Technological innovation and policy responses in health care.

摘要

This dissertation consists of three papers, two quantitative and one mixed-methods. Paper 1 uses cross-sectional and logistic regression analyses of survey data to assess Americans' opinion on the use of cost effectiveness research (CER) in government health coverage decisions, and to examine the factors predicting approval or disapproval of specific decisions. I use vignettes drawn from real international decisions to assess opinions. I find that opposition to a CER agency is widespread, with partisan affiliations playing a significant role. In general, Republicans are more likely to oppose a government agency playing a role in cost effectiveness determinations. With regards to specific examples, Americans hold even greater opposition, with no significant differences by political affiliations.;Paper 2 evaluates the hospital- and state-level factors influencing hospital adoption of electronic health records (EHRs), attempting to identify levers subject to influence by policy makers in the ongoing effort to drive increased adoption. This project employs multi-level poisson regression to examine cross-state variation in the relationship between hospital function adoption and hospital/state level characteristics. I find that a multitude of factors influence hospital EHR adoption, with several subject to influence by policy makers. In particular, prospective financial incentives at the state level to hospitals struggling to break even financially have a noted effect in increasing adoption.;Paper 3 uses a mixed-methods approach to answer the question of whether hospitals view the requirements of the EHR meaningful use incentive program as a floor, above which further development continues, or as a ceiling on their adoption efforts. I draw three key findings from this research: first, the requirements serve as either a floor or a ceiling, depending on the abilities of the facility implementing EHRs. Second, the increasing focus on meeting the requirements risks missing the forest of health care system change through the trees of meeting discrete requirements. Without further development on the technology needed for managing population health, the American health care system lacks the infrastructure for successful health reform. Third, while the meaningful use incentive program has accelerated the development and implementation of some functions, it has also slowed development of other important functions.