The formation and evolution of physician treatment styles: An application to cesarean sections

Small-area-variation studies have shown that physician treatment styles differ substantially both between and within markets, controlling for patient characteristics. Using data on the universe of deliveries in Florida and New York over a 15-year period, we examine why treatment styles differ across...

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Bibliographic Details
Published in:Journal of health economics 2009-12, Vol.28 (6), p.1126-1140
Main Authors: Epstein, Andrew J., Nicholson, Sean
Format: Article
Language:English
Subjects:
Adult
Algorithms
Caesarean section
Cesarean section
Cesarean Section - utilization
Doctors
Female
Florida
Health administration
Health care
Health economics
Humans
Markets
Medical care
Medical treatment
New York
Obstetricians
Peer effects
Peer groups
Physician treatment styles
Physician treatment styles Small-area variation Peer effects
Physicians
Practice Patterns, Physicians
Pregnancy
Small-area variation
Social norms
Studies
Treatment methods
Young Adult
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Summary:Small-area-variation studies have shown that physician treatment styles differ substantially both between and within markets, controlling for patient characteristics. Using data on the universe of deliveries in Florida and New York over a 15-year period, we examine why treatment styles differ across obstetricians at a point in time and why styles change over time. We find that variation in c-section rates across physicians within a market is about twice as large as variation between markets. Surprisingly, residency programs explain no more than four percent of the variation in physicians’ risk-adjusted c-section rates, even among newly trained physicians. Although we find evidence that physicians learn from their peers, they do not substantially revise their prior beliefs regarding treatment due to the local exchange of information. Our results indicate that physicians are not likely to converge over time to a community standard; thus, within-market variation in treatment styles is likely to persist.
ISSN:0167-6296
1879-1646
DOI:10.1016/j.jhealeco.2009.08.003