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. (JEL D83, H75, I11, I18).

中文翻译：

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医生信念和患者偏好：医疗保健支出地区差异的新视角


关于医疗保健支出地区差异的原因存在相当大的争议。本研究利用与按服务收费的医疗保险支出相关的患者和医生调查中的小插曲，询问患者需求方因素或医生供给方因素是否解释了这些差异。结果表明，患者需求在解释差异方面相对不重要。医生的组织因素很重要，但最重要的因素是医生对治疗的信念。在医疗保险中，我们估计 35% 的临终关怀支出和 12% 的心脏病患者（以及所有参保者）支出与未经临床证据支持的医生信念相关。 （JEL D83、H75、I11、I18）。