The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care

• 成果类型: Article
• 署名作者: Abaluck, Jason; Agha, Leila; Kabrhel, Chris; Raja, Ali; Venkatesh, Arjun
• 署名单位: Yale University; National Bureau of Economic Research; Dartmouth College; Harvard University; Harvard University Medical Affiliates; Massachusetts General Hospital; Harvard University; Harvard University; Harvard University Medical Affiliates; Massachusetts General Hospital; Yale University; Yale New Haven Hospital
• 刊物名称: AMERICAN ECONOMIC REVIEW
• ISSN/ISSBN: 0002-8282
• DOI: 10.1257/aer.20140260
• 发表日期: 2016
• 页码: 3730-3764
• 关键词: SUSPECTED PULMONARY-EMBOLISM; DEEP-VEIN THROMBOSIS; emergency-department; COMPUTED-TOMOGRAPHY; CLINICAL-MODEL; CT ANGIOGRAPHY; HEALTH; RISK; management

摘要

A large body of research has investigated whether physicians overuse care. There is less evidence on whether, fora fixed level of spending, doctors allocate resources to patients with the highest expected returns. We assess both sources of inefficiency, exploiting variation in rates of negative imaging tests for pulmonaty embolism. We document enormous across-doctor heterogeneity in testing conditional on patient population, which explains the negative relationship between physicians' testing rates and test yields. Furthermore, doctors do not target testing to the highest risk patients, reducing test yields by one-third. Our calibration suggests misallocation is more costly than overuse.