David C. Chan Jr
Center for Health Policy and
Center for Primary Care and Outcomes Research
117 Encina Commons
Stanford, CA 94305
NBER Program Affiliations:
NBER Affiliation: Faculty Research Fellow
Institutional Affiliation: Stanford University
NBER Working Papers and Publications
|February 2018||Industry Input in Policymaking: Evidence from Medicare|
with Michael J. Dickstein: w24354
In setting prices for physician services, Medicare solicits input from a committee that evaluates proposals from industry. We investigate whether this arrangement leads to prices biased toward the interests of committee members. We find that increasing a measure of affiliation between the committee and proposers by one standard deviation increases prices by 10%, demonstrating a pathway for regulatory capture. We then evaluate the effect of affiliation on the quality of information used in price-setting. More affiliated proposals produce less hard information, measured as lower quality survey data. However, affiliation results in prices that are more closely followed by private insurers, suggesting that affiliation may increase the total information used in price-setting.
|September 2016||A Doctor Will See You Now: Physician-Patient Relationships and Clinical Decisions|
with Erin Johnson, M. Marit Rehavi, Daniela Carusi: w22666
We estimate the effect of physician-patient relationships on clinical decisions in a setting where the treating physician is as good as randomly assigned. OBs are 25% (4 percentage points) more likely to perform a C-section when delivering patients with whom they have a pre-existing clinical relationship (their “own patients”) than when delivering patients with whom they had no prior relationship. OBs’ decisions are consistent with receiving greater disutility from their own patients’ difficult labors. After a string of difficult labors, OBs are more likely to perform C-sections on their own patients, and this can explain the entire own patient effect.
|January 2016||Informational Frictions and Practice Variation: Evidence from Physicians in Training|
Substantial practice variation across physicians for seemingly similar patients remains an unresolved puzzle. This paper studies physicians in training to explore the behavioral foundations of practice variation. A discontinuity in the formation of teams reveals a large contribution of relative experience in the size of practice variation. Among the same physician trainees, convergence towards a common practice differs by practice environment, with more convergence in specialist-driven services. Rich trainee characteristics and training histories, including the practice styles of prior supervising physicians, explain little if any variation. These findings suggest a major role for informational frictions in the origins of practice variation.
|March 2015||The Efficiency of Slacking Off: Evidence from the Emergency Department|
Work schedules play an important role in utilizing labor in organizations. In this study of emergency department physicians in shift work, schedules induce two distortions: First, physicians "slack off" by accepting fewer patients near end of shift (EOS). Second, physicians distort patient care, incurring higher costs as they spend less time on patients accepted near EOS. Examining how these effects change with shift overlap reveals a tradeoff between the two. Within an hour after the normal time of work completion, physicians are willing to spend hospital resources eight times more than their market wage to preserve their leisure. Accounting for overall costs, I find that physicians slack off at approximately second-best optimal levels.