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. The purpose of this paper is to use a case study approach to understand how organizational and country level factors influence hospital investment behavior. Design/methodology/approach – The paper developed a conceptual framework based upon decision theory and institutional theory from which key questions were derived. The paper conducted semi-structured group interviews with relevant stakeholders in six hospitals located in five countries (Germany, India, Thailand, South Korea, USA). Findings – The paper 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 – The paper 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/value – 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.