Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Dr. Robert E. Hurley


New medical technologies have been viewed as the primary cause of rising health are expenditures by health policy researchers in the United States. Since the mid 1990s, with the prevalence of obesity among Americans, the utilization of bariatric surgery, a medical innovation, has increased rapidly among U.S. hospitals. Generally, current literature only states that the volume of bariatric procedures is increasing dramatically.Very limited studies have been conducted to investigate the growth of bariatric procedures.The objective of this study is (1) to provide a detailed description about the adoption and utilization of bariatric procedure in hospitals in 11 states, and (2) to identify the factors significantly enhancing hospitals to adopt or expand the service of surgical treatment for obesity.A panel design from 1995 to 2000 was employed in this study. Several databases are merged together for the final analysis. The descriptive analyses show that the increase in bariatric procedures is coming from two contributors: the entry of hospitals into the market of bariatric surgery, and the continuous expansion of capacity of offering the surgery by antecedent adopters. The panel analyses provided mixed support to the factors influencing hospitals' decision on adoption or expansion of bariatric surgery. The fixed-effects logit model suggests that hospital size, competition and cumulative adoption rate in a local market are strong predictors of hospitals' adoption of the surgery. The fixed effects model shows that ownership status, payment mix improvement, and cumulative adoption rate in a local market are strongly impact the expansion rate of bariatric procedures in hospitals.These findings suggest determinants enhancing hospitals to adopt or expand the bariatric service program. As the provision of bariatric procedures continues to increase among U.S. hospitals, health plans and policy makers will face greater challenges to balance the demand of patients with morbid obesity and the rapid increasing healthcare expenditures related to the surgery.


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