title: Managed care and the dissemination of robotic prostatectomy.
abstract: OBJECTIVE
  Robotic prostatectomy has rapidly disseminated over the past decade. How managed care, thought by many to be a barrier to new technology, influences the dissemination of robotics is unknown. We sought to better understand the relationship between a market's managed-care penetration and the dissemination of robotic prostatectomy.
  
  
  METHODS
  We used SEER-Medicare data from 2003 through 2007 to identify men ≥66 years of age treated with radical prostatectomy for prostate cancer. We categorized Health Service Areas (HSAs) according to the degree of managed-care penetration (ie, low vs high). We assessed adoption of robotic prostatectomy and utilization among adopting HSAs using Cox proportional-hazards and Poisson regression models, respectively.
  
  
  RESULTS
  Compared with markets with little managed care, highly penetrated markets had more racial diversity (24% vs 15% nonwhite, P < .01), higher population densities (1987 vs 422 people/square mile, P < .01), and higher median incomes ($49 374 vs $36 236, P < .01). Robotic prostatectomy adoption and utilization increased over time in both HSA categories. Compared with low managed-care markets, those with high managed care adopted robotic prostatectomy more rapidly (eg, probability 0.37 [low] vs 0.52 [high] in 2007; P < .01). However, the postadoption utilization of robotic prostatectomy was constrained in these highly penetrated markets (eg, probability 0.66 [low] vs 0.52 [high] in 2007; P < .01).
  
  
  CONCLUSIONS
  High managed-care penetration was associated with more rapid robotic prostatectomy adoption. However, once adopted, utilization increased more slowly in these markets. Understanding this paradox is important as more technologies are unveiled in an increasingly cost-conscious health care environment.
authors: University of Michigan, Ann Arbor, MI, USA.
authors: Yun
authors: Y
authors: Zhang
authors: University of Michigan, Ann Arbor, MI, USA.
authors: Brent K
authors: BK
authors: Hollenbeck
authors: University of Michigan, Ann Arbor, MI, USA.
authors: Florian R
authors: FR
authors: Schroeck
authors: University of Michigan, Ann Arbor, MI, USA jacobsbl107@gmail.com.
authors: Bruce L
authors: BL
authors: Jacobs
mesh_terms: D000368:Aged; D004059:Diffusion of Innovation; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: adoption; managed care; prostate cancer; robotic prostatectomy; utilization