IDEAS home Printed from https://ideas.repec.org/p/mhe/chemon/2025-01.html
   My bibliography  Save this paper

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

    Download full text from publisher

    File URL: http://monash-ch-econ-wps.s3-ap-southeast-2.amazonaws.com/RePEc/mhe/chemon/2025-01.pdf
    Download Restriction: no
    ---><---

    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).
    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. Yann Bramoullé & Habiba Djebbari & Bernard Fortin, 2020. "Peer Effects in Networks: A Survey," Annual Review of Economics, Annual Reviews, vol. 12(1), pages 603-629, August.
    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. Dimant, Eugen, 2015. "On Peer Effects: Behavioral Contagion of (Un)Ethical Behavior and the Role of Social Identity," MPRA Paper 68732, University Library of Munich, Germany.
    4. Diemer, Andreas, 2022. "Endogenous peer effects in diverse friendship networks: Evidence from Swedish classrooms," Economics of Education Review, Elsevier, vol. 89(C).
    5. Zhang, Hongliang, 2016. "The role of testing noise in the estimation of achievement-based peer effects," Economics of Education Review, Elsevier, vol. 54(C), pages 113-123.
    6. Alexandra de Gendre & Nicolás Salamanca, 2020. "On the Mechanisms of Ability Peer Effects," Melbourne Institute Working Paper Series wp2020n19, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    7. Barrenho, E.; & Miraldo, M.; & Propper, C; & Rose, C.;, 2019. "Peer and network effects in medical innovation: the case of laparoscopic surgery in the English NHS," Health, Econometrics and Data Group (HEDG) Working Papers 19/10, HEDG, c/o Department of Economics, University of York.
    8. 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).
    9. d'Este, Rocco & Einiö, Elias, 2021. "Beyond Black and White: The Impact of Asian Peers on Scholastic Achievement," Economics of Education Review, Elsevier, vol. 83(C).
    10. Robert Fairlie & Daniel Oliver & Glenn Millhauser & Randa Roland & Robert W. Fairlie, 2024. "Estimating Peer Effects among College Students: Evidence from a Field Experiment of One-to-One Pairings in STEM," CESifo Working Paper Series 11404, CESifo.
    11. Essbaumer, Elisabeth, 2024. "Peer Effects and Social Mobility," Economics Working Paper Series 2401, University of St. Gallen, School of Economics and Political Science.
    12. 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.
    13. Matthew A. Lenard & Mikko Silliman, 2024. "Informal Social Interactions, Academic Achievement and Behaviour: Evidence from Peers on the School Bus," CESifo Working Paper Series 11115, CESifo.
    14. Vincent Boucher & Yann Bramoullé, 2020. "Binary Outcomes and Linear Interactions," Working Papers halshs-03031767, HAL.
    15. Thomas Cornelissen & Christian Dustmann & Uta Schönberg, 2017. "Peer Effects in the Workplace," American Economic Review, American Economic Association, vol. 107(2), pages 425-456, February.
    16. Gerhards, Leonie & Gravert, Christina, 2020. "Because of you I did not give up – Peer effects in perseverance," Journal of Economic Psychology, Elsevier, vol. 81(C).
    17. Vincent Boucher & Yann Bramoullé, 2020. "Binary Outcomes and Linear Interactions," AMSE Working Papers 2038, Aix-Marseille School of Economics, France.
    18. Freyens, Benoit Pierre & Gong, Xiaodong, 2020. "Judicial arbitration of unfair dismissal cases: The role of peer effects," International Review of Law and Economics, Elsevier, vol. 64(C).
    19. Coveney, Max & Oosterveen, Matthijs, 2021. "What drives ability peer effects?," European Economic Review, Elsevier, vol. 136(C).
    20. Humlum, Maria Knoth & Thorsager, Mette, 2021. "The Importance of Peer Quality for Completion of Higher Education," Economics of Education Review, Elsevier, vol. 83(C).

    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

    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:mhe:chemon:2025-01. 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: Johannes Kunz (email available below). General contact details of provider: https://edirc.repec.org/data/dxmonau.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.