Diffusion of innovations in health care: does the structural context determine its direction?

ABSTRACT

OBJECTIVES: The aim of this study was to present and illustrate an instrument to measure the level of innovation at country level. METHODS: The data used are the Organisation for Economic Co-operation and Development (OECD) health data 2009, in particular the information on use of medical technology. Two composite scales expressing a relative level of adoption of innovations in health care are regressed, using multilevel regression analysis, on country characteristics. The country characteristics are selected as proxies on availability or scarcity of resources in a country. We expect that scarcity will promote adoption of innovations that enhance efficiency, and that availability of resources will promote advanced, expensive innovations. RESULTS: Two scales were constructed. One scale indicates the use of efficiency-enhancing innovations (day case treatment), and the other scale indicates availability of advanced technical innovations. The application of day case treatment is significantly associated with education level (+), the ratio of people aged 15-64 versus younger and older people (+) and the number of hospital beds (-). Availability of advanced medical devices are associated with the expenditure on health (+), demographic dependency (-), number of hospital beds (+), and the annual reduction of hospital beds (-). CONCLUSIONS: Diffusion of innovations is influenced by characteristics of the country and of the healthcare system; fewer resources encourage diffusion of innovations that enhance efficiency and more resources encourage diffusion of complex, expensive devices. This indicates that decisions by healthcare professionals on which innovation to adopt is embedded in a context that is influenced and shaped by the availability of resources on macro level.