The Value of (Sub) Specialization: Evidence from Oncology
（子）专业化的价值：来自肿瘤学的证据
Abstract
We estimate the returns to specialization in medical oncology, in which subspecialists focus on specific cancer types. Using 2.2 million Medicare chemotherapy episodes from 2008–2020, we instrument for subspecialist access with differential distance to cancer-type-specific subspecialists versus general oncologists. Access to a relevant subspecialist reduces three-year mortality by 4.5 percentage points (10 percent), without increasing Medicare spending or measured provider fragmentation. Subspecialists also increase the use of newer therapies and diagnosis-specific clinical trials. These findings show that specialization raises productivity when expertise is closely matched to the task.
中文摘要
我们估计医学肿瘤学中专业化的回报，其中亚专科医生专注于特定癌症类型。使用 2008–2020 年间 220 万例 Medicare 化疗病例，我们以到癌症类型特定亚专科医生与到普通肿瘤医生的距离差异作为亚专科医生可及性的工具变量。能够获得相关亚专科医生使三年死亡率降低 4.5 个百分点（10%），且不增加 Medicare 支出或测得的提供者碎片化。亚专科医生还增加了对较新疗法和诊断特异性临床试验的使用。这些发现表明，当专业知识与任务紧密匹配时，专业化会提高生产率。