Health Care Quality Revealed in Hospital and Physician Behavior

Abstract

Improving the quality of care is a major objective of health care systems, yet its determinants remain poorly understood. Across three quasi-experimental studies, this dissertation examines how health care quality is impacted by three phenomena ubiquitous in health care: hospital payment, physicians’ impressions of each other, and physician peer motivation. In Chapter 1, I leverage plausibly exogenous changes in Medicare payment to study the causal effect of hospital-specific Medicare fee changes on hospitals’ quality investment decisions and quality outcomes. In Chapter 2 (with J. Michael McWilliams), I leverage a natural experiment that plausibly randomly assigns patients to specialists to investigate whether PCPs’ stated preferences for specialists are predictive of patient-reported and revealed experiences with specialist care. In Chapter 3 (with J. Michael McWilliams), I use medical licensing data to study whether physician peer relationships—formed in the past during medical training—motivate improved specialist care for patients. Together, these studies advance our understanding of how hospital and physician behavior can shape health care quality and suggest new avenues for policy development.