Working Paper: NBER ID: w21218
Authors: Janet Currie; W. Bentley Macleod; Jessica Van Parys
Abstract: When a patient arrives at the Emergency Room with acute myocardial infarction (AMI), the provider on duty must quickly decide how aggressively the patient should be treated. Using Florida data on all such patients from 1992-2014, we decompose practice style into two components: The provider’s probability of conducting invasive procedures on the average patient (which we characterize as aggressiveness), and the responsiveness of the choice of procedure to the patient’s characteristics. We show that within hospitals and years, patients with more aggressive providers have consistently higher costs and better outcomes. Since all patients benefit from higher utilization of invasive procedures, targeting procedure use to the most appropriate patients benefits these patients at the expense of the less appropriate patients. We also find that the most aggressive and responsive physicians are young, male, and trained in top 20 schools.
Keywords: healthcare; provider practice style; patient outcomes; heart attacks
JEL Codes: I11
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Provider characteristics (I11) | Practice style (Y20) |
| Aggressive treatment (E63) | Higher costs (G19) |
| Aggressive treatment (E63) | Better patient outcomes (I11) |
| Provider aggressiveness (I11) | Patient health outcomes (I11) |
| Higher utilization of invasive procedures (I11) | Improved outcomes (I14) |
| Provider responsiveness to patient characteristics (I11) | Better outcomes (I14) |