NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

Ariel Dora Stern

Harvard Business School
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NBER Working Papers and Publications

August 2013Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending
with David Cutler, Jonathan Skinner, David Wennberg: w19320
There is considerable controversy about the causes of regional variations in health care expenditures. We use vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures to test whether patient demand-side factors or physician supply-side factors explain regional variations in spending. We find patient demand is relatively unimportant in explaining variation in spending after accounting for physician beliefs. Physician organizational factors matter, but the single most important factor is physician beliefs about treatment: 35 percent of Medicare end-of-life spending, 12 percent of spending for heart attack patients, and 12 percent of total Medicare spending, are associated with physician beliefs unsupported by clinical evidence.
 
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