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Physician Practice Preferences and Healthcare Expenditures: Evidence from Commercial Payers

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Listed:
  • Jeffrey Clemens
  • Pierre-Thomas Léger
  • Yashna Nandan
  • Robert Town

Abstract

We examine the relationship between physician preferences and both the intensity and cost of care delivered to commercially insured heart attack patients. We match survey data on physician preferences, collected by Cutler, Skinner, Stern, and Wennberg (2019) (CSSW), to medical claims data from the Health Care Cost Institute, which spans over 50 million insurance beneficiaries. In contrast to CSSW, who find strong correlations between aggressive practice preferences and both expenditure and utilization for the Medicare population, we find relationships that are both economically and statistically smaller in magnitude within the commercially insured population. Variations in commercial insurers’ prices appear to play an important mediating role.

Suggested Citation

  • Jeffrey Clemens & Pierre-Thomas Léger & Yashna Nandan & Robert Town, 2024. "Physician Practice Preferences and Healthcare Expenditures: Evidence from Commercial Payers," NBER Working Papers 33090, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:33090
    Note: AG EH LS PE
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    References listed on IDEAS

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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(1), pages 103-140.
    2. Jeffrey Clemens & Joshua D. Gottlieb, 2014. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?," American Economic Review, American Economic Association, vol. 104(4), pages 1320-1349, April.
    3. Danil Agafiev Macambira & Michael Geruso & Anthony Lollo & Chima D. Ndumele & Jacob Wallace, 2022. "The Private Provision of Public Services: Evidence from Random Assignment in Medicaid," NBER Working Papers 30390, National Bureau of Economic Research, Inc.
    4. Dingel, Jonathan & Gottlieb, Joshua & Lozinski, Maya & Mourot, Pauline, 2023. "Market Size and Trade in Medical Services," CEPR Discussion Papers 18029, C.E.P.R. Discussion Papers.
    5. Marika Cabral & Colleen Carey & Sarah Miller, 2021. "The Impact of Provider Payments on Health Care Utilization of Low-Income Individuals: Evidence from Medicare and Medicaid," NBER Working Papers 29471, National Bureau of Economic Research, Inc.
    6. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    7. Amanda Starc & Robert J Town, 2020. "Externalities and Benefit Design in Health Insurance," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 87(6), pages 2827-2858.
    8. Jeffrey Clemens & Joshua D. Gottlieb & Jeffrey Hicks, 2021. "How Would Medicare for All Affect Health System Capacity? Evidence from Medicare for Some," Tax Policy and the Economy, University of Chicago Press, vol. 35(1), pages 225-262.
    9. Jeffrey Clemens & Joshua D. Gottlieb, 2017. "In the Shadow of a Giant: Medicare’s Influence on Private Physician Payments," Journal of Political Economy, University of Chicago Press, vol. 125(1), pages 1-39.
    10. Ivan Badinski & Amy Finkelstein & Matthew Gentzkow & Peter Hull, 2023. "Geographic Variation in Healthcare Utilization: The Role of Physicians," NBER Working Papers 31749, National Bureau of Economic Research, Inc.
    11. David Cutler & Jonathan S. Skinner & Ariel Dora Stern & David Wennberg, 2019. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 192-221, February.
    12. Abe Dunn & Joshua D Gottlieb & Adam Hale Shapiro & Daniel J Sonnenstuhl & Pietro Tebaldi, 2024. "A Denial a Day Keeps the Doctor Away," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 139(1), pages 187-233.
    13. Zarek C. Brot-Goldberg & Amitabh Chandra & Benjamin R. Handel & Jonathan T. Kolstad, 2017. "What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 132(3), pages 1261-1318.
    14. Amitabh Chandra & Evan Flack & Ziad Obermeyer, 2024. "The Health Costs of Cost Sharing," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 139(4), pages 2037-2082.
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    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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