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Radiating influence? Spillover effects among physicians

Author

Listed:
  • Giovanni van Empel

    (Australian National University)

  • Daniel Avdic

    (Deakin University)

  • Umair Khalil

    (Deakin University)

  • Johannes S. Kunz

    (Monash University)

  • Bo Lagerqvist

    (UCR and SCAAR Study Group, Uppsala University)

  • Johan Vikström

    (IFAU and Uppsala University)

Abstract

We study spillovers in healthcare by exploring how cardiologists’ treatment choices are influenced by their peers. We employ clinical quality data from Sweden on the use of radiation in diagnostic angiography procedures. To account for endogeneity concerns, we instrument peers’ weekly radiation output using the plausibly exogenous arrival of emergency cases they handle. Our estimates suggest that focal cardiologists increase their radiation output by 0.7 standard deviations for each standard deviation increase in their peers’ output. These workplace spillovers lead to improved quality of care. Focal physicians detect additional blocked arteries, which increases treatment intensity and leads to lower risk-adjusted patient mortality.

Suggested Citation

  • Giovanni van Empel & Daniel Avdic & Umair Khalil & Johannes S. Kunz & Bo Lagerqvist & Johan Vikström, 2025. "Radiating influence? Spillover effects among physicians," Papers 2025-01, Centre for Health Economics, Monash University.
    • Handle: RePEc:mhe:chemon:2025-01
    as

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    References listed on IDEAS

    as
    1. Sacerdote, Bruce, 2011. "Peer Effects in Education: How Might They Work, How Big Are They and How Much Do We Know Thus Far?," Handbook of the Economics of Education, in: Erik Hanushek & Stephen Machin & Ludger Woessmann (ed.), Handbook of the Economics of Education, edition 1, volume 3, chapter 4, pages 249-277, Elsevier.
    2. Beugnot, Julie & Fortin, Bernard & Lacroix, Guy & Villeval, Marie Claire, 2019. "Gender and peer effects on performance in social networks," European Economic Review, Elsevier, vol. 113(C), pages 207-224.
    3. Fabian Waldinger, 2012. "Peer Effects in Science: Evidence from the Dismissal of Scientists in Nazi Germany," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 79(2), pages 838-861.
    4. Arcidiacono, Peter & Nicholson, Sean, 2005. "Peer effects in medical school," Journal of Public Economics, Elsevier, vol. 89(2-3), pages 327-350, February.
    5. Marisa Miraldo & Carol Propper & Christiern Rose, 2020. "Identification of Peer Effects using Panel Data," Discussion Papers Series 639, School of Economics, University of Queensland, Australia.
    6. 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.
    7. Godøy, Anna & Dale-Olsen, Harald, 2018. "Spillovers from gatekeeping – Peer effects in absenteeism," Journal of Public Economics, Elsevier, vol. 167(C), pages 190-204.
    8. Amitabh Chandra & Amy Finkelstein & Adam Sacarny & Chad Syverson, 2016. "Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector," American Economic Review, American Economic Association, vol. 106(8), pages 2110-2144, August.
    9. Keane, Michael & Neal, Timothy, 2023. "Instrument strength in IV estimation and inference: A guide to theory and practice," Journal of Econometrics, Elsevier, vol. 235(2), pages 1625-1653.
    10. Kandel, Eugene & Lazear, Edward P, 1992. "Peer Pressure and Partnerships," Journal of Political Economy, University of Chicago Press, vol. 100(4), pages 801-817, August.
    11. 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.
    12. Cheti Nicoletti & Kjell G. Salvanes & Emma Tominey, 2018. "The Family Peer Effect on Mothers' Labor Supply," American Economic Journal: Applied Economics, American Economic Association, vol. 10(3), pages 206-234, July.
    13. Charles F. Manski, 1993. "Identification of Endogenous Social Effects: The Reflection Problem," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 60(3), pages 531-542.
    14. Han, Li & Li, Tao, 2009. "The gender difference of peer influence in higher education," Economics of Education Review, Elsevier, vol. 28(1), pages 129-134, February.
    15. 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.
    16. Bet Caeyers & Marcel Fafchamps, 2016. "Exclusion Bias in the Estimation of Peer Effects," NBER Working Papers 22565, National Bureau of Economic Research, Inc.
    17. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    18. Leonardo Bursztyn & Florian Ederer & Bruno Ferman & Noam Yuchtman, 2014. "Understanding Mechanisms Underlying Peer Effects: Evidence From a Field Experiment on Financial Decisions," Econometrica, Econometric Society, vol. 82(4), pages 1273-1301, July.
    19. Angrist, Joshua D., 2014. "The perils of peer effects," Labour Economics, Elsevier, vol. 30(C), pages 98-108.
    20. Isaiah Andrews & James H. Stock & Liyang Sun, 2019. "Weak Instruments in Instrumental Variables Regression: Theory and Practice," Annual Review of Economics, Annual Reviews, vol. 11(1), pages 727-753, August.
    21. 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).
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    More about this item

    Keywords

    peer effect; team management; physician practice style; healthcare quality;
    All these keywords.

    JEL classification:

    • D83 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Search; Learning; Information and Knowledge; Communication; Belief; Unawareness
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • J24 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Human Capital; Skills; Occupational Choice; Labor Productivity
    • M12 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Business Administration - - - Personnel Management; Executives; Executive Compensation
    • M54 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Personnel Economics - - - Labor Management

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