Productivity spillovers in health care: Evidence from the treatment of heart attacks

• 成果类型: Article
• 署名作者: Chandra, Amitabh; Staiger, Douglas O.
• 署名单位: Harvard University; National Bureau of Economic Research; Dartmouth College
• 刊物名称: JOURNAL OF POLITICAL ECONOMY
• ISSN/ISSBN: 0022-3808
• DOI: 10.1086/512249
• 发表日期: 2007
• 页码: 103-140
• 关键词: acute myocardial-infarction; quality-of-care; INSTRUMENTAL-VARIABLES; network externalities; regional-variations; PRIMARY ANGIOPLASTY; REDUCE MORTALITY; UNITED-STATES; TECHNOLOGY; diffusion

摘要

A large literature in medicine documents variation across areas in the use of surgical treatments that is unrelated to outcomes. Observers of this phenomenon have invoked flat of the curve medicine to explain it and have advocated for reductions in spending in high- use areas. In contrast, we develop a simple Roy model of patient treatment choice with productivity spillovers that can generate the empirical facts. Our model predicts that high- use areas will have higher returns to surgery, better outcomes among patients most appropriate for surgery, and worse outcomes among patients least appropriate for surgery, while displaying no relationship between treatment intensity and overall outcomes. Using data on treatments for heart attacks, we find strong empirical support for these and other predictions of our model and reject alternative explanations such as flat of the curve medicine or supplier- induced demand for geographic variation in medical care.