Discretion in Clinical Decision Making: Evidence from Bunching
利用智利619,907名患者的微观数据，研究发现约10%的诊所存在血压读数聚集在高血压诊断阈值以下的现象，表明医生利用自由裁量权将部分假阳性结果重新分类，从而改善了患者风险分层。
Abstract Should healthcare providers strictly adhere to clinical guidelines, or is some discretion beneficial? Using bunching estimation and microdata from 619,907 patients in Chile, I examine discretion in the diagnosis of hypertension (blood pressure ≥ 140/90mmHg). I find bunching in blood pressure at 10% of clinics, where 6 to 62% of patients' test results expected just above the hypertension diagnostic threshold are instead recorded just below it, suggesting providers use their discretion to consider some tests false positives. Leveraging variation in bunching across clinics, I show that affected patients have lower cardiovascular risk, suggesting discretion improves patient classification, partially driven by heuristic thinking.