Tor Iversen, University of Oslo - Market conditions and technology adoption in primary care

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Title: Market conditions and technology adoption in primary care

Abstract:  Medical technology contributes to improved longevity and quality of life. Studies have shown that payment system, insurance coverage, and market conditions contribute to technology adoption by providers. These studies typically consider the entire health system or the hospital sector. Technology adoption in primary care has not been studied much. The present study explores factors that contribute to technology adoption by primary care physicians.
We develop predictions of technology adoption by practicing physicians based on a simple theory of benefit and cost. The empirical study makes use of data covering all general practitioners (GPs) in Norway between 2009 and 2014. In Norway, residents are listed with a GP. More than 95% of GPs are self-employed and paid by a combination of capitation fees and fee-for-service. In 2009, a systematic surveillance program for patients with diabetes type 2 (T2D) was introduced. While GPs have gradually adopted the program, still only a quarter of GPs are making use of it. We first assess factors that are associated with technology adoption by individual GPs. We estimate two-part regression models and hazard functions by duration models. An education program for GPs was introduced in two counties during the observation period. By means of a difference-in-differences model, we estimate the effect of the education program on technology adoption.
Results show that technology adoption among GPs is positively associated with the number of listed patients with T2D, and the number of GPs in the community who have adopted the technology in previous periods (peer effects). We find that technology adoption is negatively associated with a GP’s age, and patients’ access to private specialists and hospitals. We find that the introduced education program has a positive and large effect.
The empirical results give support to the predictions that additional education of GPs, organization, and access to specialized care affect technology adoption in primary care. We discuss why competition among GPs is not associated with technology adoption in this study.

Presenter: Tor Iversen, University of Oslo

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