Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending

• 成果类型: Article
• 署名作者: Cutler, David; Skinner, Jonathan S.; Stern, Ariel Dora; Wennberg, David
• 署名单位: Harvard University; National Bureau of Economic Research; Dartmouth College; Dartmouth College; Harvard University; Harvard University; Harvard University Medical Affiliates; Brigham & Women's Hospital; Harvard University; Harvard T.H. Chan School of Public Health
• 刊物名称: AMERICAN ECONOMIC JOURNAL-ECONOMIC POLICY
• ISSN/ISSBN: 1945-7731
• DOI: 10.1257/pol.20150421
• 发表日期: 2019
• 页码: 192-221
• 关键词: coronary-angiography; geographic-variation; heart-failure; medicare; cancer; vignettes; QUALITY; Heterogeneity; association; uncertainty

摘要

There is considerable controversy about the causes of regional variations in health care expenditures. Using vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures, this study asks whether patient demand-side factors or physician supply-side factors explain these variations. The results indicate that patient demand is relatively unimportant in explaining variations. Physician organizational factors matter, but the most important factor is physician beliefs about treatment. In Medicare, we estimate that 35 percent of spending for end-of-life care and 12 percent of spending for heart attack patients (and for all enrollees) is associated with physician beliefs unsupported by clinical evidence.