Temporal and Demographic Dynamics of Novel Healthcare Technology Diffusion

Abstract

How do Academic Medical Centers (AMCs) distribute use of novel healthcare technology after adoption? We study this question through the lens of post-adoption technology assimilation, and we argue that assimilation is not simply a matter of aggregate diffusion over time. Instead, it has a distributional dimension: who gains access to a technology, and when, shifts systematically as the technology becomes embedded in an organization’s routines. We examine this distributional dimension empirically in the context of AMCs, using race and income as observable markers of a technology’s assimilation over time. AMCs are located in cities with a large number of Black patients, and also treat a large number of White (often wealthier) patients drawn to cutting-edge care. Studying the diffusion of robotic-assisted prostatectomy at AMCs, we find a striking reversal: in the first four quarters after adoption, Black patients are 11.2 percentage points more likely than White patients to receive robotic surgery. This early access advantage is temporary. As the technology becomes assimilated into routine practice, growth among wealthier (and disproportionately White) patients overtakes this early pattern, reversing the initial pattern of access. Importantly, this early-access pattern does not compromise the quality of care among Black patients. Our study extends research on post-adoption technology assimilation by showing that assimilation has a distributional dimension: race and income are the empirical markers through which we observe this shift in our setting, not the theoretical contribution itself. The diffusion of novel healthcare technology is thus less a fixed pattern of inequity and more a temporally dynamic process of technology allocation, utilization, and institutional routinization.