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Physicians, Hospitals, Opioids, and Nutrition

Paper Session

Saturday, Jan. 4, 2020 12:30 PM - 2:15 PM (PDT)

Manchester Grand Hyatt, Gaslamp AB
Hosted By: Health Economics Research Organization
  • Chair: Kosali Simon, Indiana University

Owning the Agent: Hospital Influence on Physician Behaviors

Ian McCarthy
,
Emory University
Haizhen Lin
,
Indiana University
Michael Richards
,
Baylor University

Abstract

When making health care decisions, the physician has a clear informational advantage over the patient and acts as a designated authority figure in many decisions. Physician agency problems then derive from misalignment between the physician's financial incentives and the patient's preferences. Alongside this traditional physician agency problem, the presence of differential financial incentives between physicians and hospitals generates an incentive for hospitals to influence physician behaviors and exploit agency problems toward their own objectives. The goal of this paper is to quantify the extent of any such hospital influence using within-physician variation across hospitals, where we use hospital ownership of physician practices as a measure of physician-hospital relationships.

Physician Responses to Malpractice Allegations: Evidence from Florida Emergency Departments

Caitlin Carroll
,
University of Minnesota
David Cutler
,
Harvard University
Anupam Jena
,
Harvard University

Abstract

A substantial literature has studied the influence of malpractice pressure on physician behavior. However, these studies generally focus on variation in state laws governing malpractice exposure. In this project, we test how physicians respond to malpractice allegations made against them. Our sample is Emergency Department physicians in Florida, where we have the universe of data on patients and how they are treated along with a census of malpractice complaints. We find that physicians oversee 7% fewer discharges after malpractice allegations and treat each discharge about 5% more expensively after an allegation. These effects are true for both allegations that result in money paid and allegations which are dropped. Further, the increase in treatment is not limited to patients with conditions similar to what the physician is sued for. The results thus suggest significant, if modest, generalized impacts of malpractice claims on medical practice.

Effect of United States Drug Enforcement Administration (DEA)’s “Scheduling” of Tramadol Products on Opioid Prescribing

Sumedha Gupta
,
Indiana University-Purdue University Indianapolis
Thuy Nguyen
,
Indiana University
Patricia Freeman
,
University of Kentucky
Kosali Simon
,
Indiana University

Abstract

Using claims data from a large, commercial insurer, we examine how prescribing of tramadol and other opioid analgesics changed in response to the DEA moving tramadol to a more restrictive tier of the Controlled Substance Act (CSA) in July 2014. We find evidence that tighter controls on prescribing of tramadol have led to significant declines in tramadol use, but that there appears no impact of this scheduling event on prescribing of other opioid analgesics. Our findings imply that the Controlled Substance Act (CSA) scheduling of drugs can serve as an important policy tool to curb high levels of opioid prescribing.

Mothers as Insurance: Family Spillovers from Child Targeted Programs

Marianne Bitler
,
University of California-Davis
Janet Currie
,
Princeton University
Hilary Hoynes
,
University of California-Berkeley
Lisa Schulkind
,
University of North Carolina-Charlotte
Barton Willage
,
Louisiana State University

Abstract

The WIC program aims to ensure that low-income children and pregnant women have access to healthful food. It is one of the larger food assistance programs, with around half of infants participating. Despite the fact that three quarters of the WIC caseload is children, the bulk of the existing evidence is about effects of prenatal WIC exposure. Evidence about impacts of WIC on children is much more limited. We use regression discontinuity (RD) to estimate causal effects of WIC on child health and nutrition. Our RD models leverage sharp changes in program eligibility to examine effects of WIC on food and nutrient consumption and food insecurity. We also examine spillovers to other family members who are not directly eligible for the programs. We find that the first stage is economically meaningful, with between 14 and 18 percent of children being on WIC right before they age out of the program at 5. We find little or no effect on consumption among the children aging out themselves. There is however evidence that mothers protect their children by reducing their own consumption when the children age out of WIC, suggesting that maternal consumption serves as a buffer for child consumption as measures of food insecurity increase.
Discussant(s)
David Powell
,
RAND Corporation
Nathan Wilson
,
Federal Trade Commission
Diane Whitmore Schanzenbach
,
Northwestern University
JEL Classifications
  • I1 - Health
  • I0 - General