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Bourke, Jane, Dr.
Languages: English
Types: Doctoral thesis
Subjects: RA
In this thesis we explore innovation in general practices in Ireland. Drawing on an\ud encompassing equilibrium, disequilibrium and learning-by-using model of adoption,\ud we examine the influences of general practitioner (GP) and practice characteristics,\ud strategic behaviour, learning and knowledge spillovers, and cumulative learning\ud from previous adoption decisions on the perceived benefits of adopting and using\ud innovations in general practices. Ours is the first application of this theoretical\ud framework to timing of adoption, multiple technology adoption and intensity of\ud adoption decision-making in a health care setting. Our examination focuses on three\ud innovations, prescription drugs, medical equipment and Information and\ud Communications Technology (ICT).\ud Our analysis is based on two data sources, a secondary dataset which brings together\ud GPs prescribing history over a 4½ year time period with information on the\ud characteristics of the 625 GPs themselves, and a cross-sectional primary dataset\ud which provides us with information for 601 general practices concerning practice\ud structure and use of medical equipment and ICT. Employing duration analysis,\ud multivariate Probit and ordered Probit econometric techniques, we examine the\ud adoption, use and intensity of use of prescription drugs, medical equipment and ICT\ud respectively.\ud Irish GPs exhibit notable innovative behaviour with respect to prescribing innovation\ud and practice development. Our research demonstrates that Irish GPs respond to\ud informational stimuli with respect to adoption and use of new prescription drugs,\ud medical equipment and ICT. Furthermore, Irish GPs are incentivised by commercial\ud and market considerations. In addition, we find the extent which a practice adopts\ud technologies and learns from that experience influences both ensuing prescribing and\ud investment decision-making. Our empirical findings support an economic approach\ud to examining decision-making in a health care setting and the application of our\ud encompassing theoretical model to examinations of adoption and use of innovations\ud by health care professionals.
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