Abstract
Physicians play a crucial role in the healthcare market. As key providers of healthcare services and the primary point of contact with patients, physicians’ behavior can directly influence the quantity, quality, and cost of healthcare services. This dissertation consists of three essays that study the economics of physician behavior. Specifically, I investigate how patient violence, medical malpractice litigation, and the legalization of physician multi-site practice affect the decision-making of physicians in China.
In essay 1, I investigate the impact of patient violence on physicians’ service delivery behaviors at the online health platform. To do so, I utilize data on media reports of patient violent incidents and physician-quarter level online health consultation data from across China. Employing a stacked difference-in-difference strategy, I compare the behavior of physicians who experience the current violence to those that experience such violence two years later, leveraging the potential randomness of the timing of a violent incident within a short period. The results show that patient violence has a negative effect on the number of services provided by the physicians. Further analysis indicates that this reduction is primarily driven by two factors: a decrease in services with higher privacy risks and a decrease in patients who share similar characteristics with criminals. In addition, there is a significant decrease in the number of positive comments left by patients on the website, both regarding treatment effectiveness and physicians’ service attitude. The findings imply that violence against physicians can decrease patients’ access to care and the quality of care.
In essay 2, I examine the effect of medical malpractice litigation on diagnostic tests in Chinese hospitals. The analysis utilizes hospital quarterly reports and civil lawsuits regarding medical damage liability disputes in Shenzhen, employing a difference-in-differences strategy. On average, litigation results in a marginal increase in diagnostic tests, which is statistically indistinguishable from zero. However, there is significant heterogeneity in how hospitals respond to court rulings. Among hospitals that have lost litigation cases, there is a notable 15.6% increase in the number of magnetic resonance imaging (MRI) scans, while the positive rate of these tests decreases by 6.6 percentage points. More specifically, I estimate that for every 10,000 Chinese yuan (approximately 1409.13 USD) of compensation a hospital is required to pay after losing a lawsuit, there is an average increase of 18.3 MRI scans per quarter. Similarly, for every 1 percentage point increase in the proportion of medical errors for which the court holds the hospital liable, the hospital would see an additional 13.0 MRI scans per quarter. Back-of-the-envelope calculation indicates that the annual cost of these additional MRI tests resulting from losing a lawsuit amounts to approximately 1.21 billion USD.
In essay 3, I examine the effect of legalizing physicians’ multi-site practice (MSP) in China. In an effort to increase physicians’ mobility across different medical institutions, the Chinese government introduced a plan in 2009 that allowed physicians to practice at multiple locations. I assemble a unique dataset that includes information on the registration status of over 470,000 licensed physicians in China. This data enables me to identify physicians who practiced at multiple locations within each city both before and after the policy implementation. Exploiting the staggered rollout of the MSP policy across different cities, I find the policy leads to a substantial increase in the number of MSP physicians registered at primary care institutions. Additionally, it increases the probability of people seeking care at primary care institutions, decreases patients’ perceived health status and out-of-pocket health expenses, with these effects being more pronounced for rural residents. These findings provide relevant evidence for measures and impacts to enhance primary care capacity in both developed and developing countries.
Physicians play a crucial role in the healthcare market. As key providers of healthcare services and the primary point of contact with patients, physicians’ behavior can directly influence the quantity, quality, and cost of healthcare services. This dissertation consists of three essays that study the economics of physician behavior. Specifically, I investigate how patient violence, medical malpractice litigation, and the legalization of physician multi-site practice affect the decision-making of physicians in China.