NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH
loading...

Who is Tested for Heart Attack and Who Should Be: Predicting Patient Risk and Physician Error

Sendhil Mullainathan, Ziad Obermeyer

NBER Working Paper No. 26168
Issued in August 2019
NBER Program(s):Program on the Economics of Aging, Health Care Program, Health Economics Program, Labor Studies Program, Productivity, Innovation, and Entrepreneurship Program

In deciding whether to test for heart attack (acute coronary syndromes), physicians implicitly judge risk. To assess these decisions, we produce explicit risk predictions by applying machine learning to Medicare claims data. Comparing these on a patient-by-patient basis to physician decisions reveals more about low-value care than the usual approach of measuring average testing results. It more precisely quantifies over-use: while the average test is marginally cost-effective, tests at the bottom of the risk distribution are highly cost-ineffective. But it also reveals under- use: many patients at the top of the risk distribution go untested; and they go on to have frequent adverse cardiac events, including death, in the next 30 days. At standard clinical thresholds, these event rates suggest they should have been tested. In aggregate, 42.8% of the potential welfare gains of improving testing would come from addressing under-use. Existing policies though are too blunt: when testing is reduced, for example, both low-value and high-value tests fall. Finally, to understand physician error we build a separate algorithm of the physician and find evidence of bounded rationality as well as biases such as representativeness. We suggest models of physician moral hazard should be expanded to include ‘behavioral hazard’.

download in pdf format
   (1068 K)

email paper

Machine-readable bibliographic record - MARC, RIS, BibTeX

Document Object Identifier (DOI): 10.3386/w26168

 
Publications
Activities
Meetings
NBER Videos
Themes
Data
People
About

National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138; 617-868-3900; email: info@nber.org

Contact Us