Are patient-regarding preferences stable? Evidence from a laboratory experiment with physicians and medical students from different countries

Wang, Jian; Iversen, Tor; Hennig‐Schmidt, Heike; Godager, Geir

doi:10.1016/j.euroecorev.2020.103411

Cited by 38 publications

(57 citation statements)

References 95 publications

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“…In keeping with HSW (2011), Hennig-Schmidt & Wiesen [20], Brosig-Koch et al [18,21] and Wang et al [22], as well as the theoretical predictions of Ellis & McGuire [3], we expect experimental physicians to overserve FFS patients and under-serve CAP patients, thus providing more services to FFS patients than similar CAP patients in our experiment.…”

Section: Hypothesessupporting

confidence: 77%

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Custom-made health-care: an experimental investigation

et al. 2020

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Background Physicians’ financial interests might conflict with the best service to patients. It is essential to gain a thorough understanding of the effect of remuneration systems on physician behaviour. Methods We conducted a controlled laboratory experiment using a within-subject design to investigate physician behaviour underpayment heterogeneity. Each physician provided medical care to patients whose treatments were paid for under fee-for-service (FFS) or capitation (CAP). Results We observed that physicians customized their care in response to the payment system. FFS patients received considerably more medical care than did CAP patients with the same illness and treatment preference. Physicians over-served FFS patients and under-served CAP patients. After a CAP payment reduction, we observed neither a quantity reduction under CAP nor a spillover in FFS patients’ treatment. Conclusions The results suggest that, in our experimental model, fee regulation can be used to some extent to control physician spending since we did not identify a behavioural response to the CAP payment cut. Physicians did not recoup lost income by altering treatment behaviour toward CAP and/or FFS patients. Experimental economics is an excellent tool for ensuring the welfare of all those involved in the health system. Further research should investigate payment incentives as a means of developing health care teams that are more efficient.

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Section: Hypothesessupporting

confidence: 77%

“…Analysis of the mean deviation for CAP patients shows that CAP patients received significantly fewer services than optimal in each sequence. The mean deviation is negative for 21 (22) physicians in S1 (S2), implying that under CAP, physicians tended to significantly under-provide (S1, S2: p < 0.01; WTs).…”

Section: Over-or Under-provision Of Medical Servicesmentioning

confidence: 98%

Custom-made health-care: an experimental investigation

et al. 2020

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“…With this variation we can test whether the norms induced by the medical framing lead to behavioral differences between students without medical background and trained medical doctors. Brosig-Koch et al [ 35 ] show that medical doctors behave in a similar way as students but are on average more concerned with Patient payoff, while Wang et al [ 43 ] show that medical doctors are slightly less Patient -oriented. As the differences in these two studies were small we expect no difference between subject pools.…”

Section: Experimental Designmentioning

confidence: 99%

“…The results from Brosig-Koch et al [ 35 ] show that in the experimental analysis of physician behavior the decisions of business and economics students are similar to those of medical doctors. In contrast, Wang et al [ 43 ] find that medical doctor subjects provide less patient benefit. In general, Engel [ 33 ] shows that non-student subjects give more in dictator games.…”

Section: Introductionmentioning

confidence: 99%

Physician Behavior under Prospective Payment Schemes—Evidence from Artefactual Field and Lab Experiments

Reif

Hafner

Seebauer

2020

IJERPH

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Recent experimental studies analyze the behavior of physicians towards patients and find that physicians care for their own profit as well as patient benefit. In this paper, we extend the experimental analysis of the physician decision problem by adding a third party which represents the health insurance that finances medical service provision under a prospective payment scheme. Our results show that physicians take into account the payoffs of the third party, which can lead to underprovision of medical care. We conduct a laboratory experiment in neutral as well as in medical framing using students and medical doctors as subjects. Subjects in the medically framed experiments behave weakly and are more patient orientated in contrast to neutral framing. A sample of medical doctors exhibits comparable behavior to students with medical framing.

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“…The decision to prescribe a drug to a patient is a standard discrete economic choice [39], and the choice modelling literature comprises a rich toolbox for analyzing how individuals' choice combinations are affected by the characteristics of the available alternatives, as well as differences in context [40]. Choice models are now commonly used in studies applying experimental data (see for example [11,[55][56][57][58]). We examine and quantify the intervention effect on prescribing choices of the individual physicians.…”

Section: Empirical Strategymentioning

confidence: 99%

The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment

Cheo

Godager

et al. 2020

Health Econ Rev

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Background Health care systems in many countries are characterized by limited availability of provider performance data that can be used to design and implement welfare improving reforms in the health sector. We question whether a simple mystery shopper scheme can be an effective measure to improve primary care quality in such settings. Methods Using a randomized treatment-control design, we conducted a field experiment in primary care clinics in a Chinese city. We investigate whether informing physicians of a forthcoming mystery shopper audit influences their prescribing behavior. The intervention effects are estimated using conditional fixed-effects logistic regression. The estimated coefficients are interpreted as marginal utilities in a choice model. Results Our findings suggest that the mystery shopper intervention reduced the probability of prescribing overall. Moreover, the intervention had heterogeneous effects on different types of drugs. Conclusions This study provides new evidence suggesting that announced performance auditing of primary care providers could directly affect physician behavior even when it is not combined with pay-for-performance, or measures such as reminders, feedback or educational interventions.

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Are patient-regarding preferences stable? Evidence from a laboratory experiment with physicians and medical students from different countries

Cited by 38 publications

References 95 publications

Custom-made health-care: an experimental investigation

Custom-made health-care: an experimental investigation

Physician Behavior under Prospective Payment Schemes—Evidence from Artefactual Field and Lab Experiments

The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment

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