This website uses cookies.

By clicking the "Accept" button or continuing to browse our site, you agree to first-party and session-only cookies being stored on your device to enhance site navigation and analyze site performance and traffic. For more information on our use of cookies, please see our Privacy Policy.

« Back to Results

Physician Behavior

Paper Session

Saturday, Jan. 4, 2020 8:00 AM - 10:00 AM (PDT)

Marriott Marquis, Torrey Pines 1
Hosted By: American Economic Association
  • Chair: Mariana Carrera, Montana State University

Does the Patient-Provider Match Matter? Evidence from Gender Matching

Becky Staiger
,
Yale University

Abstract

There is a long-held belief that the relationship between a patient and their provider is fundamentally important to the delivery of high-value healthcare. However, there is little empirical evidence on the effects of the patient-provider relationship on patient health outcomes. Existing research has estimated the impacts of patient-provider concordance in demographic characteristics in emergency delivery (e.g. Greenwood et al. 2018) and preventive care uptake (e.g. Alsan et al. 2019), but there is a paucity of evidence in settings where such relationships arguably matter the most—namely, outpatient care and management of chronic disease. In this paper, I begin to fill this gap in understanding by providing evidence on the impact of patient-provider gender concordance on utilization and quality of care in the outpatient setting for Medicaid enrollees with chronic conditions.

Specifically, I use data from a novel and largely unutilized national Medicaid claims database, the Medicaid Analytic eXtract (MAX), together with an instrumental variables design to address patient sorting across providers. My instrument for the gender of a patient’s provider is the share of providers of that gender treating other enrollees in that patient’s zip code, year, and month of enrollment. I evaluate the effect of gender concordance on several measures of quality of care, such as days from first visit to diagnosis and number of preventable condition-specific ambulatory care sensitive condition (ACSC) hospitalizations; and utilization, such as general inpatient hospitalizations and ED visits.

Preliminary results indicate that male patients have significantly worse health outcomes when treated by male providers than female providers, both in terms of overall utilization and quality of care indicators. There is no significant difference in outcomes for female patients treated by female versus male providers, though female patients tend to be diagnosed more quickly when treated by female providers.

These findings suggest that gender concordance for male patients and male providers may be problematic for certain patient populations, particularly for male patients who are exogenously matched to male providers. Furthermore, my preliminary evidence suggests that male providers who accept Medicaid patients may be adversely selected on the margin and have worse outcomes than their female colleagues.

Do Pro-Social and Financial Concerns Reduce the Provision of Unnecessary Medical Treatment? Evidence from South Africa

Mylene Lagarde
,
London School of Economics and Political Science
Duane Blaauw
,
University of Witwatersrand

Abstract

In many health systems, scarce resources are often misused on the provision of unnecessary medical treatment. In the absence of direct financial incentive for providers, two issues may contribute to over-treatment decisions. Since providers rarely bear the cost of their treatment recommendations, they have no incentive to choose a less costly treatment. This problem is compounded when the treatment cost is borne by a third-party payer, as prosocial concerns to minimise patients’ costs do not apply.

We study the effects of these prosocial and financial incentives in an audit study of 120 dispensing general practitioners (GPs) in South Africa. These private GPs face a rationing incentive that should reduce the over-prescription of drugs because they charge a fixed consultation fee that is inclusive of drugs.
Each GP was visited by ‘mystery’ standardised patients portraying a simple case of respiratory viral infection, whose correct treatment does not require antibiotics. We manipulated two attributes of the patients conducting the audit. First, providers were randomised to receiving patients who were either covered by private insurance or who paid out-of-pocket. Second, to create an exogenous variation in the rationing incentive faced by GPs, two patients were sent to each GP: one who took the drugs dispensed as part of the consultation and one who requested a separate prescription to obtain drugs in a pharmacy.

In the absence of rationing incentive, providers choose drugs that are 20% more expensive than with the dispensing rationing incentive. However, we find no evidence that rationing incentives increase provider effort during the consultation or reduce the prescription of unnecessary antibiotics. Meanwhile, we find no evidence that doctors prescribe fewer unnecessary or cheaper drugs to uninsured patients.
Our results suggest a limited role for financial incentives to reduce unnecessary medical treatment.

Can Female Doctors Cure the Gender STEMM Gap? Evidence from Randomly Assigned General Practitioners

Alexander L.P. Willen
,
Norwegian School of Economics
Julie Riise
,
University of Bergen
Barton Willage
,
Louisiana State University

Abstract

We use random assignment of general practitioners (GPs) to provide the first evidence on the effects of female role models in childhood on the long-run educational outcomes of girls. We find that girls who are exposed to female GPs in childhood are significantly more likely to sort into traditionally male-dominated education programs in high school, most notably STEMM. These effects persist as females enter college and select majors. We also find strong positive effects on educational performance throughout their academic careers, suggesting that female role models in childhood improve education matches of girls. The effects we identify are significantly larger for high-ability girls with low educated parents, suggesting that female role models may improve intergenerational mobility and narrow the gifted gap for disadvantaged girls.

Medical Guidelines and Doctor Behavior

Armando N. Meier
,
University of Chicago
Ziad Obermeyer
,
University of California-Berkeley
Devin G. Pope
,
University of Chicago
Kevin Volpp
,
University of Pennsylvania

Abstract

Guidelines structure peoples’ behavior in domains ranging from finance to medical decision-making. Guidelines offer a valuable rule of thumb, but they could lead to errors in complex environments if people adhere to guidelines rigidly. We use millions of patients’ blood test results to examine doctors’ reaction to new information for pervasive screening tests (such as prostate cancer screening tests). We find that doctors rigidly adhere to medical guidelines. Although patients are comparable, doctors treat patients just above the medical guideline threshold substantially different from patients just below. We discuss potential reasons for rigid guideline adherence and implications for medical cost, patient health, and guideline design.

The Economics of Pain and Addiction

Joshua Tibbitts
,
Washington State University
Jill J. McCluskey
,
Washington State University
Ron Mittelhammer
,
Washington State University
Jonathan Yoder
,
Washington State University

Abstract

Pain and addiction are complements. Individuals who suffer from pain, either physical or mental, may use analgesic substances to reduce their pain. If the analgesic has addictive properties, then individuals may become subject to addiction. Thus, individuals seeking pain amelioration become dependent upon analgesics; in some cases, this dependence can lead to addiction. This circumstance represents a dilemma for those attempting to cope with their pain: a tradeoff between pain and dependence with possible addiction. We develop a rational choice model in which an agent’s pain evolves intertemporally as a function of intake of a potentially addictive analgesic. Consumption of this analgesic not only alleviates pain but may also contribute to rewarding stimuli, which is represented by the net value of reward and withdrawal i.e. habit formation. To our knowledge, this paper is the only paper in the economics literature that models pain as an antecedent to dependence and possibly addiction. This paper has important policy implications, especially as it pertains to the opioid crisis. Since the late 19th century, the health community has gone through repeated cycles of ignoring either pain or addiction. Prior to the current opioid crisis, physicians were criticized for their failure to treat physical pain. However, physicians’ perceived failure to treat pain had stemmed from their hesitancy to prescribe analgesics with potentially addictive properties, due to the previous morphine crisis where physicians ignored addiction to treat pain. In response to the current opioid crisis, many in the health community fear that legislation will largely ignore pain to mitigate addiction, which would repeat the cycle. Because of the tradeoff between pain and dependence with possible addiction, we posit that there is an optimal level of pain and addiction and that our model will help aide policymakers in understanding that optimum.
JEL Classifications
  • I1 - Health