Physician Ownership of Non-Physician Medical Services
Dr. Brian Chen's research has examined the tradeoffs between moral hazard and efficiencies in the integration of physician and non-physician medical services in the presence of asymmetric information. He has looked at a policy intervention in Taiwan that prohibited self-referrals of patients to physician-owned pharmacies unless the physician group integrated pharmacy services into the clinic by hiring an onsite pharmacist. He found that the policy reduced drug expenditures by close to thirty percent among physicians that did not have an onsite pharmacist. However, these physicians responded by increasing the overprovision of diagnostic services not covered by the policy, thereby reducing the effectiveness of the policy. Forty-five percent of the clinics that did not have an onsite pharmacist prior to the policy hired one subsequent to the implementation of the policy. Overall, after integration, the policy applied to only seventeen percent of clinics, and only reduced average discretionary expenditures by about two-point-five percent. Chen's research also shows that despite the reduction in drug utilization, patients treated at clinics without an onsite pharmacist did not have greater observable adverse health events than patients treated at integrated clinics. His results show that moral hazard costs of self-referral incentives are large, that the “safe harbor” exemption severely reduces the effectiveness of the policy, and that the exemption explains much of the recent integration of ancillary services into physician offices.
Dr. Brian Chen recently completed his Ph.D. in business administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.
Daniel and Nancy Okimoto Conference Room
Brian Chen
Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055
Dr. Brian Chen is currently a visiting scholar with the Asia Health Policy Program and Center for East Asian Studies at Stanford University. He was recently Shorenstein Asia-Pacific Research Center's 2009-2010 postdoctoral fellow in Comparative Health Policy. As a visiting scholar, Dr. Chen will conduct collaborative research about health of the elderly and chronic disease in China.
As an applied economist, Chen’s research focuses on the impact of incentives in health care organizations on provider and patient behavior. For his dissertation, Chen empirically examined how vertical integration and prohibition against self-referrals affected physician prescribing behavior. His job market paper was selected for presentation at the American Law and Economics Association’s Annual Meeting, the Academy of Management, the Canadian Law and Economics Association, the Conference on Empirical Legal Studies, and the First Annual Conference on Empirical Health Law and Policy at Georgetown Law Center in 2009. The paper was also nominated for best paper based on a dissertation at the Academy of Management.
Chen comes to the Shorenstein Asia-Pacific Research Center not only with a multidisciplinary law and economics background, but also with an international perspective from having lived and worked in Taiwan, Japan, and France. He has a particularly intimate knowledge of the Taiwanese health care system from his experience as an assistant to the hospital administrator at a medical college in Taiwan.
During his past residence as a postdoctoral fellow with the Asia Health Policy Program, Chen conducted empirical research on cost containment policies in Taiwan and Japan and how those policies impacted provider behavior. His work also contributed to the program’s research activities on comparative health systems and health service delivery in the Asia-Pacific, a theme that encompasses the historical evolution of health policies; the role of the private sector and public-private partnerships; payment incentives and their impact on patients and providers; organizational innovation, contracting, and soft budget constraints; and chronic disease management and service coordination for aging populations.
Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.