Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Gabriel Picone, Ph.D.

Co-Major Professor

Murat Munkin, Ph.D.

Committee Member

Bradley Kamp, Ph.D.

Committee Member

Giulia La Mattina, Ph.D.

Committee Member

Etienne Pracht, Ph.D.


Spatial probit, Surgical robot, Bayesian, GIS


The surgical robot experienced rapid uptake throughout hospitals in the US despite lack of clinical evidence that it is superior to existing methods and undeterred by its high cost. This type of technology may be a “weapon” in the medical arms race hypothesis which asserts that competition among hospitals may be welfare reducing wherein it encourages resource use that is not commensurate with beneficial health outcomes. This paper is a case-study of the diffusion of the surgical robot among hospitals in Florida. We address the medical arms race hypothesis directly by investigating whether a hospital’s decision to adopt a robot is a function of the neighboring, competing hospitals’ decisions to do so. Using a spatial autoregressive probit model, we find that the spatial coefficient is significant and negative. That is, when neighboring hospitals operate a robot, a given hospital is less likely to operate one. Indeed, hospitals appear to consider the behavior of rival hospitals, but not in a way that would be consistent with a medical arms race. Support is lent to the hypothesis that as more hospitals become providers of robotic-assisted surgery, the less profitable it becomes to enter the market.