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Diagnosis and Unnecessary Procedure Use: Evidence from C-Section

  • Janet Currie
  • W. Bentley MacLeod

This paper develops and applies a model in which doctors have two dimensions of skill: diagnostic skill and skill performing procedures. Higher procedural skill increases the use of intensive procedures across the board, while better diagnostic skill 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 improving diagnostic skill would reduce C-section rates by 15.8% among the lowest risk, and increase them by 4.7% among the high risk while improving outcomes among all women.

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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
Date of revision:
Handle: RePEc:nbr:nberwo:18977
Contact details of provider: Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.
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  1. Jonathan Gruber & Maria Owings, 1994. "Physician Financial Incentives and Cesarean Section Delivery," NBER Working Papers 4933, National Bureau of Economic Research, Inc.
  2. Janet Currie & W. Bentley MacLeod, 2006. "First Do No Harm?: Tort Reform and Birth Outcomes," NBER Working Papers 12478, National Bureau of Economic Research, Inc.
  3. Andrew Epstein & Sean Nicholson, 2005. "The Formation And Evolution Of Physician Treatment Styles: An Application To Cesarean Sections," Working Papers id:176, eSocialSciences.
  4. Daniel P. Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," NBER Working Papers 5466, National Bureau of Economic Research, Inc.
  5. Joseph G. Altonji & Charles R. Pierret, 2001. "Employer Learning And Statistical Discrimination," The Quarterly Journal of Economics, MIT Press, vol. 116(1), pages 313-350, February.
  6. Kessler, Daniel & McClellan, Mark, 1996. "Do Doctors Practice Defensive Medicine?," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 353-90, May.
  7. Henry S. Farber & Robert Gibbons, 1991. "Learning and Wage Dynamics," NBER Working Papers 3764, National Bureau of Economic Research, Inc.
  8. Grant, Darren, 2009. "Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project," Journal of Health Economics, Elsevier, vol. 28(1), pages 244-250, January.
  9. 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.
  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. Alan M. Garber & Jonathan Skinner, 2008. "Is American Health Care Uniquely Inefficient?," NBER Working Papers 14257, National Bureau of Economic Research, Inc.
  12. 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.
  13. 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.
  14. 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.
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