Economists have long been interested in how new products and services spread; what factors or practices might encourage their use. In health care, work has been done in regard to the diffusion of new drugs, devices and procedures. A lot of this is driven by profit-seeking motives. Policymakers have also been interested in diffusion in regard to ideas they think will improve the health care system, for example, value-based purchasing or greater use of information technology. An article in Health Affairs discusses factors related to diffusion of innovations in the health system. (HA Article) Diffusion is defined as a social process that involves people responding after they learn about a new product, service, process, or approach to an issue. Obviously the inventor or creator of the innovation is going to use it, but how does it spread after that, and how quickly, are critical questions. Creating awareness is obviously critical, and if you have lots of money, there are mass communication channels. Social media may offer a cheaper avenue for awareness today, but its uptake can be uncertain and uneven. Awareness is one thing, willingness to try or acceptance of benefits is another. Having credible champions or early adopters is a frequently used tactic. Most innovations actually don’t diffuse, they fail to obtain widespread adoption. And not all innovations that are widely adopted are that beneficial, we see examples of that in health care, for example, me too drugs. The existing resources of a targeted community may also affect diffusion rates; populations with a high level of resources are usually more likely to be early adopters. Some of these resources may be innate characteristics, like the capability of a population to find and absorb information about the innovation, to aid in the decision whether to adopt it. People’s readiness to adopt innovations can be used to sub-segment and target populations and to create differential messages to persuade adoption.
Efforts to improve the health system by changing how it delivers and pays for care are subject to all these factors relating to adoption of innovations and more broadly, to changing behavior. When governments are involved, there is always the risk of misguided “innovation”, that fails to achieve the supposed objectives and may even have negative consequences. We have seen this with things like the hospital readmission reduction programs, quality reporting, and even the push to have more use of EHRs. And government has a lot of sticks and carrots to throw around to force behavior change, whether the targeted population thinks the “innovation” makes sense or not. Far better, in my judgment, to rely on private activities to create innovation and to be involved in its diffusion, or lack thereof. As the science of diffusion and other aspects of behavior change grows, there is an increasing risk that it is misused by those who think a particular behavior is desirable, without respecting the free choice of individuals. We need restrictions on these tactics to ensure that the fundamental right to free choice is respected and that those who think they know best for all of us are kept under tight control.