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Haste or Waste? Peer Pressure and Productivity in the Emergency Department
[The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care]

Author

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  • David Silver
Abstract
Motivated by wide cross-sectional variations in intensity of care that are unrelated to quality of care, researchers and policymakers commonly claim that healthcare providers waste considerable resources, engaging in so-called “flat-of-the-curve” medicine. A key yet elusive prediction of this hypothesis is that providers ought to be able to cut back on care without sacrificing quality. This article examines the effects of a particular form of provider cutbacks—those generated by physicians working in high-pressure peer group environments. Using expansive, time-stamped discharge data from 137 hospital-based emergency departments, I document that physicians systematically alter their pace and intensity of care across frequently shuffled peer groups. Peer groups that induce a physician to work faster also induce her to order fewer tests and spend less money. Contrary to the flat-of-the-curve hypothesis, these cutbacks lead to large reductions in quality of care. This evidence, paired with the fact that slower physicians do not produce better average outcomes, suggests that cross-physician differences in resource utilization reflect substantial differences in physician productivity within a hospital.

Suggested Citation

  • David Silver, 2021. "Haste or Waste? Peer Pressure and Productivity in the Emergency Department [The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care]," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 88(3), pages 1385-1417.
    • Handle: RePEc:oup:restud:v:88:y:2021:i:3:p:1385-1417.
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    File URL: http://hdl.handle.net/10.1093/restud/rdaa054
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    Cited by:

    1. Maria De Paola & Roberto Nisticò & Vincenzo Scoppa, 2024. "Workplace Peer Effects in Fertility Decisions," CSEF Working Papers 714, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    2. Zheng, Hongyun & Vatsa, Puneet & Ma, Wanglin & Zhou, Xiaoshou, 2023. "Working hours and job satisfaction in China: A threshold analysis," China Economic Review, Elsevier, vol. 77(C).
    3. Avdic, Daniel & Ivets, Maryna & Lagerqvist, Bo & Sriubaite, Ieva, 2023. "Providers, peers and patients. How do physicians’ practice environments affect patient outcomes?," Journal of Health Economics, Elsevier, vol. 89(C).
    4. Ivan Badinski & Amy Finkelstein & Matthew Gentzkow & Peter Hull, 2023. "Geographic Variation in Healthcare Utilization: The Role of Physicians," NBER Working Papers 31749, National Bureau of Economic Research, Inc.
    5. Gautam Gowrisankaran & Keith Joiner & Pierre Thomas Léger, 2023. "Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments," Management Science, INFORMS, vol. 69(6), pages 3202-3219, June.
    6. Yingchao Lan & Deepa Goradia & Aravind Chandrasekaran, 2022. "Ancillary Cost Implications of Physicians Multisiting and Inter‐Organizational Collaboration During Healthcare Delivery," Production and Operations Management, Production and Operations Management Society, vol. 31(2), pages 561-582, February.
    7. Diego Battiston & Jordi Blanes i Vidal & Tom Kirchmaier & Katalin Szemeredi, 2023. "Peer pressure and manager pressure in organisations," CEP Discussion Papers dp1924, Centre for Economic Performance, LSE.
    8. Atul Gupta & Ambar La Forgia & Adam Sacarny, 2024. "Turbocharging Profits? Contract Gaming and Revenue Allocation in Healthcare," NBER Working Papers 32564, National Bureau of Economic Research, Inc.
    9. Petek, Nathan, 2022. "The marginal benefit of hospitals: Evidence from the effect of entry and exit on utilization and mortality rates," Journal of Health Economics, Elsevier, vol. 86(C).
    10. Musa Mohammed & Nasir Shafiq & Ali Elmansoury & Al-Baraa Abdulrahman Al-Mekhlafi & Ehab Farouk Rached & Noor Amila Zawawi & Abdulrahman Haruna & Aminu Darda’u Rafindadi & Muhammad Bello Ibrahim, 2021. "Modeling of 3R (Reduce, Reuse and Recycle) for Sustainable Construction Waste Reduction: A Partial Least Squares Structural Equation Modeling (PLS-SEM)," Sustainability, MDPI, vol. 13(19), pages 1-22, September.
    11. Alquezar-Yus, M.;, 2023. "Time Constraints and the Quality of Physician Care," Health, Econometrics and Data Group (HEDG) Working Papers 23/06, HEDG, c/o Department of Economics, University of York.

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