van Empel G, Avdic D, Khalil U, Kunz J, Lagerqvist B and Vikström J, (2024), "Radiating influene? Spillover effects among physicians", mimeo Monash University
Abstract: We study spillovers in healthcare by exploring how cardiologists’ diagnostic choices are influenced by their peers. We use rich clinical quality data from Sweden to instrument peers’ average weekly radiation output, our endogenous variable of interest, using the peer’s lagged arrival of emergency cases. Our IV estimates imply that focal cardiologists change their own radiation output by 0.5 SD for each SD change in their peers’ output. We show that our results are neither driven by endogenous peer formation nor patient selection. Effects are also stronger in academic hospitals and among younger cardiologists. These spillovers enhance patient welfare as well by increasing the share of appropriate radiation dosage and by reducing subsequent 30-day risk-adjusted mortality.
Avdic D, Lagerqvist B, Gutacker N, van Empel G and Vikström J, (2024), "Provider responses to market entry under competing health technologies", mimeo Monash University
Abstract: We study whether multi-technology healthcare providers respond to market entry of specialized single-technology competitors by inducing demand for legacy health technologies. To this end, we use the relaxation of regulatory restrictions in cardiac care in Sweden that led to a rapid expansion in the number of hospitals providing catheter-based treatment only. To establish causality, we exploit a feature of the Swedish healthcare system that restricts patient choice of healthcare providers, allowing providers considerable discretion in allocating patients to treatments. Relating observed treatments of residents in catchment areas where hospitals opened a catheter lab to residents in unaffected catchment areas, we find that patients with clinical indications for cardiac surgery were 10 percent more likely to receive catheter-based treatment after their local hospital opened a catheter lab. In contrast, we find no evidence that incumbent hospitals reduced their use of catheter treatment on their remaining patient population to offset reductions in surgical volume. We conclude that the lack of response to market entry among incumbent providers likely contributed to the swift technological change in the clinical management of acute coronary syndrome in the 2000s.
3. Lundborg P, S James, B Lagerqvist and J Vikström (2021), ``Learning-by-Doing and Productivity Growth among High-Skilled Workers: Evidence from the Treatment of Heart Attacks'', IZA DP No. 147446.
Abstract: Learning-by-doing is a fundamental concept in economics, yet documenting it in high-skilled settings is hindered by non-random task assignment and limited perfor-mance measures. To address these challenges, we utilize quasi-random physician-patient assignment in heart attack treatments. Our findings reveal extended learning curves across the first 1000 treatments, impacting proficiency and decision-making. Physicians working alongside experienced colleagues learn faster, recent experience holds greater value, and experienced physicians adapt their treatment decisions to patient characteristics. Our findings highlight the power of learning-by-doing for productivity growth in high-skilled environments.
Avdic D., S. von Hinke, B. Lagerqvist, C. Propper and J. Vikström (2024), "Do responses to news matter? Evidence from interventional cardiology", Journal of Health Economics, 94 (March)
Abstract: We examine physician responses to a global information shock and how these impact their patients. We exploit international news over the safety of an innovation in healthcare, the drug-eluting stent. We use data on interventional cardiologists’ use of stents to define and measure cardiologists’ responsiveness to the initial positive news and link this to their patients’ outcomes. We find substantial heterogeneity in responsiveness to news. Patients treated by cardiologists who respond slowly to the initial positive news have fewer adverse outcomes. This is not due to patient–physician sorting. Instead, our results suggest that the differences are partially driven by slow responders being better at deciding when (not) to use the new technology, which in turn affects their patient outcomes.
Avdic D., P. Lundborg and J. Vikström (2024), "Does Health-Care Consolidation Harm Patients? Evidence from Maternity Ward Closures", American Economic Journal: Economic Policy, 16(1), 160--189.
Abstract: We study the effects of mergers of maternal health services in Sweden on maternal and neonatal health. Using data on all hospital births in Sweden over two decades, we compare changes to birth-related health outcomes across areas that were differently exposed to maternity ward mergers. Our results show that the mergers led to increases in maternal obstetric trauma but to decreases in fetal stress, infant trauma, and clavicle injuries among newborns. We find suggestive evidence that the adverse health outcomes among women are driven by ward overcrowding, whereas increases in travel distance resulting from the mergers have no effects. The results also suggest that the positive health effects of mergers on infant health partly reflect a move from births at smaller to larger wards of higher quality. Policy-makers should weigh the benefits of the merger policy, in terms of reduced salary costs and improved newborn health outcomes, against the costs, in terms of worse maternal health outcomes.
Bucher-Koenen T., H. Farbmacher, R. Guber and J. Vikström (2020), "Double trouble: The burden of child rearing and working on maternal mortality", Demography, 57, 559-576.
Abstract: We document increased old-age mortality rates among Swedish twin mothers compared to non-twin mothers. Results are based on administrative data on mortality for the years 1990 to 2010. We argue that twins are an unplanned shock to fertility in the cohorts of older women considered. Deaths due to lung cancer, chronic obstructive pulmonary disease and heart attacks, which are associated with stress during life, are signi cantly increased. Stratifying the sample by education and pension income shows the highest increase in mortality rates among highly educated mothers and those with above-median pension income. These results are consistent with the existence of a double burden from child rearing and working on mothers' health.
Avdic D., P. Lundborg and J. Vikström (2019), "Estimating Returns to Hospital Volume: Evidence from Advanced Cancer Surgery", Journal of Health Economics, 63, 81-99.
Abstract: High-volume hospitals typically perform better than low-volume hospitals. In this paper, we studywhether such patterns reflect a causal effect of case volume on patient outcomes. To this end, weexploit closures and openings of entire cancer clinics in Swedish hospitals which provides sharp andarguably exogenous variation in case volumes. Using detailed register data on more than 100,000 treat-ment episodes of advanced cancer surgery, our results suggest substantial positive effects of operationvolume on survival. Complementary analyses point to learning-by-doing as an important explanation.
Van den Berg G.J., P. Lundborg and J. Vikström (2017), "The Economics of Grief", Economic Journal, 127, 1794-1832.
Abstract: We study the short-run and long-run economic impact of one of the largest losses that an individual can face; the death of a child. We utilise unique registers on the entire Swedish population, combining information on the date and cause of death with parental outcomes. We exploit the longitudinal dimension of the data and deal with several selection issues. Losing a child has adverse effects on labour income, employment status, marital status and hospitalisation. The value of policy measures aimed at preventing mortal accidents of children is underestimated if it does not take bereavement effects on parents into account.
Andersson E., P. Lundborg and J. Vikström (2015), "Income receipt and mortality - evidence from Swedish public sector employees", Journal of Public Economics, 131, 21--32.
Abstract: In this paper, we study the short-run effect of salary receipt on mortality among Swedish public sector employees. By exploiting variation in paydays across work-places, we completely control for mortality patterns related to, for example, public holidays and other special days or events coinciding with paydays and for general within-month and within-week mortality patterns. We find a dramatic increase in mortality on the day that salaries arrive. The increase is especially pronounced for younger workers and for deaths due to activity-related causes such as heart conditions and strokes. The effect is entirely driven by an increase in mortality among low incomeindividuals,who aremore likely to experience liquidity constraints. All things considered, our results suggest that an increase in general economic activity on salary receipt is an important cause of the excess mortality.
Lundborg P., M. Nilsson and J. Vikström (2015), "Heterogeneity in the impact of health shocks on labour outcomes: evidence from Swedish workers", Oxford Economic Papers, 67, 715--739.
Abstract: This article provides new evidence on heterogeneity in the impact of health shocks by using register-based data on the entire population of Swedish workers. We formulate a difference-in-difference design, where we compare the change in labour earnings across matched workers with a high and low level of education who experience the same type of health shocks. Our results suggest major heterogeneity in the effects, where a given health shock has a greater relative negative impact on low-skilled individuals/individuals with a low level of education. These results hold across different types of health shocks and become more pronounced with age. Low-skilled workers are also more likely to leave the labour force and receive disability insurance, sickness insurance, and unemployment benefits following a health shock. Our results suggest that heterogeneity in the effect of health shocks offers one explanation as to how the educational gradient in health arises.
23. Lombardi S, G van den Berg and J Vikström (2024), "Empirical Monte Carlo Evidence on Estimation of Timing-of-Events Models", Econometric Reviews, accepted.
22. Cederlöf J, M Söderström and J Vikström (2024), "What makes a good caseworker?", Journal of European Economic Association, accepted.
21. Cheung M, J Egebark, A Forslund, L Laun, M Rödin and J Vikström (2024), "Does job search assistance reduce unemployment? Experimental evidence on displacement effects and mechanisms", Journal of Labor Economics, 43(1), 47--81.
20. Avdic D., S. von Hinke, B. Lagerqvist, C. Propper and J. Vikström (2024), "Do responses to news matter? Evidence from interventional cardiology", Journal of Health Economics, 94 (March)
19. Avdic D., P. Lundborg and J. Vikström (2024), "Does Health-Care Consolidation Harm Patients? Evidence from Maternity Ward Closures", American Economic Journal: Economic Policy, 16(1), 160--189.
18. Caliendo M, R Mahlstedt, G van den Berg and J Vikström (2023), "Side effects of labor market policies", Scandinavian Journal of Economics, 124(2), 339-375.
17. G.J. van den Berg and J. Vikström (2022), "Long-Run Effects of Dynamically Assigned Treatments: A New Methodology and an Evaluation of Training Effects on Earnings", Econometrica, 90(3), 1338-1354.