Paper Doctor’s Orders: A Field Experiment on Fiscal Responsibility in Health Care

To help address the rising costs of health care, we conduct a field experiment that aims to reduce the cost of supplies used in surgical procedures. Specifically, we develop an algorithm to identify plausible “swaps” in common supplies used in operating rooms, which would generate considerable savings but would not have any adverse impacts on patient outcomes (e.g., gauze). We partner with the University of Utah Health Care and Duke Health to roll out our experiment, which seeks to identify the best way to mo- tivate doctors to agree to implement our suggested supply swaps. Our treatments are motivated by the significant attention constraints faced by O.R. doctors. Specifically, we explore whether providing salient information on cost savings options is enough to motivate doctors (i.e., information alone) or whether additional incentives are neces- sary to motivate cost savings behavior – our incentive treatments appeal to altruism, peer comparison, and financial incentives. We evaluate the relative effectiveness of each approach by measuring the one-click responses of doctors to accept or decline the supply swap. Should the doctors accept our proposed swaps, savings in the first year alone would be roughly $5M across the University of Utah Surgery Department and roughly $2M for the Duke Health Ambulatory Surgery Center. Overall, our paper provides causal evidence on effective strategies to align incentives in a decentralized or- ganizational model, where agents face significant constraints in their ability to process information.

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