Conceptual and empirical issues of technological change in the health care sector : Innovation and diffusion of hemodialysis and renal transplantation

Abstract: The present study focuses on one instance of technological change in medical practice; the innovation and diffusion of hemodialysis and renal transplantation (ESRD treatment)- two therapeutic innovations aimed at the treatment of patients suffering from chronic renal failure. The purpose of the thesis is to study the processes by which medical technology is developed imd disseminated. Control and management of technological change are also considered. Conceptual frameworks for analyzing the biomedical innovation process and the diffusion process respectively were developed on the basis of current theories of technological change in sociology and economics. The empirical investigation has two parts: one which examines the biomedical innovation processes of hernodialysis and renal transplantation, and one which examines the planned and actual diffusion ofhemodialysis and renal transplantation in Sweden between 1965 and 1983. Economic consequences of the diffusion of the two treatment modalities are investigated as well.The findings from the first part of the empirical study suggest that knowledge accumulation, knowlegde synthesis and acts of insight are central elements in the innovation process. The process is international, and draws from scientific and technological advances as well as advances in medical practice. Thus, there is no one logical place to intervene in the process, should that be desirable. The findings from the diffusion study show that there are large, persistant regional variations in acceptance rates, in the overall provision of ESRD treatment and in the mix of ESRD treatment. It was also found that mix of treatment is an important determinant of ESRD program costs; the more transplantation contributes to the ESRD treatment program the less expensive the program becomes. The regional variations seem to reflect priorities set by the actors involved. The findings suggest that medical technology characteristics and structural factors of general and technology-specific nature as well have determined these choices.