Essays in the microeconomics of medical specialization.

摘要

This dissertation consists of two essays. In the first essay, I examine the interaction between medical specialization and patient referrals. I develop a model that demonstrates which doctors are likely to specialize, which doctors are likely to refer, and which doctors are likely to treat patients without a referral. I show that the introduction of more specialists -- and the corresponding need for more referring doctors -- can reduce the overall number of health care providers actually treating patients. Finally, I compare the socially optimal and joint profit maximizing (1) quantity of specialists, (2) price of specialist services, and (3) price of generalist services. I find that, when doctors collectively set prices for both specialist and generalist treatment. Depending on the parameters, the joint maximization problem can result in (a) too many specialists and two few generalists; (b) too many generalists and too few specialists; or (c) the optimal number of specialists and generalists. This ambiguous result shares similarities with the textbook model of the quantity decisions of a multimarket monopolist.;The second essay considers the role played by fellowship programs in the training of medical researchers. Many hospitals hire senior researchers straight out of their own or another hospital's fellowship program. As a result, medical programs both "train" fellows and provide a supply of medical talent for that hospital in the next period. Using an overlapping generation model, I derive three results linking the underlying features of the medical marketplace, the size of fellowship programs, and the quality of medical research. First, when the hospital's time horizon or discount rate increases, the hospital tends to employ more fellows each period. Second, when the fellow's outside option depends on their skill level, the hospital employs fewer fellows each period. Finally, when the fellow's outside option depends on their skill level and the number of other fellows in the private-sector market, the hospital employs more fellows than in the case where the outside option depends on the fellow's skill level only.