Working Paper: NBER ID: w22171
Authors: David H. Howard; Guy David; Jason Hockenberry
Abstract: Physicians, acting in their role as experts, are often faced with situations where they must trade off personal and patient welfare. Physicians’ incentives vary based on the organizational environment in which they practice. We use the publication of a major clinical trial, which found that a common knee operation does not improve outcomes for patients with osteoarthritis, as an “informational shock” to gauge the impact of physicians’ agency relationships on treatment decisions. Using a 100% sample of procedures in Florida from 1998 to 2010, we find that publication of the trial reduced procedure volume, but the magnitude of the decline was smaller in physician-owned surgery centers. Incentives affected physicians’ reactions to evidence.
Keywords: physician ownership; treatment decisions; evidence-based medicine; healthcare policy
JEL Codes: I11; L21; O33
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Moseley trial publication (Y50) | arthroscopic knee surgeries volume in hospital-based centers (I11) |
| Moseley trial publication (Y50) | arthroscopic knee surgeries volume in freestanding centers (L83) |
| financial incentives in freestanding centers (J32) | likelihood of altering treatment practices (C22) |
| physician ownership (I11) | treatment decisions following Moseley trial (Y50) |