Institutionalizarion of public policies & diffusion of innovation: the case of interventional radiology

Diffusion of innovation theories are many among various scientific fields including sociology. In its seminal work Rogers emphasis the role of social system & legitimation as a major force during the so-called phase of persuasion toward market penetration. But markets are a myth as it has been stress by Flingstein: they are social constructions designed by political work of the different stakeholders who needs institutions that limit uncertainty & enable action. Indeed the healthcare market is a good example with many institutions such as drug market access & pricing/reimbursement regulation. With its theory of prescribers, Hatchuel highlights the role of the physician as well the role of agencies (government health agencies, WHO, …) in providing unknown information ie value to the buyer in this uncertain world. Today, the social construction of the value of medical innovation, & its social recognition is dependent on the increasing role of the evaluation made by the agencies of Health Technology Assessment (HTA). It's a multidisciplinary analysis tool that examines medical, economic, social & ethical implications of value, distribution & use of medical technology in public health. The emergence of new medical imaging practices such as interventional radiology involves specific institutional conditions (regulations, laws, norms, standards, ...). We postulate that medico-economic evaluation by HTA agencies contributes to the social construction of the value of these medical innovations acting as a brake or as an accelerator of diffusion. By looking at HTA national public policy, academic expertise & knowledge circulation, our analysis underlines the influence of the country's healthcare system & exogenous macroeconomic factors.