OBJECTIVES: The aim of the study was to measure the effect of supplementary fees on the use of drug-eluting stents (DES) in AMI patients instead of conventional bare-metal stents (BMS). German DRG fees do not distinguish between different types of coronary stents. To compensate hospitals for higher costs of DES, supplementary payments could be negotiated between the hospital and the sickness funds. METHODS: Administrative data of one of the largest German sickness funds was used to identify the determinants of DES use in AMI patients. The dataset contained information on demographic characteristics and co-morbidities on patient level. Information on hospital and regional level including the supplementary fee for the use of DES was merged. 9.453 patients with an admission due to an AMI and the implantation of a BMS or DES between 2004 through to 2006 were included in the analysis. For analyzing the data, a logistic multilevel regression approach was used; the dependent variable was binary, taking the value of 1 if a DES was implanted and 0 if a BMS was implanted. In the regression, a comprehensive set of covariates on patient level as well as variables on hospital and regional level were included. To test robustness of the estimation, several models were estimated. RESULTS: A substantial share of the variance (around 20%) was related to the hospital level. Preliminary results suggest that supplementary fees had a borderline significant positive impact on DES use. Further hospital characteristics also had a significant impact on the use of DES (p<0.05), as well as area characteristics. CONCLUSIONS: Although there seems to be a small influence of supplementary fees on the use of DES, further hospitals’ and area characteristics might be of higher importance than reimbursement incentives. Attributing the diffusion of technologies to financial incentives only would fall too short.