Abstract
ObjectiveThis article examines what the adoption and use of advanced medical technologies – computed tomography (CT) and magnetic resonance imaging (MRI) – by public hospitals depend on and to what extent.MethodsFrom a sample of panel data for all public hospitals in the health service of Galicia (a subregion of the Galicia-North of Portugal Euroregion) for the 2010–2017 period, we grouped explanatory variables into inputs (resources), outputs (activities) and socio-demographic variables. Factor analysis was used to reduce as much as possible the number of analysed variables, discriminant analysis to examine the technologies adoption decision, and multiple regression analysis to investigate their use.ResultsFactor analysis identified motivators on adoption and use of CT and MRI medical technologies as follows: hospital inputs/outputs (Factor 1); radiology studies and adoption of CT by public hospitals (Factor 2); research/teaching role and big-ticket diagnostic and therapeutic (lithotripsy) technologies (Factor 3); number of transplants (Factor 4); cancer diagnosis/treatment (Factor 5); and catchment area geographical dispersion (Factor 6). Cronbach’s alpha of 0.881 indicated an acceptable degree of reliability of the factor variables. Regarding adoption of these technologies, Factor 1 is the most influential, explaining 37% of the variance and showing adequate global internal consistency, whereas Factor 2 is limited to 13% of the variance. In the discriminant analysis, values for Box’s M test and canonical correlations such as Wilks’s lambda for the two technologies underpin the reliability and predictive capacity of the discriminant equations. Finally, and according to the regression analysis, the factor with the greatest influence on CT and MRI use is Factor 2, followed by Factors 1 and 3 in the case of CT use, and Factors 3 and 5 in the case of MRI use.ConclusionCT and MRI adoption by public hospitals is mainly determined by hospital inputs and outputs. However, the use of both medical technologies is mainly influenced by conventional radiology studies and CT adoption. These results suggest that both choices – adoption and use of advanced medical technology – may be separate decisions as they are taken possibly by different people (the former by managers and policymakers and the latter by physicians).
Highlights
A significant percentage of increased hospital expenditure comes from the use of more inputs per unit of final output
To explain the maximum percentage of variance and an acceptable parsimony of the exploratory factor analysis, we set the percentage of explained variance to 86%, which is verified for the six factors detailed below: Factor 1: beds, surgical specialists, medical specialists, radiology specialists, emergency admissions, emergencies, admissions, surgeries, consultations, and average stay
We found that the socio-demographic factor is non-significant in explaining computed tomography (CT) use, whereas the opposite holds for magnetic resonance imaging (MRI) use
Summary
A significant percentage of increased hospital expenditure comes from the use of more inputs per unit of final output. The input that has experienced greatest growth in recent decades has been medical technologies [1], accounting for 33– 50% of increased healthcare spending [2]. While the adoption and use of new medical technologies improves the quality of medical care by improving health outcomes, those technologies contribute to the continuing rise in healthcare expenditure [3]. A crucial issue in determining healthcare policies in most OECD countries is the development and adoption of innovative medical technologies in a context of exacerbated healthcare spending resulting from major demographic changes linked to greater life expectancy and ageing. Puig i Junoy [5] suggest that innovation adoption in hospitals depends on the characteristics of the technology itself (i.e. the marginal advantage over the previously used technology), the objectives of the hospital as a firm (i.e. the characteristics of the entity adopting the technology), and the characteristics of the market
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