Physician Influence on the Cost, Quality and Organization of Healthcare Delivery
Saturday, Jan. 7, 2017 7:30 PM – 9:30 PM
- Chair: James B. Rebitzer, Boston University
Causes and Consequences of Fragmented Care Delivery: Theory, Evidence and Public Policy
AbstractThe US Healthcare delivery system is famously inefficient, but the causes of the inefficiencies are poorly understood. In this paper, we analyze one widely discussed source of inefficiency, the “fragmentation hypothesis”. According to this hypothesis healthcare is spread out across an excessively large number of poorly coordinated providers leading to low quality and high costs. The fragmentation hypothesis is widely discussed and has motivated important policy initiatives, but theoretical and evidentiary support are weak. This paper addresses three fundamental questions for the economic analysis of care fragmentation: (1) to what extent are observed patterns of care fragmentation the result physician practice styles that are independent of a patient’s clinical condition and preferences; (2) does fragmentation influence utilization independent of a patient's clinical condition and preferences; and (3) under what circumstances will public policy interventions seeking to reduce fragmented care lead to lower-cost and more efficient healthcare delivery.
Information or Compensation? Understanding the Role of Information Technology in Physician Response to Pay-For Performance
AbstractPreventive health care services are often under-provided, due both to physician incentives and patient behavior regarding such services. We study the impact of physician financial incentives and physician use of information technology on preventive service take up using a unique proprietary data set from a large insurer that covers most of the population for the state of Hawaii. The data contain micro-level information on patient claims, physician financial incentives / payments, and physician logins to an IT platform designed to help them improve their use of preventive services. We leverage these data, together with exogenous variation in the financial incentives and adoption of IT to quantify the impact of these factors on physician preventive care utilization. We study how IT and financial incentives complement each other for this purpose, and use the micro-data to study physician heterogeneity in use of preventive care as a function of these factors. Finally, we study the relationship between patient cost-sharing incentives, physician use of IT, and physician financial incentives.
Physician Investment in Hospitals: Specialization, Incentives, and the Quality of Cardiac Care
AbstractPhysician ownership of hospitals involves several competing economic forces. Physician-owners may be incentivized to “cherry-pick" and treat profitable patients at their facilities. However, physician-owned hospitals are often specialized and may provide higher-quality care. This paper uses a structural choice-outcome model to estimate hospital quality, patient-hospital matching, and preferences for treating patients at owned vs. competing hospitals. Instrumental variables analysis of cardiac mortality is used to capture quality; I document a significant mortality improvement at physician-owned hospitals. I use new data on ownership to estimate physician-owner preferences; controlling for matching and baseline patient preferences, there is little evidence of physician-owner cherry-picking.
- I1 - Health