The effects of reimbursement mechanisms on medical technology diffusion in the hospital sector in the Italian NHS

Health Policy. 2014 Apr;115(2-3):215-29. doi: 10.1016/j.healthpol.2013.12.004. Epub 2013 Dec 16.


Objectives: The aim of this study was to investigate how the differences across the regional reimbursement mechanisms and in particular the use of the DRGs impact on the level in the high technology equipment diffusion.

Methods: Based on hospital sector data at a regional level we build up indicators to measure the regional diffusion of high technological medical equipment in the period 1997-2007. These indicators are regressed on regional healthcare characteristics to investigate the relationship between the different reimbursement systems offered by Italian regions and the level of high technological medical equipment.

Results: Our results suggest that the per-case payment system is generally associated with a lower level of regional technology endowment per million of inhabitants, especially for the complex and expensive medical equipment.

Conclusions: Our findings cast some doubts that an effective regulation of reimbursement mechanisms cannot limit the excessive diffusion of medical equipment that is a relevant driver of the increase in expenditure.

Keywords: DRG; Decentralization; Hospital care; Medical equipment; Prospective payment systems; Technology diffusion.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomedical Technology / economics
  • Biomedical Technology / statistics & numerical data*
  • Diagnosis-Related Groups / economics
  • Diagnosis-Related Groups / statistics & numerical data
  • Diffusion of Innovation*
  • Economics, Hospital
  • Hospitals / statistics & numerical data*
  • Humans
  • Italy
  • National Health Programs / economics
  • National Health Programs / organization & administration
  • National Health Programs / statistics & numerical data
  • Reimbursement Mechanisms*