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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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Citations

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Cited by:
  1. 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, Elsevier, vol. 30(1), pages 163-180, January.
  2. Eibich, Peter & Ziebarth, Nicolas R., 2014. "Analyzing Regional Variation in Health Care Utilization Using (Rich) Household Microdata," EconStor Open Access Articles, ZBW - German National Library of Economics, pages 41–53.
  3. Ching-to Albert MA & Ting Liu, 2011. "Health Insurance, Treatment Plan, and Delegation to Altruistic Physician," Boston University - Department of Economics - Working Papers Series, Boston University - Department of Economics WP2011-022, Boston University - Department of Economics.
  4. Daniele Fabbri & Chiara Monfardini, 2008. "Style of practice and assortative mating: a recursive probit analysis of Caesarean section scheduling in Italy," Applied Economics, Taylor & Francis Journals, Taylor & Francis Journals, vol. 40(11), pages 1411-1423.
  5. 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, Springer, vol. 9(4), pages 333-345, December.
  6. Andrew J. Epstein & Sean Nicholson & David A. Asch, 2013. "The Production of and Market for New Physicians' Skill," NBER Working Papers 18678, National Bureau of Economic Research, Inc.
  7. 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.
  8. Janet Currie & W. Bentley MacLeod, 2013. "Diagnosis and Unnecessary Procedure Use: Evidence from C-Section," NBER Working Papers 18977, National Bureau of Economic Research, Inc.
  9. Bardey, David & Canta, Chiara & Lozachmeur, Jean-Marie, 2012. "The regulation of health care providers’ payments when horizontal and vertical differentiation matter," Journal of Health Economics, Elsevier, Elsevier, vol. 31(5), pages 691-704.
  10. Shurtz, Ity, 2013. "The impact of medical errors on physician behavior: Evidence from malpractice litigation," Journal of Health Economics, Elsevier, Elsevier, vol. 32(2), pages 331-340.
  11. Andrew Epstein & Jonathan D. Ketcham & Sean Nicholson, 2008. "Professional Partnerships and Matching in Obstetrics," NBER Working Papers 14070, National Bureau of Economic Research, Inc.
  12. Leonel Muinelo & Máximo Rossi & Patricia Triunfo, 2005. "Comportamiento médico: una aplicación a las cesáreas en el Uruguay," Documentos de Trabajo (working papers), Department of Economics - dECON 0605, Department of Economics - dECON.
  13. Nigam, Amit, 2012. "The effects of institutional change on geographic variation and health services use in the USA," Social Science & Medicine, Elsevier, Elsevier, vol. 74(3), pages 323-331.
  14. 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, Departamento de Economía - Universidad Pública de Navarra 1212, Departamento de Economía - Universidad Pública de Navarra.
  15. Erin M. Johnson & M. Marit Rehavi, 2013. "Physicians Treating Physicians: Information and Incentives in Childbirth," NBER Working Papers 19242, National Bureau of Economic Research, Inc.

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