International study of technology investment decisions at hospitals

Purpose: Healthcare costs have increased considerably over the past decades around the world. Major contributors to this trend are expensive medical technologies. In this research, we used a case study approach to understand how organizational and country level factors influence hospital investment behavior. Design and methodology: We developed a conceptual framework based upon decision theory and institutional theory from which key questions were derived. We conducted semi-structured group interviews with relevant stakeholders in six hospitals located in five countries (Germany, India, Thailand, South Korea, United States). Findings: We found that the investment decisions of the interviewed hospitals are primarily affected by the healthcare system, the socio-economic and cultural context, and the organization’s mission. Most of the interviewed hospitals consider multiple criteria in their decision-making framework and share similar organizational processes. Practical implications: We identified an international best practice approach to investment decision-making at one of the hospitals. The other hospitals, despite being leading institutions in their respective countries, do not have sufficiently advanced and objective assessment approaches and would benefit from a more data-driven and systematic decision process. Originality: Prior research has documented that investment decisions at hospitals are driven by organizational factors. This paper shows how, in addition, country level factors – in particular healthcare system and cultural aspects – affect hospital decision-making behavior.