Research

We investigate how multi-technology hospitals respond to market entry of single-technology competitors using a rescindment of provider regulations for heart attack treatments in Sweden that led to a rapid expansion in the number of hospitals offering only catheter-based treatment. We exploit that individuals are restricted in their choice of hospital by comparing treatments of patients residing in catchment areas affected by provider market entry to patients residing in unaffected areas. Our results show that patients with clinical indications for cardiac surgery were 10 percent more likely to receive catheter-based treatment after their designated hospital established a cath lab and document adverse health effects for inframarginal patients. We find no evidence that incumbent hospitals responded to this demand reallocation by augmenting their own demand which likely contributed to the swift technological change in the treatment of heart attacks.

We study spillovers in healthcare by exploring how physicians' treatment choices are influenced by their peers using Swedish clinical quality data on the use of radiation in diagnostic angiography procedures. To account for endogenous peer formation, we instrument co-workers' weekly radiation output using the plausibly exogenous arrival of emergency cases they handle. Our estimates suggest that focal cardiologists increase their radiation output by 0.7 standard deviations for each standard deviation increase in their peers' output, with stronger effects for younger doctors and male cardiologists. We document that these peer effects enhance the quality of care by improving use shares of appropriate radiation dosages and lower risk-adjusted patient mortality.

In this study, we expand on our first meta paper and reproduce and replicate the main claims from additional empirical papers published in leading economic and political science outlets. We will also include a number of reproductions and replications from Nature Human Behaviour. For each study, we worked in small teams and either conducted a robustness reproduction —which is the ability to duplicate the results of a prior study using the same data but different procedures as were used by the original investigator — or recoded the study using the raw or intermediate data. Some teams did a combination of a robustness reproduction, recoding, or using new data. In this pre-analysis plan, we detail our 2nd meta paper’s research questions and methodology.

In settings where resistance and rampant misinformation against vaccines exist, the prospect of containing infectious diseases remains a challenge. Can delivery of information regarding the benefits of vaccination through personal home visits by local ambassadors increase vaccine uptake? We conduct a door-to-door randomized information campaign targeted towards COVID-19 unvaccinated individuals in rural Indonesia. We recruited ambassadors from local villages tasked to deliver information about COVID-19 vaccines and promote vaccination through one-on-one meetings, using an interpersonal behavioral change communication approach. To investigate which type of ambassador---health cadres, influential individuals, and laypersons---is the most effective, we randomly vary the type of ambassador that delivers the information at the village level. We find that the overall vaccination take-up is quite moderate and that there are no differences in vaccination outcomes across the treatment groups. These results highlight the challenge of boosting vaccine uptake in late stages of a pandemic.

Competition by general practices can improve quality only if quality affects patient choice of practice. Each year 1% of English patients leave their practice and join another local practice without changing their address (non-movers). If quality does not affect non- movers’ decisions about leaving or joining local practices it is unlikely it will affect overall demand for a practice. Using 2006/7-2010/11 data on 6766 English practices we estimate fixed effects panel count data models of non-movers leaving and joining practices. Fewer non-movers leave after increases in clinical quality, proportion of patients satisfied with access, doctors per patient, and proportion of doctors qualified in the UK. More join after patient satisfaction with access and doctors per patient increase. A 10% increase in opening hours satisfaction is associated with a 5.75% reduction in non-movers leaving and a 2.9% increase in non-movers joining. Better information on quality could increase practice incentives to improve quality.