Diffusion of competing innovations: The effects of network structure on the provision of healthcare

Medical innovations, in the form of new medication or other clinical practices, evolve and spread through health care systems, impacting on the quality and standards of health care provision, which is demonstrably heterogeneous by geography. Our aim is to investigate the potential for the diffusion of innovation to influence health inequality and overall levels of recommended care. We extend existing diffusion of innovation models to produce agent-based simulations that mimic population wide adoption of new practices by doctors within a network of influence. Using a computational model of network construction in lieu of empirical data about a network, we simulate the diffusion of competing innovations as they enter and proliferate through a state system comprising 24 geopolitical regions, 216 facilities and over 77,000 individuals. Results show that stronger clustering within hospitals or geo-political regions is associated with slower adoption amongst smaller and rural facilities. Results of repeated simulation show how the nature of uptake and competition can contribute to low average levels of recommended care within a system that relies on diffusive adoption. We conclude that an increased disparity in adoption rates is associated with high levels of clustering in the network, and the social phenomena of competitive diffusion of innovation potentially contributes to low levels of recommended care.