DIFFUSION OF LAPAROSCOPIC CHOLECYSTECTOMY AMONG GENERAL SURGEONS IN THE UNITED-STATES

Introduced in 1989, laparoscopic cholecystectomy has rapidly become th e treatment of choice for symptomatic gallstones. This study describes the diffusion of laparoscopic cholecystectomy among general surgeons; assesses the importance of various reasons for surgeons adopting the procedure; and examines the influence of surgeon, practice, and health care market characteristics on the timing of adoption. The data were obtained from a survey of a national sample of surgeons. Most surgeons (81%) adopted laparoscopic cholecystectomy by early 1992. More than t hree fourths of adopters identified the desire to keep up with the sta te-of-the-art and improved patient outcomes as very or extremely impor tant reasons for adoption. Results of proportional hazards regression analysis indicate that individual surgeons' adoption behavior generall y was consistent with expected utility maximization in an uncertain ne w technological environment. Of particular interest, fee-for-service p ayment and more competitive practice settings and markets were associa ted with earlier adoption. These findings suggest that the ''technolog ical imperative'' and surgeons' perception of the relative clinical an d financial advantages of laparoscopic cholecystectomy were important reasons for the rapid diffusion of laparoscopic cholecystectomy. Polic ies that accelerate current trends toward payment of physicians based on salary or capitation and promote the growth of multispecialty group practice could slow the diffusion of new physician-based product inno vations in health care.