The influence of hospital competition on the diffusion of the PET-­‐CT scanner in the Netherlands

Background Managed competition is introduced to change the incentives and market so that the efficiency of health care delivery improves. Price competition however may meet difficulties in the health care sector and may lead to a medical arms race. Hospitals compete for physicians’ loyalty by making available the latest technology. The resulting excess capacity increases total health expenditure. Competition also increases the marketing costs for hospitals to build a reputation as a modern hospital. The Dutch Health Inspectorate (IGZ) states that there is an overcapacity of PET-­‐CT scanners in the Netherlands. If the PET-­‐CT is only used for proven cost-­‐effective indications, the Netherlands would only need 9 PET-­‐CT scanners in comparison to the at least 44 scanners we currently have. To understand the diffusion of the PET-­‐CT scanner in the Netherlands, this study identifies all relevant actors that are involved in the diffusion process and focuses on the incentives that influence the (individual) decision-­‐making process of the actors and the influence of hospital competition on these incentives. Methods Prior theoretical studies are collected to gain insight into the existing knowledge about the decision-­‐making process used when purchasing medical technology. To map the current distribution of the PET-­‐CT scanner in the Netherlands, grey literature is also used. Interviews are used to get a clear view on which theoretical incentives are relevant in practice. Interviews are held with actors on micro, meso and macro level. The interviewees were asked to fill in a short questionnaire with multiple-­‐choice questions and propositions that form the starting point of the semi-­‐structured interviews. Indicators are attributed to the theoretical concepts to make them measurable. The interview data are analyzed by open labeling, followed by attribution of these labels to the theoretical indicators. Results The distribution of PET-­‐CT scanners in the Netherlands is not optimal. In certain regions and for certain indications overcapacity or overconsumption exists whereas for others a shortage occurs. Hospital managers and specialists are identified as the most important decision making actors for medical technology. Their primary incentive seems to be the provision of needed care. The insurer and the industry are ranked to both have an average influence on the diffusion process and operate primarily from economic incentives. The antitrust authority and other governmental institutions are attributed no or limited influence on the diffusion process. Conclusions Hospitals use medical technology to build a reputation as a modern hospital and to attract patients and physicians. Quality competition therefore seems to have a positive effect on the diffusion of PET-­‐CT technology in the Netherlands. The existence of price competition, and therefore its influence on the diffusion process, is less clear. The Dutch system is still in transition and insurers will probably become more important influencers of the diffusion process in the future. This might increase price competition and the influence of it on the diffusion of medical technology.