Utilization, Diffusion, and Substitution of High-Technology Procedures

摘要

The project analyzed the growth in utilization rates and the patterns of diffusion for three groups of high-technology physician services delivered to Medicare beneficiaries. One technology in each group represented a recent innovation, and the other represented a more established service. The services included: magnetic resonance imaging (MRI) of the head versus computerized axial tomography (CT) of the head; percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass graft (CABG) surgery; and extracorporeal shock wave lithotripsy (ESWL) versus open and endoscopic surgical techniques for eliminating stones from the kidney and upper urinary tract. Results showed that Medicare spending per eligible grew more rapidly for the newer technologies. With the exception of CT services, utilization rates for black beneficiaries were lower than for white beneficiaries even when urban/rural residence was controlled for. In general, utilization rates for new technologies were lower in rural areas, but rates of increase over time were generally greater than in urban areas. The report also includes an exploratory investigation into modeling the diffusion of related technologies.