中文摘要
由于诊疗强度存在广泛的横截面差异，而这些差异与医疗质量无关，研究人员和政策制定者通常声称，医疗服务提供者浪费了大量资源，从事所谓的“曲线平坦段”医疗。这一假说有一个关键但难以验证的预测：医疗服务提供者应当能够在不牺牲质量的情况下减少医疗服务。本文考察了一种特定形式的医疗服务削减所产生的影响，即医生在高压力的同伴群体环境中工作时所作的削减。利用来自137个医院急诊科的大规模、带有时间戳的出院数据，我发现，医生在频繁重组的不同同伴群体中，会系统性地调整诊疗节奏与强度。促使一名医生加快工作速度的同伴群体，也会促使该医生安排更少的检查并减少支出。与“曲线平坦段”假说相反，这些削减导致医疗质量大幅下降。这一证据，加上工作速度较慢的医生并未取得更好的平均诊疗结果这一事实，表明医生之间资源利用的差异反映了同一家医院内医生生产率的较大差异。
Abstract
Abstract Motivated by wide cross-sectional variations in intensity of care that are unrelated to quality of care, researchers and policymakers commonly claim that healthcare providers waste considerable resources, engaging in so-called “flat-of-the-curve” medicine. A key yet elusive prediction of this hypothesis is that providers ought to be able to cut back on care without sacrificing quality. This article examines the effects of a particular form of provider cutbacks—those generated by physicians working in high-pressure peer group environments. Using expansive, time-stamped discharge data from 137 hospital-based emergency departments, I document that physicians systematically alter their pace and intensity of care across frequently shuffled peer groups. Peer groups that induce a physician to work faster also induce her to order fewer tests and spend less money. Contrary to the flat-of-the-curve hypothesis, these cutbacks lead to large reductions in quality of care. This evidence, paired with the fact that slower physicians do not produce better average outcomes, suggests that cross-physician differences in resource utilization reflect substantial differences in physician productivity within a hospital.