Working Papers
- Measuring how physician financial incentives impact on medical service provision has been a preoccupation of healthcare economists for many years. While the literature has explored the financial incentives of primary care physicians in great detail, the fields in which specialist physicians work has been largely overlooked. In this paper, a theoretical model is developed in which the quantity of specialist medical services is a function of both specialist and primary care physician financial incentives. The empirical section of the paper employs the Restricted Use 1996/1997 Community Tracking Study (CTS) dataset to test the model's predictions using surgery rates as a proxy for the quantity of specialist services. The CTS is a household based survey which includes observational data on both primary care and specialist compensation. Using a variety of econometric specifications and controlling for adverse selection, I find the financial compensation has a large effect on surgery rates. When specialists are paid through a fee-for-system (FFS) methodology rather than a capitation or salaried basis, surgery rates increase 155%. There is suggestive evidence that surgery rates fall when primary care physicians are paid on a fee-for-service basis compared to capitation or salaried payments.
Adam Smith meets Jonas Salk: Estimating the Social Cost of Third-Party Influenza Vaccination Restrictions (with John Fontanesi)
- Influenza is the 7th leading killer in the United States. In order an attempt to attenuate the threat of an influenza outbreak, the Centers for Disease Control and Prevention (CDC) have established guidelines recommending that all parents of children between 0 and 60 months old should be vaccinated. Insurance companies, however, will not reimburse pediatricians who administer influenza vaccinations to adults. This seemingly innocuous insurance company restriction, however, is creating significant costs for society. Using a new observational dataset we estimate the cost of this insurance restriction and find that the cost of the insurance restriction to be between $5.8 and $188.4 million. If proposed CDC policies to vaccinate parents of all children 0-18 years old were adopted, the cost of the insurance company restriction could increase to a figure as large as $560 million. While narrowly the paper advocates allowing pediatricians to vaccinate adults, more generally it warns of the costs inherent when third party entities inhibit the scope of physician-patient interaction.
Why Aristotle didn't get his flu shot: The impact of prudence on prevention (with Daniel Wiesen)
- Compliance with preventive care recommendations throughout the world is thought to be below optimal levels. One possible explanation for this empirical finding is that risk and prudence preferences may be lead rational individuals to choose preventive care levels below full compliance. In fact, it has been proven within the expected utility framework that prudent individuals will select less preventive care than imprudent individuals. In this paper, we collect data using an experimental setting to determine whether or not prudent individuals prefer lower levels of prevention.
Last updated November 16, 2007
Home URL: http://econ.ucsd.edu/~jshafrin/
University of California, San Diego, Department of Economics