Leila Agha

Published Research
    with David Molitor
    Forthcoming at Review of Economics and Statistics

The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care
    with Jason Abaluck, and Christopher Kabrhel, Ali Raja, Arjun Venkatesh
    2016, American Economic Review, 106(12): 3730-64.
    NIHCM Research Award Honorable Mention
 

    Previous title: "Negative Tests and the Efficiency of Medical Care: What Determines         Heterogeneity in Imaging Behavior?"


Big Names or Big Ideas: Do Peer-Review Panels Select Top Science Proposals?
   with Danielle Li
   2015, Science, 348(6233):434-438.
    

   2014, Journal of Health Economics, 34: p.19-30.  

Current Research
    with Brigham Frandsen and James Rebitzer
    under review

Personalized Medicine and Patient Selection: Discretion vs. Guidelines
    with Jason Abaluck and David Chan
    
Efficient care requires that care be administered to patients who stand to benefit most. Clinical risk scores are an increasingly common tool to achieve this. However, scores typically summarize baseline risk absent treatment while clinicians would like to know treatment effects. We make use of a large database of detailed clinical records from the Veterans Health Administration to study anticoagulation treatment choices and outcomes for patients with atrial fibrillation. We estimate how anticoagulation affects stroke and hemorrhage across patients with different characteristics using variation generated by quasi-random assignment of patients to physicians with different propensities to prescribe anticoagulation. Our model allows heterogeneous treatment effects to vary flexibly with observable characteristics and allows for the possibility  that physicians are selecting patients into treatment based on unobservable treatment  effect heterogeneity. We use the model to compare patient outcomes under the status quo, under strict adherence to standard and optimal treatment rules, and under  discretionary adherence to standard and optimal treatment rules. Optimal guidelines  have the potential to reduce stroke incidence by two thirds relative to current practice,  without increasing the rate of adverse side effects.

Coordination within Teams and the Costs of Health Care
    with Keith M. Ericson, Kimberly Geissler, Benjamin Lubin, and James Rebitzer

 We examine how primary care physicians (PCPs) assemble teams of specialists to care for their patients. In our model, PCPs can invest in a relationship with specialists that requires upfront costs but has benefits for care coordination. PCPs who work with fewer specialists (have higher referral concentration) invest more in relationship-specific capital. Using the Massachusetts APCD, we show that this team-based coordination of care measure is virtually uncorrelated with existing patient-based coordination of care measures. We identify the effect of referral concentration on spending by comparing the spending of individuals who see the same specialist, but come from PCPs with different referral concentration. We use the same technique with standardized prices to distinguish whether the effects are a result of specialist prices or utilization effects. We find that a one standard deviation increase in coordination of care by a PCP (a change of 0.05 in HHI) reduces average costs by 2.2%. 


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