Technology Diffusion and Productivity Growth in Health Care

Review of Economics and Statistics
Jonathan Skinner and Douglas Staiger

We draw on macroeconomic models of diffusion and productivity to explain empirical patterns of survival gains in heart attacks. Using Medicare data for 2.8 million patients from 1986 to 2004, we find that hospitals rapidly adopting cost-effective innovations such as beta blockers, aspirin, and reperfusion had substantially better outcomes for their patients. Holding technology adoption constant, the marginal returns to spending were relatively modest. Hospitals increasing the pace of technology diffusion (‘‘tigers’’) experienced triple the survival gains compared to those with diminished rates (‘‘tortoises’’). In sum, small differences in the propensity to adopt effective technology lead to wide productivity differences across hospitals

Antibiotic Use in Cold and Flu Season and Prescribing Quality

Medical Care
Alsan M, Morden NE, Gottlieb JD, Zhou W , Skinner JS

Excessive antibiotic use in cold and flu season is costly and contributes to antibiotic resistance. The study objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of prescribing quality.

The Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life

Annals of Internal Medicine
Kelley AS, McGarry K, Gorges R, Skinner JS

Common diseases, particularly dementia, have large social costs for the U.S. population. However, less is known about the end-of-life costs of specific diseases and the associated financial risk for individual households.

Statins and subarachnoid hemorrhage in Medicare patients with unruptured cerebral aneurysms

International Journal of Stroke
Bekelis K, Smith J, Zhou W, MacKenzie TA, Roberts DW, Skinner JS, …

Statins have been shown to decrease aneurysm progression and rupture in two experimental settings: animals with cerebral aneurysm and humans with abdominal aortic aneurysms.

Aims: To investigate statin use and outcomes in humans with unruptured cerebral aneurysms through Medicare administrative data.

Are Black-White Mortality Rates Converging? Acute Myocardial Infarction in the U.S., 1993-2010

Insights in the Economics of Aging
Chandra A, Hoppenfeld T, Skinner J

There is a vast literature documenting the presence of pervasive racial disparities in U.S. health care (IOM, 2002). More recently, researchers have studied changes over time in the extent of racial and socioeconomic disparities, to test whether the public focus on disparities in health care has led to fundamental changes in practice styles, improved sensitivity by health care providers to different cultural norms, and less biased treatment and outcome decisions. In many cases, there has been a notable reduction in the magnitude of disparities in treatment and the use of “effective” care (Trivedi et al., 2005; Trivedi et al., 2011; Jha et al., 2005). There is less progress, however, with respect to racial disparities in overall health outcomes (e.g. Cutler and Meara, 2008).

How can this puzzle be explained? Many efforts to address disparities have focused on how physicians treat patients of different races and ethnicities. For example, the public knowledge that stenting rates for Black patients are so much lower than those for white patients could lead to cardiologists at the margin to question their decisions not to provide stents to their Black patients. An increasing share of minority health professionals could also lead to a decline in the extent of disparities in treatments of diverse patient populations. Over a sufficiently lengthy period of time, we might expect to see a convergence in treatment patterns as a result of efforts to reduce both implicit and explicit biases in health care within the hospital.