Scandinavian Working Papers in Economics

Working Paper Series, Center for Labor Studies,
Uppsala University, Department of Economics

No 2014:9: Learning-by-Doing in a Highly Skilled Profession when Stakes are High: Evidence from Advanced Cancer Surgery

Daniel Avdic (), Petter Lundborg () and Johan Vikström ()
Additional contact information
Daniel Avdic: Uppsala Center for Labor Studies, Postal: Department of Economics, Uppsala University, P.O. Box 513, SE-751 20 Uppsala, Sweden
Petter Lundborg: Lund University and IZA, Postal: Department of Economics, Lund University,, P.O. Box 705, SE-220 07 Lund, Sweden
Johan Vikström: Uppsala Center for Labor Studies, Postal: Department of Economics, Uppsala University, P.O. Box 513, SE-751 20 Uppsala, Sweden

Abstract: Although learning-by-doing is believed to be an important source of productivity growth, there is limited evidence that production volume affects productivity in a causal sense. We document evidence of learning-by-doing in a highly skilled profession where stakes are high; advanced cancer surgery. For this purpose, we introduce a novel instru- ment that exploits the closure and opening of entire cancer clinics which have given rise to sharp and exogenous changes in the cancer surgical volumes at Swedish public sec- tor hospitals. Using detailed register data on more than 100,000 episodes of advanced cancer surgery, our results suggest positive eects of surgery volumes on survival. In addition, we provide evidence on the mechanisms through which these improvements occur. We also show that the results are not driven by changes in patient composition or by other changes at the hospital level.

Keywords: hospital volume; learning-by-doing; cancer surgery; survival; causal effect

JEL-codes: I11; I12; I18; L11

47 pages, July 4, 2014

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