abstract: 'Background The development of products and services for health care

  systems is one of the most important phenomena to have occurred in the

  field of health care over the last 50 years. It generates significant

  commercial, medical and social results. Although much has been done to

  understand how health technologies are adopted and regulated in

  developed countries, little attention has been paid to the situation in

  low- and middle-income countries (LMICs). Here we examine the

  institutional environment in which decisions are made regarding the

  adoption of expensive medical devices into the Brazilian health care

  system.

  Methods We used a case study strategy to address our research question.

  The empirical work relied on in-depth interviews (N = 16) with

  representatives of a wide range of actors and stakeholders that

  participate in the process of diffusion of CT (computerized tomography)

  scanners in Brazil, including manufacturers, health care organizations,

  medical specialty societies, health insurance companies, regulatory

  agencies and the Ministry of Health.

  Results The adoption of CT scanners is not determined by health policy

  makers or third-party payers of public and private sectors. Instead,

  decisions are primarily made by administrators of individual hospitals

  and clinics, strongly influenced by both physicians and sales

  representatives of the medical industry who act as change agents.

  Because this process is not properly regulated by public authorities,

  health care organizations are free to decide whether, when and how they

  will adopt a particular technology.

  Conclusions Our study identifies problems in how health care systems in

  LMICs adopt new, expensive medical technologies, and suggests that a set

  of innovative approaches and policy instruments are needed in order to

  balance the institutional and professional desire to practise a modern

  and expensive medicine in a context of health inequalities and basic

  health needs.'
affiliation: 'Silva, HP (Corresponding Author), Univ Sao Paulo, Fac Med, Dept Prevent
  Med, Sch Med, Av Dr Arnaldo 455, BR-01246903 Sao Paulo, Brazil.

  Silva, Hudson P.; Viana, Ana L. D., Univ Sao Paulo, Fac Med, Dept Prevent Med, Sch
  Med, BR-01246903 Sao Paulo, Brazil.'
author: Silva, Hudson P. and Viana, Ana L. D.
author-email: hudson@usp.br
author_list:
- family: Silva
  given: Hudson P.
- family: Viana
  given: Ana L. D.
da: '2023-09-28'
doi: 10.1093/heapol/czq076
eissn: 1460-2237
files: []
issn: 0268-1080
journal: HEALTH POLICY AND PLANNING
keywords: Health technology diffusion; CT scanners; Brazil
keywords-plus: CARE
language: English
month: SEP
number: '5'
number-of-cited-references: '31'
orcid-numbers: 'Silva, Hudson P/0000-0001-7507-0917

  '
pages: 385-394
papis_id: aef0b822bd7beb820b29f2edd939828f
ref: Silva2011healthtechnology
researcherid-numbers: 'Silva, Hudson/ISU-3802-2023

  Silva, Hudson P/C-3969-2012

  Viana, Ana LD/B-2617-2013'
times-cited: '16'
title: 'Health technology diffusion in developing countries: a case study of CT scanners
  in Brazil'
type: article
unique-id: WOS:000294072400004
usage-count-last-180-days: '1'
usage-count-since-2013: '18'
volume: '26'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2011'