Diagnosing Expertise: Human Capital, Decision Making and Performance Among Physicians
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.
|Date of creation:||Apr 2013|
|Date of revision:|
|Note:||CH HC HE LS|
|Contact details of provider:|| Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.|
Web page: http://www.nber.org
More information through EDIRC
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- 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.
- Jonathan Gruber & Maria Owings, 1994.
"Physician Financial Incentives and Cesarean Section Delivery,"
NBER Working Papers
4933, National Bureau of Economic Research, Inc.
- Jonathan Gruber & Maria Owings, 1996. "Physician Financial Incentives and Cesarean Section Delivery," RAND Journal of Economics, The RAND Corporation, vol. 27(1), pages 99-123, Spring.
- Andrew Epstein & Sean Nicholson, 2005.
"The Formation And Evolution Of Physician Treatment Styles: An Application To Cesarean Sections,"
- 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.
- Andrew Epstein & Sean Nicholson, 2005. "The Formation and Evolution of Physician Treatment Styles: An Application to Cesarean Sections," NBER Working Papers 11549, National Bureau of Economic Research, Inc.
- 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.
- Henry S. Farber & Robert Gibbons, 1996. "Learning and Wage Dynamics," The Quarterly Journal of Economics, Oxford University Press, vol. 111(4), pages 1007-1047.
- 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.
- 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.
- 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.
- 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.
- Alan M. Garber & Jonathan Skinner, 2008.
"Is American Health Care Uniquely Inefficient?,"
Journal of Economic Perspectives,
American Economic Association, vol. 22(4), pages 27-50, Fall.
- Daniel P. Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," NBER Working Papers 5466, National Bureau of Economic Research, Inc.
- 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.
- 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.
- Daniel Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 353-390.
- 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.
When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:18977. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: ()
If references are entirely missing, you can add them using this form.