Technological Development and Medical Productivity: The Diffusion of Angioplasty in New York State

David M. Cutler; Robert S. Huckman

Article | Journal of Health Economics | March 2003

Technological Development and Medical Productivity: The Diffusion of Angioplasty in New York State

by David M. Cutler and Robert S. Huckman

Abstract

A puzzling feature of many medical innovations is that they simultaneously appear to reduce unit costs and increase total costs. We consider this phenomenon by examining the diffusion of percutaneous transluminal coronary angioplasty (PTCA)—a treatment for coronary artery disease—over the past two decades. We find that growth in the use of PTCA led to higher total costs despite its lower unit cost. Over the two decades following PTCA's introduction, however, we find that the magnitude of this increase was reduced by between 10 and 20% due to the substitution of PTCA for CABG. In addition, the increased use of PTCA appears to be a productivity improvement. PTCAs that substitute for CABG cost less and have the same or better outcomes, while PTCAs that replace medical management appear to improve health by enough to justify the cost.

Keywords: Innovation and Invention; Cost; Health Care and Treatment; Health Disorders; Performance Improvement; Product; New York (state, US);

Format: Print

31 pages

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Citation:

Cutler, David M., and Robert S. Huckman. "Technological Development and Medical Productivity: The Diffusion of Angioplasty in New York State." Journal of Health Economics 22, no. 2 (March 2003): 187–217.

Article | Management Science | September 2018

Discretionary Task Ordering: Queue Management in Radiological Services

Maria Ibanez, Jonathan R. Clark, Robert S. Huckman and Bradley R. Staats

Work-scheduling research typically prescribes task sequences implemented by managers. Yet employees often have discretion to deviate from their prescribed sequence. Using data from 2.4 million radiological diagnoses, we find that doctors prioritize similar tasks (batching) and those tasks they expect to complete faster (shortest expected processing time). Moreover, they exercise more discretion as they accumulate experience. Exploiting random assignment of tasks to doctors’ queues, instrumental variable models reveal that these deviations erode productivity. This productivity decline lessens as doctors learn from experience. Prioritizing the shortest tasks is particularly detrimental to productivity. Actively grouping similar tasks also reduces productivity, in stark contrast to productivity gains from exogenous grouping, indicating deviation costs outweigh benefits from repetition. By analyzing task completion times, our work highlights the tradeoffs between the time required to exercise discretion and the potential gains from doing so, which has implications for how discretion over scheduling should be delegated.

Keywords: discretion; scheduling; queue; healthcare; learning; experience; Decentralization; operations; service operations; service delivery; Performance; Performance Effectiveness; Performance Efficiency; Performance improvement; Performance Productivity; Decisions; time management; Cost vs Benefits; Health Industry; Operations; Service Operations; Service Delivery; Performance; Performance Effectiveness; Performance Efficiency; Performance Improvement; Performance Productivity; Decisions; Time Management; Cost vs Benefits; Health Industry;

Citation:

Ibanez, Maria, Jonathan R. Clark, Robert S. Huckman, and Bradley R. Staats. "Discretionary Task Ordering: Queue Management in Radiological Services." Management Science 64, no. 9 (September 2018): 4389–4407. (Working paper available here. Winner of the 2017 Best Paper Competition of the POMS College of Healthcare Operations Management. Featured in Forbes, Quartz, and Inc.) View Details

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In 2015, the Department of Veterans Affairs (VA) ran the largest healthcare system in the United States, with over 1,700 sites of care that served nearly 9 million veterans. One year earlier, a scandal had erupted over a cover-up of the excessive wait times veterans faced to get medical appointments in some VA facilities. The fallout led to the resignation of the Secretary of Veterans Affairs, a criminal investigation by the Federal Bureau of Investigation, and the eventual replacement of 14 of VA’s top 17 leaders. This case documents the efforts of the new leadership team to improve access, regain trust, and transform the organization to address the broadening medical needs of the nation's growing veteran population.

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Technological Development and Medical Productivity: The Diffusion of Angioplasty in New York State

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