The Effect of Physician and Hospital Market Structure on Medical Technology Diffusion

Pinar Karaca-Mandic, Robert J. Town, Andrew Wilcock

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To examine the influence of physician and hospital market structures on medical technology diffusion, studying the diffusion of drug-eluting stents (DESs), which became available in April 2003. Data Sources/Study Setting: Medicare claims linked to physician demographic data from the American Medical Association and to hospital characteristics from the American Hospital Association Survey. Study Design: Retrospective claims data analyses. Data Collection/Extraction Methods: All fee-for-service Medicare beneficiaries who received a percutaneous coronary intervention (PCI) with a cardiac stent in 2003 or 2004. Each PCI record was joined to characteristics on the patient, the procedure, the cardiologist, and the hospital where the PCI was delivered. We accounted for the endogeneity of physician and hospital market structure using exogenous variation in the distances between patient, physician, and hospital locations. We estimated multivariate linear probability models that related the use of a DES in the PCI on market structure while controlling for patient, physician, and hospital characteristics. Principal Findings: DESs diffused faster in markets where cardiology practices faced more competition. Conversely, we found no evidence that the structure of the hospital market mattered. Conclusions: Competitive pressure to maintain or expand PCI volume shares compelled cardiologists to adopt DESs more quickly.

Original languageEnglish (US)
Pages (from-to)579-598
Number of pages20
JournalHealth services research
Volume52
Issue number2
DOIs
StatePublished - Apr 1 2017

Fingerprint

Percutaneous Coronary Intervention
Drug-Eluting Stents
Technology
Physicians
Medicare
American Hospital Association
Insurance Claim Review
Fee-for-Service Plans
Information Storage and Retrieval
American Medical Association
Cardiology
Stents
Linear Models
Retrospective Studies
Demography
Pressure
Cardiologists

Keywords

  • Market structure
  • medical technology diffusion

Cite this

The Effect of Physician and Hospital Market Structure on Medical Technology Diffusion. / Karaca-Mandic, Pinar; Town, Robert J.; Wilcock, Andrew.

In: Health services research, Vol. 52, No. 2, 01.04.2017, p. 579-598.

Research output: Contribution to journalArticle

@article{9992b1a6fe014dd4b6ecb8f4b125abfd,
title = "The Effect of Physician and Hospital Market Structure on Medical Technology Diffusion",
abstract = "Objective: To examine the influence of physician and hospital market structures on medical technology diffusion, studying the diffusion of drug-eluting stents (DESs), which became available in April 2003. Data Sources/Study Setting: Medicare claims linked to physician demographic data from the American Medical Association and to hospital characteristics from the American Hospital Association Survey. Study Design: Retrospective claims data analyses. Data Collection/Extraction Methods: All fee-for-service Medicare beneficiaries who received a percutaneous coronary intervention (PCI) with a cardiac stent in 2003 or 2004. Each PCI record was joined to characteristics on the patient, the procedure, the cardiologist, and the hospital where the PCI was delivered. We accounted for the endogeneity of physician and hospital market structure using exogenous variation in the distances between patient, physician, and hospital locations. We estimated multivariate linear probability models that related the use of a DES in the PCI on market structure while controlling for patient, physician, and hospital characteristics. Principal Findings: DESs diffused faster in markets where cardiology practices faced more competition. Conversely, we found no evidence that the structure of the hospital market mattered. Conclusions: Competitive pressure to maintain or expand PCI volume shares compelled cardiologists to adopt DESs more quickly.",
keywords = "Market structure, medical technology diffusion",
author = "Pinar Karaca-Mandic and Town, {Robert J.} and Andrew Wilcock",
year = "2017",
month = "4",
day = "1",
doi = "10.1111/1475-6773.12506",
language = "English (US)",
volume = "52",
pages = "579--598",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - The Effect of Physician and Hospital Market Structure on Medical Technology Diffusion

AU - Karaca-Mandic, Pinar

AU - Town, Robert J.

AU - Wilcock, Andrew

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Objective: To examine the influence of physician and hospital market structures on medical technology diffusion, studying the diffusion of drug-eluting stents (DESs), which became available in April 2003. Data Sources/Study Setting: Medicare claims linked to physician demographic data from the American Medical Association and to hospital characteristics from the American Hospital Association Survey. Study Design: Retrospective claims data analyses. Data Collection/Extraction Methods: All fee-for-service Medicare beneficiaries who received a percutaneous coronary intervention (PCI) with a cardiac stent in 2003 or 2004. Each PCI record was joined to characteristics on the patient, the procedure, the cardiologist, and the hospital where the PCI was delivered. We accounted for the endogeneity of physician and hospital market structure using exogenous variation in the distances between patient, physician, and hospital locations. We estimated multivariate linear probability models that related the use of a DES in the PCI on market structure while controlling for patient, physician, and hospital characteristics. Principal Findings: DESs diffused faster in markets where cardiology practices faced more competition. Conversely, we found no evidence that the structure of the hospital market mattered. Conclusions: Competitive pressure to maintain or expand PCI volume shares compelled cardiologists to adopt DESs more quickly.

AB - Objective: To examine the influence of physician and hospital market structures on medical technology diffusion, studying the diffusion of drug-eluting stents (DESs), which became available in April 2003. Data Sources/Study Setting: Medicare claims linked to physician demographic data from the American Medical Association and to hospital characteristics from the American Hospital Association Survey. Study Design: Retrospective claims data analyses. Data Collection/Extraction Methods: All fee-for-service Medicare beneficiaries who received a percutaneous coronary intervention (PCI) with a cardiac stent in 2003 or 2004. Each PCI record was joined to characteristics on the patient, the procedure, the cardiologist, and the hospital where the PCI was delivered. We accounted for the endogeneity of physician and hospital market structure using exogenous variation in the distances between patient, physician, and hospital locations. We estimated multivariate linear probability models that related the use of a DES in the PCI on market structure while controlling for patient, physician, and hospital characteristics. Principal Findings: DESs diffused faster in markets where cardiology practices faced more competition. Conversely, we found no evidence that the structure of the hospital market mattered. Conclusions: Competitive pressure to maintain or expand PCI volume shares compelled cardiologists to adopt DESs more quickly.

KW - Market structure

KW - medical technology diffusion

UR - http://www.scopus.com/inward/record.url?scp=85014880613&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014880613&partnerID=8YFLogxK

U2 - 10.1111/1475-6773.12506

DO - 10.1111/1475-6773.12506

M3 - Article

C2 - 27196678

AN - SCOPUS:85014880613

VL - 52

SP - 579

EP - 598

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 2

ER -