De Souza Leão Spinola, Paula; (2024) Physicians’ Treatment Behaviour: Drivers, Incentives, and Motivations. Doctoral thesis (Ph.D), UCL (University College London).

Preview

Text Spinola_10189920_Thesis_id_removed.pdf Download (4MB) | Preview

Abstract

There is evidence of large variation in medical treatments delivered across regions as well as across physicians within the same clinical environment which is not explained by patients’ characteristics. This thesis uses rich data from Brazil to empirically investigate three questions related to the determinants of physicians’ treatment behaviour in the hospital setting. First, we shed light on the role of peers in shaping physicians’ practice styles. We examine whether physicians’ use of hospital resources responds to fluctuations in health spending of their nearby colleagues acting in the same medical specialty. We find that physicians incorporate to their own spending roughly half of the observed variation in peers’ average spending during the preceding 30 days. Peers’ gender composition is also found to be a strong determinant of physicians’ behaviour. Working around a higher proportion of female doctors causes physicians to take less resource-intensive decisions. Next, we assess the impacts of a federal policy that rationed compensation in the relative use of C-sections. Although financial (dis)incentives were introduced at the hospital level and didn’t directly affect physicians’ remuneration, C-section use decreases markedly in municipalities facing high constraints from the policy. Findings that such decreases were followed by health improvements provide evidence that unjustified (and harmful) C-sections were being systematically conducted in municipalities with high C-section rates prior to the policy. The third question is related to birth timing manipulation around days characterised as being inconvenient for women to deliver, for physicians to work, and/or related to changes in the quality of hospital services. We observe that, while physicians in the private sector accommodate mothers’ preferences as well as their own demand for leisure and schedule constraints, manipulation in public hospitals is more limited and occurs, to some extent, in response to the risk profile of births and quality of service delivery.

Download activity - last month

Export as CSVXMLJSON

Download activity - last 12 months

Export as JSONXMLCSV

Downloads by country - last 12 months

Export as CSVXMLJSON

Archive Staff Only

View Item