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Diagnosing Expertise: Human Capital, Decision Making and Performance Among Physicians

  • Janet Currie
  • W. Bentley MacLeod

Expert performance is often evaluated in a one dimensional way by assuming that good experts have good outcomes. We examine the example of expertise in medicine and develop a model that allows for two dimensions of physician performance: Procedural decision making and skill performing procedures. Higher procedural skill increases the use of intensive procedures across the board, while better decision making results in fewer intensive procedures for the low risk, but more for the high risk. Deriving empirical analogues to our theoretical measures for the case of C-section, we show that poor diagnosticians can be identified using administrative data and that improving decision making would reduce C-section rates by 15.5% in the bottom half of the risk distribution, and increase them by 5.5% in the top half. Because there are many more C-sections in the high risk, these numbers imply that the overall rate of C-section is too low rather than too high and that reallocating C-sections from low risk to high risk women could improve health outcomes among mothers and babies. Our results suggest that focusing on the choices of experts as well as the outcomes achieved could contribute to evaluating expert performance in other settings.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 18977.

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Date of creation: Apr 2013
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Handle: RePEc:nbr:nberwo:18977
Note: CH HC HE LS
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  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, pages 103-140.
  2. Christopher C. Afendulis & Daniel P. Kessler, 2007. "Tradeoffs from Integrating Diagnosis and Treatment in Markets for Health Care," American Economic Review, American Economic Association, vol. 97(3), pages 1013-1020, June.
  3. Dranove David & Ramanarayanan Subramaniam & Sfekas Andrew, 2011. "Does the Market Punish Aggressive Experts? Evidence from Cesarean Sections," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(2), pages 1-33, January.
  4. Darren Grant, 2008. "Physician Financial Incentives and Cesarean Delivery: New Conclusions from the Healthcare Cost and Utilization Project," Working Papers 0801, Sam Houston State University, Department of Economics and International Business.
  5. Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 1999. "The impact of malpractice fears on cesarean section rates," Journal of Health Economics, Elsevier, vol. 18(4), pages 491-522, August.
  6. 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.
  7. Alan M. Garber & Jonathan Skinner, 2008. "Is American Health Care Uniquely Inefficient?," NBER Working Papers 14257, National Bureau of Economic Research, Inc.
  8. Jonathan Gruber & Maria Owings, 1994. "Physician Financial Incentives and Cesarean Section Delivery," NBER Working Papers 4933, National Bureau of Economic Research, Inc.
  9. Janet Currie & W. Bentley MacLeod, 2008. "First Do No Harm? Tort Reform and Birth Outcomes," The Quarterly Journal of Economics, Oxford University Press, vol. 123(2), pages 795-830.
  10. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, vol. 18(4), pages 473-490, August.
  11. Daniel P. Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," NBER Working Papers 5466, National Bureau of Economic Research, Inc.
  12. Henry S. Farber & Robert Gibbons, 1996. "Learning and Wage Dynamics," The Quarterly Journal of Economics, Oxford University Press, vol. 111(4), pages 1007-1047.
  13. Daniel Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 353-390.
  14. Joseph G. Altonji & Charles R. Pierret, 2001. "Employer Learning and Statistical Discrimination," The Quarterly Journal of Economics, Oxford University Press, vol. 116(1), pages 313-350.
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