Different Mechanisms of Agency

The goal for today’s class is to consider other sources of physician agency (i.e., underlying mechanisms that generate different incentives between physicians and patients). Focus areas and papers are listed below:

Physician Agency and Incentive Alignment

The final paper we’ll discuss today is Afendulis and Kessler (2007), which examines the role of physician agency in the the context of the scope of a physician’s practice. This is kind of a precursor for more recent work related to agency and vertical integration.

Physician Agency and Organization Structure

Physicians are increasingly employed by hospitals rather than private practice. In the presence of physician agency, this raises important questions in terms of the effects of such organizational structure on healthcare decisions. We’ll discuss Whaley et al. (2021) and Richards, Seward, and Whaley (2022) as examples of research in this area.

Physician Agency and Insurers

Just as how much physicians are paid can affect their behaviors, how they are paid might also matter. We’ll discuss Ho and Pakes (2014) as an example of research in this area, which examines the role of physician agency in the context of capitated versus fee-for-service payment models.

References

Afendulis, Christopher C., and Daniel P. Kessler. 2007. “Tradeoffs from Integrating Diagnosis and Treatment in Markets for Health Care.” American Economic Review 97 (3): 1013–20. https://doi.org/10.1257/aer.97.3.1013.
Ho, Kate, and Ariel Pakes. 2014. “Hospital Choices, Hospital Prices, and Financial Incentives to Physicians.” The American Economic Review 104 (12): 3841–84.
Richards, Michael R., Jonathan A. Seward, and Christopher M. Whaley. 2022. “Treatment Consolidation After Vertical Integration: Evidence from Outpatient Procedure Markets.” Journal of Health Economics 81 (January): 102569. https://doi.org/10.1016/j.jhealeco.2021.102569.
Whaley, Christopher M, Xiaoxi Zhao, Michael Richards, and Cheryl L Damberg. 2021. “Higher Medicare Spending on Imaging and Lab Services After Primary Care Physician Group Vertical Integration.” Health Affairs 40 (5): 702–9.