The diffusion of medical technology, local conditions, and technology re-invention: A comparative case study on coronary stenting

Hideki Hashimoto*, Haruko Noguchi, Paul Heidenreich, Olga Saynina, Abigail Moreland, Shunichi Miyazaki, Shunya Ikeda, Yoshihiro Kaneko, Naoki Ikegami

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)


Innovation of medical technology is a major driving force behind the increase in medical expenditures in developed countries. Previous studies identified that the diffusion of medical technology varied across countries according to the characteristics of regulatory policy and payment systems. Based on Roger's diffusion of innovation theory, this study purported to see how local practice norms, the evolving nature of diffusing technology, and local clinical needs in addition to differences in politico-economic systems would affect the process of innovation diffusion. Taking a case of coronary stenting, an innovative therapeutic technology in early 1990s, we provided a case study of hospital-based data between two teaching high-tech hospitals in Japan and the US for discussion. Stenting began to be widely used in both countries when complementary new technology modified its clinical efficacy, but the diffusion process still differed between the two hospitals due to (1) distinctive payment systems for hospitals and physicians, (2) practice norms in favor of percutaneous intervention rather than bypass surgery that was shaped by payment incentives and cultural attitudes, and (3) local patient's clinical characteristics that the technology had to be tailored for. The case study described the diffusion of stent technology as a dynamic process between patients, physicians, hospitals, health care systems, and technology under global and local conditions.

Original languageEnglish
Pages (from-to)221-230
Number of pages10
JournalHealth Policy
Issue number2-3
Publication statusPublished - 2006 Dec
Externally publishedYes


  • Case study
  • Coronary stenting
  • Diffusion of innovation theory
  • Diffusion of technology
  • Japan
  • US

ASJC Scopus subject areas

  • Health Policy


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