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CINCH - Health Economics Research Center

Virtual Essen Health Economics Seminar


On Monday, April 19 2021, 16:00 - 17:30, Leila Agha (Dartmouth College) will present:

Fixing Misallocation with Guidelines: Awareness vs. Adherence

Expert decisions often deviate from evidence-based guidelines. If experts are unaware of guidelines, dissemination may improve outcomes. If experts are aware of guidelines but continue to deviate, promoting stricter adherence has ambiguous effects on outcomes, depending on whether experts have information not in guidelines. We study guidelines for anticoagulant use to prevent strokes among atrial fibrillation patients. By text-mining physician notes for guideline mentions, we identify when physicians start using a guideline. After mentioning the guideline, physicians' prescription decisions become more guideline concordant, but adherence remains far from perfect. To evaluate whether non-adherence reflects physicians' superior information, we combine observational data on treatment choices with machine learning estimates of heterogeneous treatment effects from eight randomized trials. When physicians depart from guidelines, they are not responding to measurable treatment effect heterogeneity. Promoting stricter adherence to guidelines could prevent 33% more strokes, producing much larger gains than broader guideline awareness.

Room: Due to the current situation regarding the COVID-19 pandemic, the talk will be held in a virtual seminar room. For more information click here.

Virtual Essen Health Economics Seminar


On Monday, April 12 2021, 16:00 - 17:30, Esmée Zwiers (Princeton) will present:

Pill vs Gatekeeper Power: Birth Control Access, Religious Beliefs, and Women’s Outcomes

We study how access to birth control affects short- and long-term outcomes of women in a new context: the 1970 liberalization of the contraceptive pill in the Netherlands. We first document a massive immediate drop in the birth rate post-liberalization that was particularly strong for young women, the group for which access restrictions were most drastically lifted. We then exploit area level social norms – proxied by votes for religious parties who were against relaxing access rules – to obtain causal estimates of the impact of the availability of the pill on female fertility control and especially changes in the prevalence of ill-timed births. We find that women who lived in areas that were less religiously resistant to the introduction of the pill were much less likely to experience an underage birth or marriage. These women went on to invest more in education and ended up in wealthier households. We then measure the importance of birth control providers’ beliefs in providing access to the available technology by estimating the additional effect of the religiosity of local health professionals on women’s outcomes. We that find a larger proportion of religious ‘gatekeepers’ around a woman at the time of liberalization all but wiped out any positive pill impact.

Room: Due to the current situation regarding the COVID-19 pandemic, the talk will be held in a virtual seminar room. For more information click here.

New CINCH Working Paper


A new working paper has been added to the CINCH working paper series: “Providers, Peers and Patients: How do Physicians’ Practice Environments Affect Patient Outcomes?” by Daniel Avdic, Maryna Ivets, Bo Lagerqvist, and Ieva Sriubaite.

Abstract: We study the extent to which physician treatment styles are determined by their practice environment and whether such decisions affect the quality of care received by patients. Using rich data on all coronary angioplasty procedures in Sweden 2004–2013, our empirical approach compares stent choices of interventional cardiologists moving across hospitals to patient outcomes over time. To disentangle changes in practice styles attributable to physical (provider) and social (peer group) factors, we exploit quasi‐random variation on physicians working on the same day in the same hospital. Our findings suggest that (i) moving cardiologists’ stent choices rapidly adapt to their new practice environment after relocation; (ii) practice style changes are equally driven by the physical and social environments; and (iii) rates of decision errors, treatment costs and adverse clinical events among treated patients remain largely unchanged despite the altered practice styles.

See all working papers.