To identify the important tradeoffs in consulting a single expert for both diagnosis and treatment, the researchers—Christopher C. Afendulis, a lecturer in health care policy at HCP, and a colleague from Stanford—examined the costs and health outcomes of elderly Medicare beneficiaries with coronary artery disease. They compared the empirical consequences of diagnosis by cardiologists who can provide surgical treatment—“integrated” cardiologists—with the consequences of diagnosis by nonintegrated cardiologists. The research showed that diagnosis by an integrated cardiologist leads, on net, to higher health spending but similar health outcomes. The net effect contains three components: reduced spending and improved outcomes from better allocation of patients to surgical treatment options; increased spending conditional on treatment option; and worse outcomes from poorer provision of nonsurgical care.

View the abstract and other viewing options at the American Economic Review website.