IDEAS home Printed from https://ideas.repec.org/p/ces/ceswps/_9204.html
   My bibliography  Save this paper

Physician Effects in Antibiotic Prescribing: Evidence from Physician Exits

Author

Listed:
  • Shan Huang
  • Hannes Ullrich

Abstract

Human antibiotic consumption is considered the main driver of antibiotic resistance. Reducing human antibiotic consumption without compromising health care quality poses one of the most important global health policy challenges. A crucial condition for designing effective policies is to identify who drives antibiotic treatment decisions, physicians or patient demand. We measure the causal effect of physician practice style on antibiotic intake and health outcomes exploiting variation in patient-physician relations due to physician exits in general practice in Denmark. We estimate that physician practice style accounts for 53 to 56 percent of between-clinic differences in all antibiotic consumption, and for 74 to 81 percent in the consumption of second-line antibiotic drugs. We find little evidence that low prescribing styles adversely affect health outcomes measured as preventable hospitalizations due to infections. Our findings suggest that policies to curb antibiotic resistance are most effective when aimed at improving physician decision-making, in particular when they target high prescribers. High prescribing practice styles are positively associated with physician age and negatively with staff size and the availability of diagnostic tools, suggesting that improvements in the quality of diagnostic information is an important path to improved decisions.

Suggested Citation

  • Shan Huang & Hannes Ullrich, 2021. "Physician Effects in Antibiotic Prescribing: Evidence from Physician Exits," CESifo Working Paper Series 9204, CESifo.
  • Handle: RePEc:ces:ceswps:_9204
    as

    Download full text from publisher

    File URL: https://www.cesifo.org/DocDL/cesifo1_wp9204.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, vol. 115(1), pages 103-140.
    2. Michael Allan Ribers & Hannes Ullrich, 2020. "Machine Predictions and Human Decisions with Variation in Payoffs and Skill," Papers 2011.11017, arXiv.org.
    3. Salm, Martin & Wübker, Ansgar, 2020. "Sources of regional variation in healthcare utilization in Germany," Journal of Health Economics, Elsevier, vol. 69(C).
    4. Daniel Bennett & Che-Lun Hung & Tsai-Ling Lauderdale, 2015. "Health Care Competition and Antibiotic Use in Taiwan," Journal of Industrial Economics, Wiley Blackwell, vol. 63(2), pages 371-393, June.
    5. David Cutler & Jonathan S. Skinner & Ariel Dora Stern & David Wennberg, 2019. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 192-221, February.
    6. Emilia Simeonova & Niels Skipper & Peter R. Thingholm, 2020. "Physician Health Management Skills and Patient Outcomes," NBER Working Papers 26735, National Bureau of Economic Research, Inc.
    7. Epstein, Andrew J. & Nicholson, Sean, 2009. "The formation and evolution of physician treatment styles: An application to cesarean sections," Journal of Health Economics, Elsevier, vol. 28(6), pages 1126-1140, December.
    8. Currie, Janet & MacLeod, W. Bentley & Van Parys, Jessica, 2016. "Provider practice style and patient health outcomes: The case of heart attacks," Journal of Health Economics, Elsevier, vol. 47(C), pages 64-80.
    9. David C. Chan, 2021. "Influence and Information in Team Decisions: Evidence from Medical Residency," American Economic Journal: Economic Policy, American Economic Association, vol. 13(1), pages 106-137, February.
    10. Marianne Simonsen & Lars Skipper & Niels Skipper & Peter Rønø Thingholm, 2019. "Discontinuity in Care: Practice Closures among Primary Care Providers and Patient Health," Economics Working Papers 2019-08, Department of Economics and Business Economics, Aarhus University.
    11. Laxminarayan, Ramanan & Brown, Gardner M., 2001. "Economics of Antibiotic Resistance: A Theory of Optimal Use," Journal of Environmental Economics and Management, Elsevier, vol. 42(2), pages 183-206, September.
    12. Fadlon, Itzik & Van Parys, Jessica, 2020. "Primary care physician practice styles and patient care: Evidence from physician exits in Medicare," Journal of Health Economics, Elsevier, vol. 71(C).
    13. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    14. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    15. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    16. Ana Moura & Martin Salm & Rudy Douven & Minke Remmerswaal, 2019. "Causes of regional variation in Dutch healthcare expenditures: Evidence from movers," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1088-1098, September.
    17. Lina Maria Ellegård & Jens Dietrichson & Anders Anell, 2018. "Can pay‐for‐performance to primary care providers stimulate appropriate use of antibiotics?," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 39-54, January.
    18. David Molitor, 2018. "The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration," American Economic Journal: Economic Policy, American Economic Association, vol. 10(1), pages 326-356, February.
    19. Itzik Fadlon & Frederik Plesner Lyngse & Torben Heien Nielsen, 2020. "Early Career Setbacks and Women’s Career-Family Trade-Off," NBER Working Papers 28245, National Bureau of Economic Research, Inc.
    20. Currie, Janet & Lin, Wanchuan & Meng, Juanjuan, 2014. "Addressing antibiotic abuse in China: An experimental audit study," Journal of Development Economics, Elsevier, vol. 110(C), pages 39-51.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Shan Huang & Hannes Ullrich, 2023. "Provider effects in antibiotic prescribing: Evidence from physician exits," Berlin School of Economics Discussion Papers 0018, Berlin School of Economics.
    2. Avdic, Daniel & Ivets, Maryna & Lagerqvist, Bo & Sriubaite, Ieva, 2023. "Providers, peers and patients. How do physicians’ practice environments affect patient outcomes?," Journal of Health Economics, Elsevier, vol. 89(C).
    3. Ivan Badinski & Amy Finkelstein & Matthew Gentzkow & Peter Hull, 2023. "Geographic Variation in Healthcare Utilization: The Role of Physicians," NBER Working Papers 31749, National Bureau of Economic Research, Inc.
    4. Peter Rønø Thingholm, 2023. "Provider Spill-Overs in Opioid Prescription Leniency and Patient – Labor Market Outcomes," Economics Working Papers 2023-05, Department of Economics and Business Economics, Aarhus University.
    5. Simonsen, Marianne & Skipper, Lars & Skipper, Niels & Thingholm, Peter Rønø, 2021. "Discontinuity in care: Practice closures among primary care providers and patient health care utilization," Journal of Health Economics, Elsevier, vol. 80(C).
    6. Fadlon, Itzik & Van Parys, Jessica, 2020. "Primary care physician practice styles and patient care: Evidence from physician exits in Medicare," Journal of Health Economics, Elsevier, vol. 71(C).
    7. Hannes Ullrich & Michael Allan Ribers, 2023. "Machine predictions and human decisions with variation in payoffs and skill: the case of antibiotic prescribing," Berlin School of Economics Discussion Papers 0027, Berlin School of Economics.
    8. Naimi Johansson & Mikael Svensson, 2022. "Regional variation in prescription drug spending: Evidence from regional migrants in Sweden," Health Economics, John Wiley & Sons, Ltd., vol. 31(9), pages 1862-1877, September.
    9. Attema, Arthur E. & Galizzi, Matteo M. & Groß, Mona & Hennig-Schmidt, Heike & Karay, Yassin & L’Haridon, Olivier & Wiesen, Daniel, 2023. "The formation of physician altruism," Journal of Health Economics, Elsevier, vol. 87(C).
    10. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Neighborhoods, networks, and delivery methods," Journal of Health Economics, Elsevier, vol. 80(C).
    11. Leila Agha & Keith Marzilli Ericson & Xiaoxi Zhao, 2020. "The Impact of Organizational Boundaries on Healthcare Coordination and Utilization," NBER Working Papers 28179, National Bureau of Economic Research, Inc.
    12. Barrenho, Eliana & Miraldo, Marisa & Propper, Carol & Walsh, Brendan, 2021. "The importance of surgeons and their peers in adoption and diffusion of innovation: An observational study of laparoscopic colectomy adoption and diffusion in England," Social Science & Medicine, Elsevier, vol. 272(C).
    13. Tamara Bischof & Boris Kaiser, 2021. "Who cares when you close down? The effects of primary care practice closures on patients," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2004-2025, September.
    14. Lundborg, Petter & James, Stefan & Lagerqvist, Bo & Vikström, Johan, 2021. "Learning-by-Doing and Productivity Growth among High-Skilled Workers: Evidence from the Treatment of Heart Attacks," IZA Discussion Papers 14744, Institute of Labor Economics (IZA).
    15. Avdic, Daniel & Blankart, Katharina, 2021. "A Hard Look at “Soft” Cost‐control Measures in Healthcare Organizations: Evidence from Preferred Drug Policies in Germany," CINCH Working Paper Series (since 2020) 74978, Duisburg-Essen University Library, DuEPublico.
    16. Johansson, Naimi & Jakobsson, Niklas & Svensson, Mikael, 2024. "Place or patient as the driver of regional variation in healthcare spending – Discrepancies by category of care," Social Science & Medicine, Elsevier, vol. 342(C).
    17. Avdic, Daniel & Blankart, Katharina, 2021. "A Hard Look at “Soft” Cost‐control Measures in Healthcare Organizations: Evidence from Preferred Drug Policies in Germany," CINCH Working Paper Series (since 2020) 74978, Duisburg-Essen University Library, DuEPublico.
    18. Salm, Martin & Wübker, Ansgar, 2020. "Sources of regional variation in healthcare utilization in Germany," Journal of Health Economics, Elsevier, vol. 69(C).
    19. Christian Posso & Jorge Tamayo & Arlen Guarin & Estefania Saravia, 2024. "Luck of the Draw: The Causal Effect of Physicians on Birth Outcomes," Borradores de Economia 1269, Banco de la Republica de Colombia.
    20. David Card & Alessandra Fenizia & David Silver, 2019. "The Health Impacts of Hospital Delivery Practices," NBER Working Papers 25986, National Bureau of Economic Research, Inc.

    More about this item

    Keywords

    antibiotic prescribing; practice styles; general practitioners;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J44 - Labor and Demographic Economics - - Particular Labor Markets - - - Professional Labor Markets and Occupations
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ces:ceswps:_9204. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Klaus Wohlrabe (email available below). General contact details of provider: https://edirc.repec.org/data/cesifde.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.