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Huskamp H.A.,Harvard University | O'Malley A.J.,Harvard University | Horvitz-Lennon M.,RAND Corporation | Taub A.L.,Cornerstone Research | And 3 more authors.
Psychiatric Services | Year: 2013

Objective: The authors examined physician adoption of second-generation antipsychotic medications and identified physician-level factors associated with early adoption. Methods: The authors estimated Cox proportionalhazards models of time to adoption of nine second-generation antipsychotics by 30,369 physicians who prescribed antipsychotics between 1996 and 2008, when the drugs were first introduced, and analyzed the total number of agents prescribed during that time. The models were adjusted for physicians' specialty, demographic characteristics, education and training, practice setting, and prescribing volume. Data were from IMS Xponent, which captures over 70% of all prescriptions filled in the United States, and the AmericanMedical Association Physician Masterfile. Results: On average, physicians waited two or more years before prescribing new second-generation antipsychotics, but there was substantial heterogeneity across products in time to adoption. General practitioners were much slower than psychiatrists to adopt second-generation antipsychotics (hazard ratios (HRs) range .102.35), and solo practitioners were slower than group practitioners to adopt most products (HR range .772.89). Physicians with the highest antipsychotic-prescribing volume adopted second-generation antipsychotics much faster than physicians with the lowest volume (HR range .152.39). Psychiatrists tended to prescribe a broader set of antipsychotics (median=6) than general practitioners and neurologists (median=2) and pediatricians (median=1). Conclusions: As policy makers search for ways to control rapid health spending growth, understanding the factors that influence physician adoption of new medications will be crucial in the efforts to maximize the value of care received by individuals with mental disorders as well as to improve medication safety. Copyright © American Psychiatric Association. Source

Berndt E.R.,Massachusetts Institute of Technology | Gibbons R.S.,NBER | Gibbons R.S.,Massachusetts Institute of Technology | Kolotilin A.,University of New South Wales | Taub A.L.,Cornerstone Research
Journal of Health Economics | Year: 2015

We present two new findings based on annual antipsychotic US prescribing data from IMS Health on 2867 psychiatrists who wrote 50 or more prescriptions in 2007. First, many of these psychiatrists have prescription patterns that are statistically significantly different than random draws from national market shares for prescriptions by psychiatrists. For example, many have prescription patterns that are significantly more concentrated than such draws. Second, among psychiatrists who are the most concentrated, different prescribers often concentrate on distinct drugs. Motivated by these two findings, we then construct a model of physician learning-by-doing that fits these facts and generates two further predictions: both concentration (on one or a few drugs) and deviation (from the prescription patterns of others) should be smaller for high-volume physicians. We find empirical support for these predictions. Furthermore, our model outperforms an alternative theory concerning detailing by pharmaceutical representatives. © 2014 Elsevier B.V.. Source

Bauner C.,Cornerstone Research
International Journal of Industrial Organization | Year: 2015

A striking feature of many online sales platforms is the coexistence of multiple sales mechanisms. Items on eBay, for instance, are frequently offered through auctions, posted prices, and buy-it-now auctions. In this article, I study how this mechanism multiplicity influences the welfare of buyers and sellers. I specify and estimate a structural model of mechanism choice in online markets, in which I consider both sides of the market: On the demand side, buyers' choices among available listings are equilibrium outcomes of an entry game. On the supply side, sellers make equilibrium decisions when choosing sales mechanisms and prices. I estimate this model using data from sales of baseball tickets on eBay and calculate consumer and seller rents in three markets: the actual market with all three sales mechanisms and two counterfactual markets with auctions and fixed prices or only fixed-price listings, respectively. I find that the addition of auctions to fixed-price markets hurts sellers and risk-averse buyers but benefits risk-neutral buyers. Additionally, the consumer surplus increases when buy-it-now auctions are offered but the seller surplus is reduced further. I discuss the intuition for the cause of this result. © 2014 Elsevier B.V. All rights reserved. Source

Dranove D.,Northwestern University | Garthwaite C.,Northwestern University | Li B.,Cornerstone Research | Ody C.,Northwestern University
Journal of Health Economics | Year: 2015

In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH. © 2015 Elsevier B.V. Source

Rosston G.L.,Stanford University | Topper M.D.,Cornerstone Research
Information Economics and Policy | Year: 2010

The ongoing debate about possible implementation of regulatory rules requiring "network neutrality" for wireless telecommunications services is inherently about whether to impose prohibitions on the ability of network operators to control their vertical relationships. Antitrust analysis is well suited to analyze whether a wireless network neutrality rule is socially beneficial. Implementing network neutrality rules would be akin to using a per se antitrust rule regarding vertical relationships instead of the rule of reason analysis typically applied to vertical relationships in antitrust. Per se rules are used to prevent actions that rarely, if ever, have any procompetitive benefits, such as price-fixing agreements. Rule of reason analysis is used when there are potential efficiency gains from the actions under investigation. Some vertical practices of the wireless carriers, such as bandwidth restrictions, may appear to be anticompetitive, but may also have plausible efficiency justifications so should be judged under rule of reason analysis. Economic examination of the wireless industry shows significant competition between networks, which reduces the concern about vertical relationships, but also shows some areas that should be monitored by antitrust and regulatory authorities. We propose several regulatory changes that would likely increase wireless competition and lessen the perceived need for prophylactic network neutrality rules while at the same time allowing efficiency-enhancing vertical relationships. © 2009 Elsevier B.V. All rights reserved. Source

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