Changing payment instruments and the utilisation of new medical technologies

Eur J Health Econ. 2019 Sep;20(7):1029-1039. doi: 10.1007/s10198-019-01056-z. Epub 2019 May 29.


This paper empirically investigates the impact of additional reimbursement instruments on the diffusion of new technologies in inpatient care. Using 2010-2014 German panel data on hospital level for every patient undergoing coronary angioplasty, this study examines the utilisation of drug-eluting balloon catheters (DEB) over time while additional payment instruments changed. Hypothesising that the utilisation of DEB increased abruptly when a new reimbursement instrument came into force, we estimate a fixed effects regression comparing years with a change and years where the reimbursement instrument remained the same. The model is adjusted for patient age and severity of the disease. The utilisation of DEB increased from 8407 in 2010 to 19,065 in 2014. Hospitals used significantly more DEB when an additional payment instrument changed compared to years when it remained the same. The increase was roughly twice as large. In short, hospitals are incentivised to utilise new technologies if the reimbursement changes to an instrument that is designed in a more reliable way, e.g. including less bureaucracy or guaranteeing fixed prices.

Keywords: Additional payment instruments; DRG system; Diffusion of innovations; Hospital financing; New health technology; Panel data.

MeSH terms

  • Adult
  • Angioplasty, Balloon, Coronary*
  • Databases, Factual
  • Diagnosis-Related Groups
  • Diffusion of Innovation*
  • Drug-Eluting Stents*
  • Female
  • Financial Management, Hospital
  • Humans
  • Insurance, Health, Reimbursement*
  • Male
  • Middle Aged
  • Models, Econometric