Research
Working Papers
The Role of Physician Altruism in the Physician-Industry Relationship: Evidence from Linking Experimental and Observational Data
NBER Working Paper 33439 (with Anirban Basu and Jing Li)
Abstract
Altruism is a key component of medical professionalism that underlies the physician's role as a representative agent for patients. However, physician behavior can be influenced when private gains enter the objective function. We study the relationship between altruism and physicians' receipt of financial benefits from pharmaceutical manufacturers, as well as the extent to which altruism mitigates physicians' responsiveness to these industry payments. We link data on altruistic preferences for 280 physicians, identified using a revealed preference economic experiment, with administrative information on their receipt of financial transfers from pharmaceutical firms along with drug prescription claims data. Non-altruistic physicians receive industry transfers that are on average 2,184 USD or 254% higher than altruistic physicians. While industry transfers lead to higher drug spending and prescribing on paid drugs, these relationships are entirely driven by non-altruistic physicians. Our results indicate that altruism is an important determinant of physicians’ relationships with and responses to industry benefits.Publications
Provider effects in antibiotic prescribing: Evidence from physician exits
Journal of Human Resources, forthcoming (with Hannes Ullrich)
Abstract
In the fight against antibiotic resistance, reducing antibiotic consumption while preserving healthcare quality presents a critical health policy challenge. We investigate the role of practice styles in patients’ antibiotic intake using exogenous variation in patient-physician assignment. Practice style heterogeneity explains 49% of the differences in overall antibiotic use and 83% of the differences in second-line antibiotic use between primary care providers. We find no evidence that high prescribing is linked to better treatment quality or fewer adverse health outcomes. Policies improving physician decision-making, particularly among high-prescribers, may be effective in reducing antibiotic consumption while sustaining healthcare quality.Assessing the value of data for prediction policies: The case of antibiotic prescribing
Economics Letters, Vol. 213, 110360, 2022 (with Michael Allan Ribers and Hannes Ullrich)
Abstract
We quantify the value of data for the prediction policy problem of reducing antibiotic prescribing to curb antibiotic resistance. Using varying combinations of administrative data, we evaluate machine learning predictions for diagnosing bacterial urinary tract infections and the outcomes of prescription rules based on these predictions. Simple patient demographics improve prediction quality substantially but larger reductions in prescribing can be achieved by making use of rich health data. Our results suggest decreasing returns to data for prediction quality and increasing returns for policy outcomes. Hence, data needs for prediction policy problems must be assessed based on the policy objective and not only on prediction quality.The effect of a ban on gender-based pricing on risk selection in the German health insurance market
Health Economics, Vol. 29(1), pp. 3-17, 2020 (with Martin Salm)
Abstract
Starting from December 2012, insurers in the European Union were prohibited from charging gender‐discriminatory prices. We examine the effect of this unisex mandate on risk segmentation in the German health insurance market. Although gender used to be a pricing factor in Germany's private health insurance (PHI) sector, it was never used as a pricing factor in the social health insurance (SHI) sector. The unisex mandate makes PHI relatively more attractive for women and less attractive for men. Based on data from the German socio‐economic panel, we analyze how the unisex mandate affects the difference between women and men in switching rates between SHI and PHI. We find that the unisex mandate increases the probability of switching from SHI to PHI for women relative to men. On the other hand, the unisex mandate has no effect on the gender difference in switching rates from PHI to SHI. Because women have on average higher health care expenditures than men, our results imply a worsening of the PHI risk pool and an improvement of the SHI risk pool. Our results demonstrate that regulatory measures such as the unisex mandate can affect risk selection between public and private health insurance sectors.Work in Progress
Does Division of Labor Increase Productivity? Evidence from Primary Care
(with Amanda Dahlstrand, Guy Michaels, and Nestor Le Nestour)
Abstract
The idea that the division of labor increases productivity is central to economic analyses of countries, industries, social structures, and occupations within organizations. We study the division of labor within an online primary healthcare organization, where an algorithm assigns patient cases between two clinician occupations: nurses and doctors. We compare a knowledge hierarchy, in which less specialized nurses resolve some cases themselves and escalate others to doctors, with a direct-to-expert approach where cases are assigned directly to doctors. We use approximately 500,000 cases and an identification strategy that leverages temporary congestion which increases the odds of an assignment to the nurse-initiated knowledge hierarchy. We also explore how the knowledge hierarchy’s comparative advantage varies across case types and assess the extent to which task allocation aligns with comparative advantage.AI adoption in primary care: The case of antibiotic prescribing
(with Renke Schmacker and Hannes Ullrich)