Working Paper: NBER ID: w16040
Authors: David O. Meltzer; Jeanette W. Chung
Abstract: General medical care in the United States has historically been provided by physicians who care for their patients in both ambulatory and hospital settings. Care is now increasingly divided between physicians specializing in hospital care (hospitalists) and ambulatory-based care primary care physicians. We develop and find strong empirical support for a theoretical model of the division of labor in general medicine that views the use of hospitalists as balancing the costs of coordinating care across physicians in the hospitalist model against physicians' costs switching between ambulatory and hospital settings in the traditional model. Our findings suggest opportunities to improve care.
Keywords: hospitalists; division of labor; switching costs; coordination costs; healthcare delivery
JEL Codes: I1
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| switching costs increase and coordination costs decrease (D23) | hospitalist model becomes more advantageous (I11) |
| increasing coordination costs (D23) | decreased reliance on hospitalists (I11) |
| higher communication costs (L96) | preference for traditional internist models (I11) |
| increasing travel costs (R41) | enhanced use of hospitalists (I11) |
| greater total professional work time (J29) | reduced reliance on hospitalists (I11) |
| higher probabilities of admission (I23) | reduced hospitalist utilization (I11) |