and furthermore he/she will have to pay the costs of the services.

Availability of technology at the disposal promotes overuse of it and sometimes it is used unnecessarily and unreasonably.

In both public and private hospitals, doctors are encouraged to order as many investigations as possible so as to increase the revenue of the health facility.

But on the other hand, physicians order unnecessary tests with the hopes of gaining the patient’s trust and making them feel comfortable with their decision on the diagnosis.

I agree that medical technology is very important for improving quality of life so it is responsibility of everyone (i.e. the government, health care professionals, insurance companies, and patients) to work as a cohesive team to keep technology from making medical costs skyrocket.

Dr Katengesha is a medical doctor currently based in Sweden.