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“Diagnosis and unnecessary procedure use: evidence from C-section”
Following the meeting, a transcript of the discussion can be downloaded here.
Links to the article
Summary of the paper
In this paper the authors develop a model of diagnostic skill as an element of provider quality that is separate from a doctor’s skill in performing procedures. The model shows that higher surgical skill leads to higher use of surgical procedures across all patients, while better diagnostic skill results in fewer procedures for the low risk and more procedures for the high risk. When doctors face a dichotomous choice between an intensive and a non-intensive procedure they have a threshold level of patient condition; above which patients receive the intensive procedure and below which they receive the non-intensive procedure. The doctor’s threshold level is dependent on their surgical skill and the pecuniary benefit associated with carrying out the procedure. Greater diagnostic skill improves the precision of the doctor’s estimate of a patient’s condition and therefore improves the matching between patients and procedures; leading to better health outcomes. Taking the model to data on C-sections, the most common surgical procedure performed in the U.S., the authors show that improving diagnostic skills from the 25th to the 75th percentile of the observed distribution would reduce C-section rates by 11.7% among the low risk, and increase them by 4.6% among the high risk. Since there are many more low risk than high risk women, improving diagnosis would reduce overall C-section rates by about 5% of total births. Moreover, such an improvement in diagnostic skill would improve health outcomes for both high risk and low risk women, while improvements in surgical skill have the greatest impact on high risk women. The results are consistent with the hypothesis that efforts to improve diagnosis through methods such as checklists, computer assisted diagnosis, and collaborative decision making may improve patient outcomes.
- Are there other aspects of physician skill that could be estimated in this way?
- Is the characterisation of a doctor’s payoffs accurate?
- To what other procedures could the model be applied?
- To what extent could this model inform non-dichotomous physician decisions?
- What are the key policy implications of these findings?
Missed the meeting? Add your thoughts on the paper in the comments below.