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 ChanThe Determinants of Productivity in Medical 
    
    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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