Working Paper: NBER ID: w20373
Authors: Jesse Margolis; Jason Hockenberry; Michael Grossman; Shinyi Chou
Abstract: Over the last several decades, numerous medical studies have compared the effectiveness of two common procedures for Coronary Artery Disease: Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG). Most evidence indicates that CABG - the more invasive procedure - leads to superior long term outcomes for otherwise similar patients, though there is little consensus as to why. In this article, we propose a novel explanation: patient offsetting behavior. We hypothesize that patients who undergo the more invasive procedure, CABG, are more likely to improve their behavior - eating, exercise, smoking, and drinking - in a way that increases longevity. To test our hypothesis, we use Medicare records linked to the National Health Interview Survey to study one such behavior: smoking. We find that CABG patients are 12 percentage points more likely to quit smoking in the one-year period immediately surrounding their procedure than PCI patients, a result that is robust to numerous alternative specifications.
Keywords: coronary artery disease; CABG; PCI; smoking cessation; moral hazard
JEL Codes: I10; I12
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| CABG (Coronary Artery Bypass Grafting) (G34) | Quitting Smoking (J26) |
| PCI (Percutaneous Coronary Intervention) (F38) | Quitting Smoking (J26) |
| Invasiveness of CABG (F65) | Quitting Smoking (J26) |
| Hospital Stay and Recovery Experience (CABG) (I11) | Quitting Smoking (J26) |
| CABG (Coronary Artery Bypass Grafting) (G34) | Health-Related Behaviors (I12) |
| PCI (Percutaneous Coronary Intervention) (F38) | Health-Related Behaviors (I12) |