Changing payment instruments and the utilisation of new medical technologies

Abstract

This paper empirically investigates the impact of additional reimbursement instruments on the diffusion of new technologies in inpatient care. Using 2010-2014 German panel data on hospital level for every patient undergoing coronary angioplasty, this study examines the utilisation of drug-eluting balloon catheters (DEB) over time while additional payment instruments changed.Hypothesising that the utilisation of DEB increased abruptly when a new reimbursement instrument came into force, we estimate a fixed effects regression comparing years with a change and years where the reimbursement instrument remained the same. The model is adjusted for patient age and severity of the disease. The utilisation of DEB increased from 8,407 in 2010 to 19,065 in 2014. Hospitals used significantly more DEB when an additional payment instrument changed compared to years when it remained the same. The increase was roughly twice as large. In short, hospitals are incentivised to utilise new technologies if the reimbursement changes to an instrument that is designed in a more reliable way, e.g. including less bureaucracy or guaranteeing fixed prices.

Implementation of innovative medical technologies in German inpatient care: patterns of utilization and evidence development

“…However, the perceived relative advantage to current practice appears to be the subjective result of debate among health professionals and not a rational assessment based on credible evidence [ 13 , 17 ]. Indeed, previous research demonstrates that adoption and diffusion of innovations depend only partially on scientific evidence [ 18 ] and are shaped by many intra- and extra-organizational factors [ 19 , 20 ], not least environmental factors such as financial incentives [ 21 ].…”

Implementation of Innovative Medical Technologies In German Inpatient Care: Patterns of Utilization And Evidence Development

“…To understand technology adoption, an in-depth exploration of factors related to the technology itself, its potential adopters, and the context is necessary [28,29]. The importance of considering elements such as previous experience of users and nancial incentives has been established [18,20,30]. However, the (potential) in uence of scienti c evidence on the technology's safety and effectiveness has largely been explored theoretically, or only for isolated examples of technologies.…”

“…According to our analyses, there is little need to accelerate innovation processes as only eight percent of the years analyzed show an underadoption of technologies. However, this swift introduction of innovations without proof of bene t should be accompanied by meaningful clinical studies to evaluate these technologies as they are used [20]. This requires high personnel and nancial resources, de facto limiting the conduct of clinical trials to large (university) hospitals.…”

“…As mentioned, the level of reimbursement signi cantly in uences the utilization of new technologies in German healthcare [20,33]. Thus, the diffusion of innovative technologies could be managed if reimbursement of technologies were determined according to the bene t they provide.…”

“…However, the perceived relative advantage to current practice seems to be the subjective result of debate among health professionals and not a rational assessment based on credible evidence [12,16]. Indeed, previous research demonstrates that the implementation and diffusion of innovations depends only to some extent on scienti c evidence [17] and is shaped by many intra-and extra-organizational factors [18,19], not least environmental factors such as nancial incentives [20].…”