Background. Little is known about the drivers of migration of GPs. Risk attitude may play an important role as migration is fundamentally a risky decision that balances the risks of staying with the risks associated with leaving. This paper examines the association between risk attitudes and the migration of UK GPs to Australia. Methods. GPs who qualified in the UK but work in Australia and who responded to the Medicine in Australia: Balancing Employment and Life (MABEL) national longitudinal survey of doctors, were compared with GPs based in Scotland who responded to a survey. Risk attitudes were elicited for financial risks, career and professional risks and clinical risks on a scale from 1 to 5. Results. GPs in Scotland and UK trained GPs in Australia have similar risk attitudes for financial risk. However, UK trained GPs in Australia are less willing to take clinical and career risks. Conclusion. GPs who migrated to Australia after qualifying in the UK were more risk averse about their career and clinical risks. This may suggest that more risk averse GPs migrate to Australia due to pull factors such as less uncertainty around career and clinical outcomes in Australia. The uncertain NHS climate may push more risk averse doctors away from the UK.
In a perfect agency relationship, doctors consider all information and select the patient's 'utility maximising' option given the patient's preferences. The patient's time preferences are important as treatments vary in the timing and length of their benefits. However, doctors often do not have full information on patients' preferences and may apply their own preferences. This has generated empirical interest in estimating doctors' time preferences. However, these studies generally elicit doctors' private preferences (preferences for their own health) rather than professional preferences (preferences for the patient). We hypothesise that private and professional preferences may differ. Professional time preferences may be 'taught' in medical school or learned through repeated interactions with patients. If preferences differ then estimates of doctors' private preferences are less informative for medical decision-making. This study compares private and professional time preferences for health in a national sample of General Practitioners, using a between sample design. Time discounting is explored using exponential and quasi-hyperbolic models. We elicit time preferences using multiple price lists. We find no significant difference between the time preference for the self or the patient. This result holds for axiomatic discounting classification and maximum likelihood estimates. We do not find evidence of present-bias. There are a high proportion of increasingly impatient GPs, potentially implying a maximum 'willingness to wait' for treatment benefits. GPs value the health state differently between themselves or for a patient. These results suggest that we can use estimates of private preferences from doctors to inform medical decision-making.
The interest in eliciting time preferences for health has increased rapidly since the early 1990s. It has two main sources: a concern over the appropriate methods for taking timing into account in economics evaluations, and a desire to obtain a better understanding of individual health and healthcare behaviors. The literature on empirical time preferences for health has developed innovative elicitation methods in response to specific challenges that are due to the special nature of health. The health domain has also shown a willingness to explore a wider range of underlying models compared to the monetary domain. Consideration of time preferences for health raises a number of questions. Are time preferences for health similar to those for money? What are the additional challenges when measuring time preferences for health? How do individuals in time preference for health experiments make decisions? Is it possible or necessary to incentivize time preference for health experiments?
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