David H. Howard
Department of Health Policy and Management
1518 Clifton Road NE
Atlanta, GA 30322
NBER Working Papers and Publications
|April 2016||Selective Hearing: Physician-Ownership and Physicians' Response to New Evidence|
with Guy David, Jason Hockenberry: w22171
Physicians, acting in their role as experts, are often faced with situations where they must trade off personal and patient welfare. Physicians’ incentives vary based on the organizational environment in which they practice. We use the publication of a major clinical trial, which found that a common knee operation does not improve outcomes for patients with osteoarthritis, as an “informational shock” to gauge the impact of physicians’ agency relationships on treatment decisions. Using a 100% sample of procedures in Florida from 1998 to 2010, we find that publication of the trial reduced procedure volume, but the magnitude of the decline was smaller in physician-owned surgery centers. Incentives affected physicians’ reactions to evidence.
Published: David H. Howard & Guy David & Jason Hockenberry, 2016. "Selective Hearing: Physician-Ownership and Physicians’ Response to New Evidence," Journal of Economics & Management Strategy, .
|January 2015||Pricing in the Market for Anticancer Drugs|
with Peter B. Bach, Ernst R. Berndt, Rena M. Conti: w20867
Drugs like bevacizumab ($50,000 per treatment episode) and ipilimumab ($120,000 per episode) have fueled the perception that the launch prices of anticancer drugs are increasing over time. Using an original dataset of 58 anticancer drugs approved between 1995 and 2013, we find that launch prices, adjusted for inflation and drugs’ survival benefits, increased by 10%, or about $8,500, per year. Although physicians are not penalized for prescribing costly drugs, they may be reluctant to prescribe drugs with prices that exceed subjective standards of fairness. Manufacturers may set higher launch prices over time as standards evolve. Pricing trends may also reflect manufacturers’ response to expansions in the 340B Drug Pricing Program, which requires manufacturers to provide steep discounts to ...
Published: David H. Howard & Peter B. Bach & Ernst R. Berndt & Rena M. Conti, 2015. "Pricing in the Market for Anticancer Drugs," Journal of Economic Perspectives, vol 29(1), pages 139-162.
|August 2011||Comparative Effectiveness Research, COURAGE, and Technological Abandonment|
with Yu-Chu Shen: w17371
When a major study finds that a widely used medical treatment is no better than a less expensive alternative, do physicians stop using it? Policymakers hope that comparative effectiveness research will identify less expensive substitutes for widely-used treatments, but physicians may be reluctant to abandon profitable therapies. We examine the impact of the COURAGE trial, which found that medical therapy is as effective as percutaneous coronary intervention (PCI) for patients with stable angina, on practice patterns. Using hospital discharge data from US community, Veterans Administration, and English hospitals, we detect a moderate decline in PCI volume post-COURAGE. However, many patients with stable angina continue to receive PCI. We do not find differences in PCI volume trends by reimb...
Published: Howard, D. and Shen, Y. 2012. Comparative Effectiveness Research, Technological Abandonment, and Health Care Spending. Advances in Health Economics and Health Services Research, Volume 23: 103-121.