The coevolution of health care, public health, and technology in a comparative perspective

There is a widespread agreement amongst researchers and policymakers that the coevolution of technology and policy is an important topic. Scholars disagree, however, on the mechanisms that drive the coevolution of policy and technology as well as about the role institutions play in the coevolutionary process. With this paper, I contribute to this literature, in analyzing the coevolution of medical and health-related technologies with preventative and curative health policies. I use data on health reforms that distinguishes public health- and prevention-related reforms from health care policy changes, in Australia, Germany, Switzerland, the UK and the US during the period 1850-2010. My analysis reveals differences between the health care and public health policy sectors regarding the coevolution of policy and technology. In public health and prevention, the coevolution of technology and policy resulted in negative feedback effects that created a decline of public health once infections could be cured and the problem underlying the policy was resolved. On the other hand, regarding health care, there is a positive feedback loop regarding the coevolution of policy and technology. New possibilities to cure diseases resulted in the creation of health care policies, which, in turn, reinforced political support for research in health care. Political and economic institutions moderate the feedback effect of technology and policy. Liberal and open market economies, which have limited universal social insurance schemes, implemented more preventative public health policies as well as universal coverage health systems to shield citizens from health risks in a competitive labor market. Thus, they reduced the differences in the technology-policy feedback effects between health care and public health. On the other hand, countries with a social insurance system focused on a health care approach only and augmented the positive feedback effects between technology and policy in health care.