Abstract
OBJECTIVE. This study examines hospital motivations to acquire new medical technology, an issue of considerable policy relevance: in this case, whether, when, and why hospitals acquire a new capital-intensive medical technology, magnetic resonance imaging equipment (MRI). STUDY DESIGN. We review three common explanations for medical technology adoption: profit maximization, technological preeminence, and clinical excellence, and incorporate them into a composite model, controlling for regulatory differences, market structures, and organizational characteristics. All four models are then tested using Cox regressions. DATA SOURCES. The study is based on an initial sample of 637 hospitals in the continental United States that owned or leased an MRI unit as of 31 December 1988, plus nonadopters. Due to missing data the final sample consisted of 507 hospitals. The data, drawn from two telephone surveys, are supplemented by the AHA Survey, census data, and industry and academic sources. PRINCIPAL FINDING. Statistically, the three individual models account for roughly comparable amounts of variance in past adoption behavior. On the basis of explanatory power and parsimony, however, the technology model is "best." Although the composite model is statistically better than any of the individual models, it does not add much more explanatory power adjusting for the number of variables added. CONCLUSIONS. The composite model identified the importance a hospital attached to being a technological leader, its clinical requirements, and the change in revenues it associated with the adoption of MRI as the major determinants of adoption behavior. We conclude that a hospital's adoption behavior is strongly linked to its strategic orientation.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Alexander J. A., Morrisey M. A. Hospital-physician integration and hospital costs. Inquiry. 1988 Fall;25(3):388–401. [PubMed] [Google Scholar]
- Danzon P. M. Hospital 'profits': the effects of reimbursement policies. J Health Econ. 1982 May;1(1):29–52. doi: 10.1016/0167-6296(82)90020-0. [DOI] [PubMed] [Google Scholar]
- Fuchs V. R. The growing demand for medical care. N Engl J Med. 1968 Jul 25;279(4):190–195. doi: 10.1056/NEJM196807252790405. [DOI] [PubMed] [Google Scholar]
- Greer A. L. Adoption of medical technology. The hospital's three decision systems. Int J Technol Assess Health Care. 1985;1(3):669–680. doi: 10.1017/s0266462300001562. [DOI] [PubMed] [Google Scholar]
- Hillman A. L., Schwartz J. S. The adoption and diffusion of CT and MRI in the United States. A comparative analysis. Med Care. 1985 Nov;23(11):1283–1294. doi: 10.1097/00005650-198511000-00007. [DOI] [PubMed] [Google Scholar]
- Hillman B. D., Neu C. R., Winkler J. D., Aroesty J., Rettig R. A., Williams A. P. The diffusion of magnetic resonance imaging scanners in a changing U.S. health care environment. Int J Technol Assess Health Care. 1987;3(4):545–559. doi: 10.1017/s026646230001117x. [DOI] [PubMed] [Google Scholar]
- Luft H. S., Robinson J. C., Garnick D. W., Maerki S. C., McPhee S. J. The role of specialized clinical services in competition among hospitals. Inquiry. 1986 Spring;23(1):83–94. [PubMed] [Google Scholar]
- Manheim L. M., Feinglass J., Shortell S. M., Hughes E. F. Regional variation in Medicare hospital mortality. Inquiry. 1992 Spring;29(1):55–66. [PubMed] [Google Scholar]
- Romeo A. A., Wagner J. L., Lee R. H. Prospective reimbursement and the diffusion of new technologies in hospitals. J Health Econ. 1984 Apr;3(1):1–24. doi: 10.1016/0167-6296(84)90023-7. [DOI] [PubMed] [Google Scholar]
- Steinberg E. P., Sisk J. E., Locke K. E. The diffusion of magnetic resonance imagers in the United States and worldwide. Int J Technol Assess Health Care. 1985;1(3):499–514. doi: 10.1017/s0266462300001446. [DOI] [PubMed] [Google Scholar]