Health Economics, Public Economics, Applied Microeconomics
Many Doctors will see you now: High-Referring Physicians and Patient Outcomes
The Impact of Prescription Drug Monitoring Programs on Infant Health
WORKS IN PROGRESS
Effect of Patient Death on Referrals to Cardiac Specialists
Abstract: The choice of a health care provider can have important and far-reaching effects on patient health outcomes. As referring physicians act as gatekeepers to specialist access, it is important to understand how referring physicians choose providers for their patients. In this paper I examine the role of market mechanisms through which referring physicians learn about specialist quality. I study how patient death affects referrals to cardiologists and cardio-thoracic surgeons. These specialists perform complicated procedures where surgical skill and referrals from referring physicians are important. I use Medicare data to identify pairs of referring physicians and heart specialists who have a patient die within thirty days of a major surgical procedure to examine how patient death affects referrals. I construct counterfactuals for affected pairs using pairs that experience patient death but five years in the future. I find that there is a significant decrease in referrals from the referring physician to the specialist after patient death. Moreover, referring physicians refer less risky patients to these specialists. In addition, I document that referring physicians respond less to patient death when they work in the same practice as the specialists. I also examine if the physicians respond differently depending on the patient's race, but I do not find evidence suggesting that referring physicians respond differently depending on the race of the patient who died.In the next stage of the analysis I will examine whether this improves the outcomes of other patients of the referring physician and explore
whether these events affect payments to the specialists.
Do Providers Respond to Financial Incentives: Evidence from Tennessee
Abstract: In this paper I present evidence on the effect of financial incentives on procedure choice. I exploit a policy adopted by TennCAre, Tennessee’s Medicaid Program, that equalized payments for Cesarean section and vaginal births after July, 2011. Using vital statistics data from the Tennessee Department of Health for the years 2006-2018, I use July 2011 cut-off in regression discontinuity design to compare C-section rates for births in or after July 2011 to births before July 2011. Across populations, I find little evidence that this policy reduced cesarean section rates.
Medicare Advantage: A Disadvantage of Complex Cancer Surgery Patients (Revise and Resubmit).(with Mustafa Raoof, Gretchen Jacobson, Phililp Ituarte, Oliver Eng, Jae Kim, Yuman Fong)
Abstract: We assess and compare access, post-operative outcomes, and estimated cost of inpatient cancer surgery among Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries. Cross-sectional analysis of MA and TM beneficiaries. We find that MA beneficiaries incur lower cost, are less likely to receive care at high-volume hospital and have higher 30-day mortality.
1. Liver Resection Improves Survival in Colorectal Cancer Patients- (with Mustafa Raoof, Philip Ituarte, Yuman Fong)- Annals of Surgery (2019)
Abstract: The aim of this study was to estimate effect of liver section on survival of patients with colorectal cancer liver metastases. As a randomized trial is infeasible and unethical, we test this using instrumental variable (IV) analysis. Liver resection rates across geographical areas provide plausibly exogenous variation in the probability that a given patient gets liver resection. For instance, it is likely that the decision to perform liver resection will depend on the prevailing practice in the patient's area of residence. The underlying assumption is that the area resection rates are exogenous because patients typically do not choose residence based on a need for future liver resection. We used two instruments: 50-mile liver resection rate and Medical Service Study Area liver resection (MALR rate). We calculate the NALR and MSA rate excluding the index patient. Our results suggest that 23.6 months gain in survival for liver resection patients whose treatment choices were influenced by the rates of liver resection in their geographical area.
2. Systemic Failure to operate on colorectal cancer live metastases in California-(with Mustafa Raoof, Zeljka Jutric, Philip Ituarte, Beigqun Zhao, Gandeep Singh, Laleh Melstron, Susanne Warner, Bryan Clary, Yuman Fong)-Cancer Medicine (2020)
Abstract: We use California Cancer Registry data from 2000 to 2012 linked to Office of Statewide Health Planning Inpatient database to examine rates of liver resection. Our results suggest that only 10% of the patients with liver metastases underwent liver resection in California. Our results indicate that hospital that initiates first-course of treatment is likely an important determinant of liver resection so patients who get their first diagnosis at a facility that does not routinely perform liver resections are much less likely to get a liver resection.