The focus of my PhD training in economics was empirical industrial organization, a field that studies strategic interactions between firms, consumers and other agents in the economy. Since obtaining my PhD, I have started exploring a new field, health economics, first through my employment at RAND, then in my position as an assistant professor at the University of Minnesota. I have explored various topics in health economics to build from scratch a spectrum of expertise and hands-on knowledge in a field brand new for me. A natural next step for my career development is to focus on a research agenda around several important themes that interest me most, and to expand my research knowledge beyond what I have studied thus far. The key themes I would like to focus on are medical innovation and diffusion, the role of incentives at the patient and provider level, and the role of insurance. The proposed study will allow me to:(1) develop expertise in the analysis of Medicare database;(2) build capability in working with large databases;(3) enhance my statistical training;(4) understand diseases and gain clinical insights;(5) improve my ability to develop research projects, and to write grants competitive for funding at the R01 level;(6) expand my exposure to health services research and health economics community; Through the proposed project, I will start building a long-term research agenda focused on understanding the mechanisms underlying the adoption and diffusion of new medical technologies. In most circumstances, physicians are the key agent in determining whether a patient receives a given medical technology, suggesting that understanding the forces that affect physician technology adoption and use is critical to addressing utilization of medical technology. However, physician adoption of medical technology is not well studied or understood. My goal is to investigate how competition, social networks and learning from other physicians affect patterns of physician medical technology adoption in addition to the more traditional explanations such as physician, hospital and patient characteristics. I propose to study the diffusion of medical technology using coronary artery stents in the Medicare population as the exemplar. Linking Medicare claims to physician demographic data from the American Medical Association and to hospital characteristics from the American Hospital Survey: (1) I will document the variation across time, regions, and hospitals in physicians'use of bare-metal, coated and drug eluting stents. (2) I will estimate the role of physician characteristics, competition among physicians, social interactions (including learning from other physicians), and expected patient demographics on the physician's decision to adopt and use new stents. (3) I will estimate the consequences of physicians'use of new stents on patients' outcomes following stent insertion, such as rates of re-admissions, repeat percutaneous coronary interventions (PCI), and mortality.
Over the last 50 years, innovation in medical technology has been a key driver in both the improvement in life expectancy and the increase in health care costs. However, a large body of research suggests that medical technology innovations have not been evenly distributed throughout the population documenting significant variation in the timing, intensity and appropriateness of the use of medical care across regions, hospitals, physicians and patients. This variation suggests that new medical technologies are potentially under and over-utilized, and that medical care technology may not be optimally diffusing. The proposed career grant will build a long-term research agenda focused on understanding the mechanisms underlying the adoption and diffusion of new medical technologies by investigating the roles of competition, social networks and other more traditional explanations such as physician, hospital and patient characteristics on physician technology adoption.
|Karaca-Mandic, Pinar; Town, Robert J; Wilcock, Andrew (2017) The Effect of Physician and Hospital Market Structure on Medical Technology Diffusion. Health Serv Res 52:579-598|
|Bayindir, Esra Eren; Mandic, Pinar Karaca (2016) Medicare and Private Insurance Variations in New Medical Technology: The Case of Drug Eluting Stents. Health Econ Outcome Res 2:|
|Jena, Anupam B; Goldman, Dana; Karaca-Mandic, Pinar (2016) Hospital Prescribing of Opioids to Medicare Beneficiaries. JAMA Intern Med 176:990-7|
|Ma, Paul; Marinovic, Iván; Karaca-Mandic, Pinar (2015) Drug Manufacturers' Delayed Disclosure of Serious and Unexpected Adverse Events to the US Food and Drug Administration. JAMA Intern Med 175:1565-6|
|Fulton, Brent D; Hollingshead, Ann; Karaca-Mandic, Pinar et al. (2015) Republican States Bolstered Their Health Insurance Rate Review Programs Using Incentives From the Affordable Care Act. Inquiry 52:|
|Jena, Anupam B; Ho, Oliver; Goldman, Dana P et al. (2015) The Impact of the US Food and Drug Administration Chlorofluorocarbon Ban on Out-of-pocket Costs and Use of Albuterol Inhalers Among Individuals With Asthma. JAMA Intern Med 175:1171-9|
|Karaca-Mandic, Pinar; Fulton, Brent D; Hollingshead, Ann et al. (2015) States with stronger health insurance rate review authority experienced lower premiums in the individual market in 2010-13. Health Aff (Millwood) 34:1358-67|
|Krinn, Kelly; Karaca-Mandic, Pinar; Blewett, Lynn A (2015) State-based Marketplaces using 'clearinghouse' plan management models are associated with lower premiums. Health Aff (Millwood) 34:161-9|
|Lin, Chia-Wei; Karaca-Mandic, Pinar; McCullough, Jeffrey S et al. (2014) Access to oral osteoporosis drugs among female Medicare Part D beneficiaries. Womens Health Issues 24:e435-45|
|Jena, Anupam B; Goldman, Dana; Weaver, Lesley et al. (2014) Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims. BMJ 348:g1393|