TY  - JOUR
AU  - Cutler, David
AU  - Skinner, Jonathan
AU  - Stern, Ariel Dora
AU  - Wennberg, David
TI  - Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 19320
PY  - 2013
Y2  - August 2013
DO  - 10.3386/w19320
UR  - http://www.nber.org/papers/w19320
L1  - http://www.nber.org/papers/w19320.pdf
N1  - Author contact info:
David M. Cutler
Department of Economics
Harvard University
1875 Cambridge Street
Cambridge, MA  02138
Tel: 617/496-5216
Fax: 617/496-8951
E-Mail: dcutler@harvard.edu

Jonathan S. Skinner
Department of Economics
6106 Rockefeller Hall
Dartmouth College
Hanover, NH 03755
Tel: 603/646-2535
Fax: 603/646-2122
E-Mail: jonathan.skinner@dartmouth.edu

Ariel Dora Stern
Harvard Business School
Morgan Hall 433
Boston, MA 02163
Tel: 617-495-2332
E-Mail: astern@hbs.edu

David E. Wennberg
Geisel School of Medicine
35 Centerra Parkway
Lebanon
E-Mail: david.e.wennberg@dartmouth.edu
AB  - There is considerable controversy about the causes of regional variations in health care expenditures. Using vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures, this study asks whether patient demand-side factors or physician supply-side factors explain these variations. The results indicate that patient demand is relatively unimportant in explaining variations. Physician organizational factors matter, but the most important factor is physician beliefs about treatment. In Medicare, we estimate that 35 percent of spending for end-of-life care, and 12 percent of spending for heart attack patients (and for all enrollees) is associated with physician beliefs unsupported by clinical evidence.
ER  -