Physicians Treating Physicians: Information and Incentives in Childbirth

Johnson, Erin M.; Rehavi, M. Marit

doi:10.1257/pol.20140160

Cited by 71 publications

(44 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is also important to point out that in our empirical analysis we include many variables that control for observable severity such as the patient's age, gender, Charlson comorbidity index (CCI) 28 and a dummy variable indicating the specific diagnosis code of the AMI (ICD-9 code).…”

Section: Unobserved Health Severity Of First-time Ami Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Physician competition and the provision of care: evidence from heart attacks

Dunn¹,

Shapiro²

2015

ERWP

View full text Add to dashboard Cite

We study the impact of competition among physicians on service provision and patients' health outcomes. We focus on cardiologists treating patients with a firsttime heart attack treated in the emergency room. Physician concentration has a small, but statistically significant effect on service utilization. A one-standard deviation increase in cardiologist concentration causes a 5 percent increase in cardiologist service provision. Cardiologists in more concentrated markets perform more intensive procedures, particularly, diagnostic procedures-services in which the procedure choice is more discretionary. Higher concentration also leads to fewer readmissions, implying potential health benefits. These findings are potentially important for antitrust analysis and suggest that changes in organizational structure in a market,

show abstract

Section: Unobserved Health Severity Of First-time Ami Patientsmentioning

confidence: 99%

“…29 28 Specifically, we include a third order polynomial of the CCI to account for possible nonlinear effects of the patient's health condition going into the AMI. 29 This includes ten ICD-9 categories-nine dummy variables plus one omitted dummy.…”

Section: Unobserved Health Severity Of First-time Ami Patientsmentioning

confidence: 99%

Physician competition and the provision of care: evidence from heart attacks

Dunn¹,

Shapiro²

2015

ERWP

View full text Add to dashboard Cite

show abstract

“…These experts' private information is not necessarily contractible or verifiable. Additionally, they have incentives to act deceptively by charging for superfluous repairs (Olivarez-Giles, 2010;Grover et al, 2013), billing plaintiffs for lawsuits which have little probability of legal remedy, performing unnecessary medical procedures (Johnson & Rehavi, 2016), or enacting policies that benefit their employers (Carrick-Hagenbarth & Epstein, 2012).…”

Section: Introductionmentioning

confidence: 99%

Deception and reception: The behavior of information providers and users

Sheremeta

Shields

2017

Journal of Economic Behavior & Organization

View full text Add to dashboard Cite

We investigate the behavior of information providers (underwriters) and users (investors) in a controlled laboratory experiment where underwriters have incentives to deceive and investors have incentives to avoid deception. Participants play simultaneously as underwriters and investors in one-shot information transmission games. The results of our experiment show a significant proportion of both deceptive and non-deceptive underwriters. Despite the presence of deceptive underwriters, investors are receptive to underwriters' reports, gleaning information content, albeit overly optimistic. Within our sample, deception by underwriters and reception by investors are the most profitable strategies. Moreover, participants who send deceptive reports to investors, but at the same time are receptive to reports of underwriters, earn the highest payoffs. These results call into question the characterization of duped investors being irrational.

show abstract

“…to this direct financial incentive for providers to perform C-sections over vaginal births, C-sections can be more efficient for providers to perform because they can be scheduled prior to delivery and completed in less time (Gruber and Owings, 1996;Johnson and Rehavi, 2016). Providers also may favor C-sections over vaginal births to lower their risk of malpractice lawsuits (Gruber and Owings, 1996;Yang et al, 2009).…”

Section: Treatment Context: Cesarean Sectionsmentioning

confidence: 99%

“…blood clots, and emergency hysterectomy in mothers as well as asphyxia, respiratory and pulmonary disorders in infants (Johnson and Rehavi, 2016;Kozhimannil et al, 2013). 13 For the purposes of this model, there is one provider which I refer to as the hospital.…”

Section: Theoretical Framework: How Insurermentioning

confidence: 99%

Essays on the Effects of Health Insurer and Health Care Provider Organization on Patient Treatments

Johnson

View full text Add to dashboard Cite

The United States health care system has garnered significant policy attention in recent years. The importance of the health care system is in part a fiscal concern, but also because of the role it plays in peoples' lives. In many cases, patients' lives greatly depend on the quality of the health care they receive. The organization of the health care system has undergone many dramatic changes in recent years and it is important to understand how these changes impacted the way the health care system functions. The effects of the various changes on health care spending and, in particular, on patient treatment outcomes remain poorly understood. In this dissertation, I investigate how three recent trends in the organization of the U.S. health care system have impacted the treatments that patients receive: the decrease in health insurer competition, the increase in hospital-physician integration, and the use of managed care in public insurance programs.In Chapter 1, I study whether health insurer competition increases the use of costly treatments. Health insurers have an incentive to influence health care providers' treatment decisions to reduce their own reimbursement costs. If a single insurer is effective at inducing a provider to use less costly treatments, the provider may do so for patients of other insurers. While an insurer can reduce their own costs, spillover of their cost reduction can allow rival insurers to also benefit. I develop a theoretical framework demonstrating how competition can deter insurers from limiting costly treatments due to provider-level spillover concerns. I empirically test the relationship between Health Maintenance Organization (HMO) competition and Cesarean section (C-section) use. C-sections are a costly treatment that HMOs have an incentive and the potential ability to influence. I argue that HMOs' return to limiting C-sections should be lower at hospitals that contract with more HMOs due to potential spillover. I find that patients are more likely to receive C-sections at hospitals with lower HMO concentration -where spillover poses a greater deterrent to HMO cost reduction. The magnitude of this effect increases with the level of HMO competition in the market containing the hospital. Taken together, these results provide evidence that HMO competition can increase the use of C-sections at hospitals that contract with multiple HMOs.ii In Chapter 2, I study whether hospital-physician integration affects health care utilization by altering the treatments patient receive. I estimate the effect of hospitalphysician integration on the use of C-sections in childbirth using a sample of privately insured patients from California over 2005-2012. Childbirth is a convenient treatment setting to study utilization because it presents a binary choice between a high intensity, high cost procedure (C-section) and a comparatively low intensity, low cost alternative (vaginal birth). I am able to decompose the effect of hospital-physician integration on C-section use by the form of integra...

show abstract

Physicians Treating Physicians: Information and Incentives in Childbirth

Cited by 71 publications

References 48 publications

Physician competition and the provision of care: evidence from heart attacks

Physician competition and the provision of care: evidence from heart attacks

Deception and reception: The behavior of information providers and users

Essays on the Effects of Health Insurer and Health Care Provider Organization on Patient Treatments

Contact Info

Product

Resources

About