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

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  • Janet Currie
  • W. Bentley MacLeod

Abstract

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.

Suggested Citation

  • Janet Currie & W. Bentley MacLeod, 2013. "Diagnosing Expertise: Human Capital, Decision Making and Performance Among Physicians," NBER Working Papers 18977, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:18977
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    References listed on IDEAS

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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. #HEJC for 03/06/2013
      by academichealtheconomists in The Academic Health Economists' Blog on 2013-05-27 13:55:49

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    Cited by:

    1. Karen Norberg & Juan Pantano, 2016. "Cesarean sections and subsequent fertility," Journal of Population Economics, Springer;European Society for Population Economics, vol. 29(1), pages 5-37, January.
    2. Amitabh Chandra & Douglas O. Staiger, 2017. "Identifying Sources of Inefficiency in Health Care," NBER Working Papers 24035, National Bureau of Economic Research, Inc.
    3. Elliott Ash, W. Bentley MacLeod, . "Intrinsic Motivation in Public Service: Theory and Evidence from State Supreme Courts," Journal of Law and Economics, University of Chicago Press, vol. 58(4).
    4. Rudy Douven & Minke Remmerswaal & Robin Zoutenbier, 2015. "Do Extrinsically Motivated Mental Health Care Providers Have Better Treatment Outcomes?," CPB Discussion Paper 319, CPB Netherlands Bureau for Economic Policy Analysis.
    5. repec:pri:cheawb:alexander_d_jul13 is not listed on IDEAS
    6. Gautam Gowrisankaran & Keith A. Joiner & Pierre-Thomas L├ęger, 2017. "Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments," NBER Working Papers 24155, National Bureau of Economic Research, Inc.
    7. Cotet-Grecu, Anca, 2015. "The impact of non-economic damages caps on obstetrics: Incentives versus practice style," Economics & Human Biology, Elsevier, vol. 17(C), pages 29-41.
    8. Jason Abaluck & Leila Agha & Christopher Kabrhel & Ali Raja & Arjun Venkatesh, 2014. "Negative Tests and the Efficiency of Medical Care: What Determines Heterogeneity in Imaging Behavior?," NBER Working Papers 19956, National Bureau of Economic Research, Inc.
    9. Sofia Amaral-Garcia & Paola Bertoli & Veronica Grembi, 2015. "Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities in Italy," CERGE-EI Working Papers wp540, The Center for Economic Research and Graduate Education - Economics Institute, Prague.
    10. Amaral-Garcia, S. & Bertoli, P. & Grembi, V., 2014. "Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities," Health, Econometrics and Data Group (HEDG) Working Papers 14/23, HEDG, c/o Department of Economics, University of York.

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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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