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On the Sorting of Physicians across Medical Occupations

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  • Courty, Pascal

    ()
    (European University Institute)

  • Marschke, Gerald

    ()
    (University at Albany, SUNY)

Abstract

We model the sorting of medical students across medical occupations and identify a mechanism that explains the possibility of differential productivity across occupations. The model combines moral hazard and matching of physicians and occupations with pre-matching investments. In equilibrium assortative matching takes place; more able physicians join occupations less exposed to moral hazard risk, face more powerful performance incentives, and are more productive. Under-consumption of health services relative to the first best allocation increases with occupational (moral hazard) risk. Occupations with risk above a given threshold are not viable. The model offers an explanation for the persistence of distortions in the mix of health care services offered, the differential impact of malpractice risk across occupations, and the recent growth in medical specialization.

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Bibliographic Info

Paper provided by Institute for the Study of Labor (IZA) in its series IZA Discussion Papers with number 3862.

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Length: 38 pages
Date of creation: Dec 2008
Date of revision:
Handle: RePEc:iza:izadps:dp3862

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Keywords: performance measurement; moral hazard; incentives; matching; pre-matching investment; career choice; medical specialization;

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  1. David Dranove & Daniel Kessler & Mark McClellan & Mark Satterthwaite, 2003. "Is More Information Better? The Effects of "Report Cards" on Health Care Providers," Journal of Political Economy, University of Chicago Press, vol. 111(3), pages 555-588, June.
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  10. James Thornton & Fred Esposto, 2003. "How important are economic factors in choice of medical specialty?," Health Economics, John Wiley & Sons, Ltd., vol. 12(1), pages 67-73.
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  12. Leffler, Keith B, 1978. "Physician Licensure: Competition and Monopoly in American Medicine," Journal of Law and Economics, University of Chicago Press, vol. 21(1), pages 165-86, April.
  13. Tim Besley & Maitreesh Ghatak, 2005. "Competition and incentives with motivated agents," LSE Research Online Documents on Economics 928, London School of Economics and Political Science, LSE Library.
  14. Daniel A. Ackerberg & Maristella Botticini, 1999. "Endogenous Matching and the Empirical Determinants of Contract Form," Boston University - Institute for Economic Development 92, Boston University, Institute for Economic Development.
  15. Konstantinos Serfes, 2008. "Endogenous matching in a market with heterogeneous principals and agents," International Journal of Game Theory, Springer, vol. 36(3), pages 587-619, March.
  16. Sean Nicholson, 2002. "Physician Specialty Choice under Uncertainty," Journal of Labor Economics, University of Chicago Press, vol. 20(4), pages 816-847, October.
  17. Roth,Alvin E. & Sotomayor,Marilda A. Oliveira, 1992. "Two-Sided Matching," Cambridge Books, Cambridge University Press, number 9780521437882, April.
  18. Holmstrom, Bengt & Milgrom, Paul, 1991. "Multitask Principal-Agent Analyses: Incentive Contracts, Asset Ownership, and Job Design," Journal of Law, Economics and Organization, Oxford University Press, vol. 7(0), pages 24-52, Special I.
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