David E. Wennberg
Geisel School of Medicine
35 Centerra Parkway
NBER Working Papers and Publications
|August 2013||Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending|
with David Cutler, Jonathan Skinner, Ariel Dora Stern: w19320
There is considerable controversy about the causes of regional variations in health care expenditures. Using vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures, this study asks whether patient demand-side factors or physician supply-side factors explain these variations. The results indicate that patient demand is relatively unimportant in explaining variations. Physician organizational factors matter, but the most important factor is physician beliefs about treatment. In Medicare, we estimate that 35 percent of spending for end-of-life care, and 12 percent of spending for heart attack patients (and for all enrollees) is associated with physician beliefs unsupported by clinical evidence.