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Health Policy. 2017 Mar;121(3):230-242. doi: 10.1016/j.healthpol.2017.01.005. Epub 2017 Jan 24.

The determinants of medical technology adoption in different decisional systems: A systematic literature review.

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Universität Hamburg, Hamburg Center for Health Economics, Hamburg, Germany. Electronic address:
Universität Hamburg, Hamburg Center for Health Economics, Hamburg, Germany; Brown University, Center for Gerontology and Health Care Research, School of Public Health, Providence, RI, USA.
University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
Universität Hamburg, Hamburg Center for Health Economics, Hamburg, Germany.


Studies of determinants of adoption of new medical technology have failed to coalesce into coherent knowledge. A flaw obscuring strong patterns may be a common habit of treating a wide range of health care innovations as a generic technology. We postulate three decisional systems that apply to different medical technologies with distinctive expertise, interest, and authority: medical-individualistic, fiscal-managerial, and strategic-institutional decisional systems. This review aims to examine the determinants of the adoption of medical technologies based on the corresponding decision-making system. We included quantitative and qualitative studies that analyzed factors facilitating or inhibiting the adoption of medical technologies. In total, 65 studies published between 1974 and 2014 met our inclusion criteria. These studies contained 688 occurrences of variables that were used to examine the adoption decisions, and we subsequently condensed these variables to 62 determinants in four main categories: organizational, individual, environmental, and innovation-related. The determinants and their empirical association with adoption were grouped and analyzed by the three decision-making systems. Although we did not identify substantial differences across the decision-making systems in terms of the direction of the determinants' influence on adoption, a clear pattern emerged in terms of the categories of determinants that were targeted in different decision-making systems.


Decision-making systems; Determinants; Innovation; Medical technology; Systematic review

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