On Monday, November 12 2018, 14:00 - 15:30, Daniel Wiesen (University of Cologne) will present:
Physician Performance Pay: Experimental Evidence
We present causal evidence on the effect of performance pay on medical service provision from an artefactual field experiment with a representative sample of German resident primary care physicians. In the experiment, we introduce performance pay with two different bonus levels to complement capitation. Performance pay is granted if a health care quality threshold is met. In line with standard theory, we find that performance pay significantly reduces underprovision of medical services, and, on average, it improves the quality of care. The magnitude of these effects depends, however, on the patients’ severity of illness. We also find substantial evidence for crowding-out of patient-regarding behavior under performance pay. Our findings are robust towards variations in the bonus levels. Interestingly, provision behavior in the experiment relates significantly to physicians' annual profits and practice locations.
Room: WST-C.02.12, Weststadttürme Berliner Platz 6-8, Essen
On Monday, November 5 2018, 14:00 - 15:30, Daniel Howdon (University of Leeds) will present:
Early-Life Urban Living and Depression in Late-Adulthood
Background: Urbanicity has been established as a risk factor for depression at various life-course stages. Little, however, is known about the impact of childhood urbanicity on depression in late-adulthood. We aim to study the association of childhood urbanicity with depressive symptoms in late adulthood among a representative sample of the 50+ population in 13 European countries. Methods: We use 20,733 respondents from the Survey on Health, Ageing and Retirement in Europe. Childhood urbanicity is determined using self-reports of the respondents' circumstances at age 10, late-adulthood depression is assessed using the EURO-D depression scale. We condition on circumstances early in life as well as later in life; most importantly late-adulthood urbanicity. We estimate the associations using linear regression models and limited dependent variable models. Results: A pooled regression of both men and women suggests childhood urbanicity is associated in a non-monotonically with depression in late adulthood. The association is robust to the inclusion of a host of household characteristics associated with childhood urbanicity, and is independent of contemporaneous urbanicity and contemporaneous income. When broken down by gender, we find no significant association for men but a significant association for women. Conclusions: Our analysis reveals a relationship between childhood urbanicity and depression in late-adulthood. The evidence presented on the nature of this relationship is not straightforward but broadly suggestive of a link between greater urbanicity and higher levels of depressive symptoms. The life-long nature of this association may potentially inform policy agendas aimed at improving urban & suburban living conditions.
Room: WST-C.02.12, Weststadttürme Berliner Platz 6-8, Essen
A new working paper has been added to the CINCH working paper series: “Quasi-experimental evidence on the effectiveness of heart attack treatment in Germany” by Corinna Hentschker and Ansgar Wübker.
Objective. To examine the causal effect of percutaneous transluminal coronary angioplasty (PTCA) in comparison to conservative treatment methods on mortality.
Data Sources. We use a full sample of administrative hospital data from Germany for the years 2005 to 2007.
Study Design. To account for non-random treatment assignment of PTCA, instrumental variable approaches are implemented that aim to randomize patients into getting PTCA independent of heart attack severity. Instruments include differential distances to PTCA hospitals and regional PTCA rates.
Principal Findings. Our results suggest a 4.5 percentage point mortality reduction for patients who have access to PTCA compared to patients receiving only conservative treatment. We relate mortality reduction to the additional costs for this treatment and conclude that PTCA treatment is cost-effective in lowering mortality for AMI patients at reasonable cost-effectiveness thresholds.
Conclusions. Our local average treatment effect results suggest that PTCA treatment could be beneficial, at least for the group that did not receive PTCA because the nearest hospital did not provide PTCA.
