Productivity spillovers in health care: Evidence from the treatment of heart attacks
Productivity spillovers in health care: Evidence from the treatment of heart attacks
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DOI：
10.1086/512249
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发表时间：
2007-02-01
影响因子：
8.2
通讯作者：
Staiger, Douglas O.
中科院分区：
文献类型：
--
作者：
Chandra, Amitabh;Staiger, Douglas O.
大量的医学文献记录了手术治疗在不同领域的差异，这些差异与结果无关。这种现象的观察者援引“曲线平坦医学”来解释它，并主张减少高使用领域的支出。相比之下，我们开发了一个简单的罗伊模型的患者治疗选择与生产力溢出，可以产生的经验事实。我们的模型预测，高使用区域将有更高的手术回报，最适合手术的患者结局更好，最不适合手术的患者结局更差，同时显示治疗强度与总体结局之间没有关系。使用心脏病发作治疗的数据，我们发现这些和我们模型的其他预测得到了强有力的经验支持，并拒绝了其他解释，如“曲线平坦的医学”或供应商诱导的对医疗保健地理差异的需求。
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.