Who is Assigned to Difficult Cases in the Hospital
Romero N. SantiagoMentors: Guy David, Ph.D. and Mark Neuman, M.D.
Motivation Elements that distort efficient matching of patients to physicians may impact patient wellbeing. Perverse incentives to take or avoid difficult cases. For the same condition, recommendations may vary by specialty (supplier induced demand). Inefficient matching is potentially costly to the healthcare system. Hospital reputation and malpractice pressure may not provide sufficient incentives to induce efficient matching.
Strategy Used to Study Task-Talent Matching Review previous research discussing current framework of task-talent matching Read through the literature to find various incentives that could help explain cause of inefficient matching Analyze task-talent matching in a specific region and specialty to observe degree of matching problem
Project Overview Are highly talented physicians performing the most difficult cases? Theoretical Framework Empirical Work Valuable insights about research experience
Garicano’s Pyramid Hierarchy is Not a Perfect Fit for Medicine “Hierarchies and the Organization of Knowledge in Production” – Garicano “Knowledge-based hierarchy” – production workers and specialized problem solvers (industrial sector). Pyramidal structure with multiple levels, communication costs incurred with specialization Knowledge of problem solvers incorporates knowledge of those asking them for advice on solving a particular problem In medicine, no fine line between base level (production worker) and problem solver, levels overlap.
Specialization Creates Matching Issue Through Incentives Santos “Referrals” – Garicano and Agent diagnosing opportunity/task incentivized to keep most valuable ones and refer least valuable Top-down diagnosis generates no inefficiency, unlike bottom-up arrangements “Specialization and Matching” – Epstein and colleagues Physicians in group partnerships specialize more than solo physicians, utilizing referral system Matching of specialists to patient heightened under firm or group practice.
Macroscopic View of Florida’s Cardiac Surgeon Population of Health website Utilized the Florida Department Board-certified cardiac surgeons (162) Graduation Year from Medical School Residency and Fellowship Information Age of patient utilized as proxy for task difficulty Years of experience used as proxy for talent Data represents inpatient cases from 2005 to 2007 Mean age of patient = 66 years Standard Deviation = 10.7 years Mean Experience for Surgeon = 28.8 years Standard Deviation = 7.9 years
Next Steps Look for a more accurate way to define task and talent, as age and experience are very approximate proxies Analyzing various comorbidity indices to account for preexisting conditions among patients (task) Attempt to verify payment structure’s effect on task and talent matching in cardiac surgery Compare and contrast incentives and payment structures of various specialties
Interdisciplinary Mindset andCommunication are the Keys to Success Thoroughly understanding the significance of assumptions is crucial. Health services research requires an interdisciplinary approach and mindset. Learning about prior research done in one’s topic is essential for future growth and advancement. Communication and conversation is vital. Combining Economics and Medicine
Special Recognition Leonard Davis Institute of Health Economics Anesthesiology Department at Penn Medicine Mentors: Guy David, Ph.D. and Mark Neuman, M.D. LDI Staff Joanne Levy, Elisabeth Madden, Hoag Levins, Megan Pellegrino Renee Zawacki