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The formation and evolution of physician treatment styles: An application to cesarean sections

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  • Epstein, Andrew J.
  • Nicholson, Sean

Abstract

Small-area-variation studies have shown that physician treatment styles differ substantially both between and within markets, controlling for patient characteristics. Using data on the universe of deliveries in Florida and New York over a 15-year period, we examine why treatment styles differ across obstetricians at a point in time and why styles change over time. We find that variation in c-section rates across physicians within a market is about twice as large as variation between markets. Surprisingly, residency programs explain no more than four percent of the variation in physicians' risk-adjusted c-section rates, even among newly trained physicians. Although we find evidence that physicians learn from their peers, they do not substantially revise their prior beliefs regarding treatment due to the local exchange of information. Our results indicate that physicians are not likely to converge over time to a community standard; thus, within-market variation in treatment styles is likely to persist.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 28 (2009)
Issue (Month): 6 (December)
Pages: 1126-1140

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Handle: RePEc:eee:jhecon:v:28:y:2009:i:6:p:1126-1140

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Web page: http://www.elsevier.com/locate/inca/505560

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Keywords: Physician treatment styles Small-area variation Peer effects;

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References

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  1. Phelps, Charles E., 2000. "Information diffusion and best practice adoption," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 5, pages 223-264 Elsevier.
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  4. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, vol. 18(4), pages 473-490, August.
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Citations

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Cited by:
  1. BARDEY, David & CANTA, Chiara & LOZACHMEUR, Jean-Marie, . "The regulation of health care providers' payments when horizontal and vertical differentiation matter," CORE Discussion Papers RP -2441, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
  2. Grytten, Jostein & Skau, Irene & Sørensen, Rune, 2011. "Do expert patients get better treatment than others? Agency discrimination and statistical discrimination in obstetrics," Journal of Health Economics, Elsevier, vol. 30(1), pages 163-180, January.
  3. Leonel Muinelo & Máximo Rossi & Patricia Triunfo, 2005. "Comportamiento médico: una aplicación a las cesáreas en el Uruguay," Documentos de Trabajo (working papers) 0605, Department of Economics - dECON.
  4. Andrew Epstein & Jonathan D. Ketcham & Sean Nicholson, 2008. "Professional Partnerships and Matching in Obstetrics," NBER Working Papers 14070, National Bureau of Economic Research, Inc.
  5. David Cutler & Jonathan Skinner & Ariel Dora Stern & David Wennberg, 2013. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," NBER Working Papers 19320, National Bureau of Economic Research, Inc.
  6. Eibich, Peter & Ziebarth, Nicolas R., 2013. "Analyzing Regional Variation in Health Care Utilization Using (Rich) Household Microdata," IZA Discussion Papers 7409, Institute for the Study of Labor (IZA).
  7. Shurtz, Ity, 2013. "The impact of medical errors on physician behavior: Evidence from malpractice litigation," Journal of Health Economics, Elsevier, vol. 32(2), pages 331-340.
  8. D. Fabbri & C. Monfardini, 2006. "Style of practice and assortative mating: a recursive probit analysis of cesarean section scheduling in Italy," Working Papers 557, Dipartimento Scienze Economiche, Universita' di Bologna.
  9. Alejandro Arrieta & Ariadna García-Prado, 2012. "Non-elective cesarean sections in public hospitals: hospital capacity constraints and doctor´s incentives," Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra 1212, Departamento de Economía - Universidad Pública de Navarra.
  10. Ting Liu & Ching-to Albert Ma, 2012. "Health Insurance, Treatment Plan, and Delegation to Altruistic Physician," Department of Economics Working Papers 12-08, Stony Brook University, Department of Economics.
  11. Nigam, Amit, 2012. "The effects of institutional change on geographic variation and health services use in the USA," Social Science & Medicine, Elsevier, vol. 74(3), pages 323-331.
  12. Patricia Triunfo & Máximo Rossi, 2009. "The effect of physicians’ remuneration system on the Caesarean section rate: the Uruguayan case," International Journal of Health Care Finance and Economics, Springer, vol. 9(4), pages 333-345, December.

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