From Planning to the Market: Changes in Hospital Approaches to Medical Technology

  • Ann Lennarson Greer
Part of the Management of Medical Technology book series (MOMT, volume 1)


Medical procedures and technologies have expanded explosively over the last thirty years, presenting immense challenges to U.S. hospitals, typically free-standing nonprofit community institutions governed by boards of private citizens or religious orders. The potential of such hospitals to make ill-advised and costly decisions has been a constant theme of policy for two decades. A common perception is that hospital medical technologies diffuse among community hospitals too rapidly and too broadly, with too much costly duplication and without regard for under-use. This contributed in the 1970s to the introduction of governmental mechanisms for health planning and regulation and, in the 1980s, of prospective payment schemes and the market place for health care. This paper examines the technology decision processes of hospitals and hospital doctors between 1976 and 1990, the period when the U.S. experimented with governmental planning and regulation, then phased it out in favor of prospective payment and the market place for health care.


Medical Technology Community Hospital Chief Executive Officer Planning Agency Hospital Administrator 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. [1]
    J. E. Harris, “The Internal Organization of Hospitals: Some Economic Implications,” The Bell Journal of Economics, vol. 8, pp. 467–482, 1977.CrossRefGoogle Scholar
  2. [2]
    M. L. Lee, “A Conspicuous Production Theory of Hospital Behavior,” Southern Economic Journal, vol. 38, pp. 48–58, 1971.CrossRefGoogle Scholar
  3. [3]
    J. P. Newhouse, “Toward a Theory of Nonprofit Institutions: An Economic Model of the Hospital,” THe American Economic Review, vol. 60, pp. 64–70, 1970.Google Scholar
  4. [4]
    S. A. Schroeder and J. A. Showstack, “The Dynamics of Medical Technology Use: Analysis and Policy Options,” in Medical Technology: The Culprit Behind Health Care Costs?, S. Altman and R. Blendon, Eds. Washington D.C.: DHEW PHS Publication #79-3216, 1979, pp. 178–212.Google Scholar
  5. [5]
    M. Pauly and M. Redisch, “The non-for-Profit Hospital as a Physicians’ Cooperative,” THe American Economic Review, vol. 63, pp. 87–99, 1973.Google Scholar
  6. [6]
    93rd Congress of the United States, Report No.93-1285. Washington, D.C.: U.S. Government Printing Office, 1974.Google Scholar
  7. [7]
    A. C. Enthoven, “Consumer-Centered vs. Job Centered Health Insurance,” Harvard Business Review, vol. 57, pp. 141–152, 1979.Google Scholar
  8. [8]
    A. C. Enthoven, “The History and Principles of Managed Competition,” Health Aft., vol. Supplement, pp. 24–48, 1993.Google Scholar
  9. [9]
    Office of Technology Assessment, The Impact of Randomized Clinical Trials on Health Policy and Medical Practice. Washington, D.C.: US Government Printing Office, 1983.Google Scholar
  10. [10]
    J. E. Sisk, “Effects of Increased Competition in Health Care on the Use and Innovation of Medical Technology,” Health Care Management Review, vol. Summer, 1984.Google Scholar
  11. [11]
    J. L. Wagner, M. J. Krieger, R. H. Lee, A. A. Romeo, and M. Stassen, A Study of the Impact of Reimbursement Strategies on the Diffusion of Medical Technologies, Final Report to HCFA ed., vol. 1. Washington D.C.: The Urban Institute, 1982.Google Scholar
  12. [12]
    R. S. Stern and A. M. Epstein, “Institutional Responses to Prospective Payment Based on Diagnosis Related Groups,” N. Engl. J. Med., vol. 312, pp. 621–627, 1982.CrossRefGoogle Scholar
  13. [13]
    A. L. Greer, “Rationing Medical Technology: Hospital Decision-Making in the U.S. and England,” Int. J. Technol. Assess. Health Care, vol. 3, pp. 199–222, 1987.CrossRefGoogle Scholar
  14. [14]
    A. A. Romeo and J. L. Wagner, “Prospective Reimbursement and the Diffusion of New Technologies in Hospitals,” Journal of Health Economics, vol. 3, pp. 1–24, 1984.CrossRefGoogle Scholar
  15. [15]
    C. C. Havighurst, “The Changing Locus of Decision-Making in the Health Care Sector,” J. Health Polit. Policy Law, vol. 11, pp. 697–735, 1986.CrossRefGoogle Scholar
  16. [16]
    H. S. Luft, J. C. Robinson, D. W. Garnick, R. G. Hughes, S. J. McPhee, S. S. Hunt, and J. Showstack, “Hospital Behavior in a Local Market Context,” Med. Care Rev., vol. 43, pp. 217–252, 1986.CrossRefGoogle Scholar
  17. [17]
    H. S. Luft, J. C. Robinson, D. Garnick, et al., “The Role of Specialized Clinical Services in Competition Among Hospitals,” Inquiry, vol. 23, pp. 83–94,1986.Google Scholar
  18. [18]
    H. S. Luft, S. C. Maerki, and J. B. Trauner, “The Competitive Effects of Health Maintenance Organizations: Another Look at the Evidence from Hawaii, Rochester, and Minneapolis/St. Paul,” J. Health Polit. Policy Law, vol. 10, pp. 626–658, 1986.CrossRefGoogle Scholar
  19. [19]
    A. L. Greer and S. Greer, “Medical Technology Decisions in Hospitals: Changes Since 1980”, Final Report submitted to the Agency for Health Care Policy and Research, Grant # HS 06054. (N)Google Scholar
  20. [20]
    E. Rogers, Diffusion of Innovations, 3rd ed. New York: The Free Press, 1983.Google Scholar
  21. [21]
    H. D. Banta, C. J. Behney, and J. Sisk Willems, Toward a Rational Technology in Medicine. Springer Seriew on Health Care and Society, 5. New York: Springer Publishing Company, 1981.Google Scholar
  22. [22]
    S. Topping and S. R. Hernandez, “Health Care Strategy Research,” Med. Care Rev., vol. 48, pp. 47–89, 1991.CrossRefGoogle Scholar
  23. [23]
    A. L. Greer, “Adoption of Medical Technology: The Hospital’s Three Decision Systems,” Int. J. Technol. Assess. Health Care, vol. 1, pp. 669–680, 1985.CrossRefGoogle Scholar
  24. [24]
    A. L. Greer, “Medical Technology and Professional Dominance Theory,” Soc.Sci.Med., vol. 18, pp. 809–817, 1984.CrossRefGoogle Scholar
  25. [25]
    A. L. Greer, “Medical Conservatism and Technological Acquistiveness: The Paradox of Hospital Technology Adoptions,” in The Adoption and Social Consequences of Medical Technologies, J. Roth and S. Ruzak, Eds. Research in the Sociology of Health Care, Volume 4, J. Roth and S. Ruzak, Eds. Greenwich, CT: JAI Press,.1986, pp. 185–235.Google Scholar
  26. [26]
    A. L. Greer, “The State of the Art vs. the State of the Science,” Int. J. Technol. Assess. Health Care, vol. 4, pp. 5–26, 1988.CrossRefGoogle Scholar
  27. [27]
    A. L. Greer, “Diffusion of Medical Technology: The Case of ECMO,” in Report on Diffusion of ECMO Technology, L. Wright, Ed. Bethesda, MD: National Institutes of Health, 1993, pp. 15–23. (Publication #93–3399)Google Scholar
  28. [28]
    A. L. Greer, “Advances in the Study of Diffusion of Innovation in Health Care Organizations,” Milbank Q., vol. 55, pp. 505–532, 1977.Google Scholar
  29. [29]
    T. J. Allen, “The Role of Person-to-person Communications in the Transfer of Technical Knowledge,” in Biomedical Innovation, E. B. Roberts, R. I. Levy, S. N. Finkelstein, J. Moskowitz, and E. J. Sondik, Eds. Cambridge, Massachusetts: The MIT Press, 1981, pp. 34–49. (N)Google Scholar
  30. [30]
    E. Rogers, Diffusion of Innovations, 3rd ed. New York: The Free Press, 1983.Google Scholar
  31. [31]
    F. H. Goldner, “Politics as Accusation: New York’s Public and Voluntary Hospitals,” in Cities and Sickness: Health Care in Urban America, A. L. Greer and S. Greer, Eds. Urban Affairs Annual Reviews, 25. Beverly Hills, CA: Sage Publications, 1983, ch. 8, pp. 245–264.Google Scholar
  32. [32]
    W. R. Scott, “The Organization of Medical Care Services: Toward an Integrated Theoretical Model,” Med. Care Rev., vol. 50, pp. 271–303, 1993.CrossRefGoogle Scholar
  33. [33]
    J. W. Meyer and R. R. Scott, “Institutionalized Organizations: Formal Structure as Myth and Ceremony,” American Journal of Sociology, vol. 83, pp. 440–463, 1977.Google Scholar
  34. [34]
    P. Selznick, Leadership in Administration. New York: Harper & Row, 1957.Google Scholar
  35. [35]
    S. B. Jones and M. K. Du Val, “What Distinguishes the Voluntary Hospital in an Increasingly Commercial Health Care Environment?” in In Sickness and in Health: The Mission of Voluntary Health Care Institutions, J. D. Seay and B. C. Vladeck, Eds. A United Hospital Fund Book. New York: McGraw-Hill, 1988, p. 232.Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Ann Lennarson Greer
    • 1
  1. 1.Department of SociologyUniversity of Wisconsin-MilwaukeeMilwaukeeUSA

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