Changing payment instruments and the utilisation of new medical technologies


This paper empirically investigates the impact of additional reimbursement instruments on the diffusion of new technologies in inpatient care. Using 2010–2014 German panel data on hospital level for every patient undergoing coronary angioplasty, this study examines the utilisation of drug-eluting balloon catheters (DEB) over time while additional payment instruments changed. Hypothesising that the utilisation of DEB increased abruptly when a new reimbursement instrument came into force, we estimate a fixed effects regression comparing years with a change and years where the reimbursement instrument remained the same. The model is adjusted for patient age and severity of the disease. The utilisation of DEB increased from 8407 in 2010 to 19,065 in 2014. Hospitals used significantly more DEB when an additional payment instrument changed compared to years when it remained the same. The increase was roughly twice as large. In short, hospitals are incentivised to utilise new technologies if the reimbursement changes to an instrument that is designed in a more reliable way, e.g. including less bureaucracy or guaranteeing fixed prices.

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Fig. 1


  1. 1.

    DRG payment rates are calculated by multiplying the respective cost weight of a DRG with the national 2014 average base rate of 3156.82 euros, which in reality differed among the 16 federal states ranging from 1113 and 3325 euros.


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The project was funded through the Berlin Centre for Health Economics Research by the German Federal Ministry of Education and Research (Grant No. 01EH1604A). Patricia Ex received a scholarship from Cusanuswerk, the episcopal scholarship foundation.

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Ex, P., Henschke, C. Changing payment instruments and the utilisation of new medical technologies. Eur J Health Econ 20, 1029–1039 (2019).

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  • Additional payment instruments
  • Diffusion of innovations
  • New health technology
  • Hospital financing
  • DRG system
  • Panel data

JEL Classification

  • I12
  • I18
  • C32
  • C33