Doctoral Dissertation Research in Economics: The Doctor/Patient Relationship: Theory and Experiments

经济学博士论文研究：医患关系：理论与实验

• 批准号: 2215032
• 负责人: Catherine Eckel
• 金额: $ 2.5万
• 依托单位: Texas A&M University
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=2215032&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Economics; Doctor

The patient-physician relationship plays an important role in the health outcomes of patients. However, this relationship is poorly understood and constitutes a major concern in healthcare services. While a positive relationship can enhance the effectiveness of medical treatment, a negative one can lead to mistrust, lower quality care, and worse health outcomes. One common problem is that patients may not fully trust their doctors’ advice, and so may fail to comply with treatment recommendations. If a doctor anticipates that a patient will be noncompliant, then the doctor has little incentive to work hard to develop a careful diagnosis and effective treatment regime. Thus a failure of trust on both sides of the relationship can lead to worse health outcomes. This grant funds a project that uses economic theory and decision-making experiments to better understand this relationship, and to develop and test interventions with the potential to improve trust in patient/physician relationships. The project makes contributions in three areas. 1) The model is adapted from the “credence good” literature and hypothesizes that the inability of patients to observe the doctor’s diagnostic precision is the main reason behind their distrust. It further predicts that patients’ distrust will discourage doctors from incurring the cost of better diagnosis and treatment. Thus the model expands the standard interaction between consumers and expert sellers in a credence good market to include the consumer’s active participation in product/service choices – i.e. patients can participate in choosing their own medical treatments even if they are not experts in diagnosis. 2) This project designs a patient-doctor ‘experimental model’ that enables the characterization and isolation of key elements in the doctor/patient relationship, and then conducts lab and online experiments to verify the model predictions. These experiments are the first to incorporate active decision making by patients, highlighting the importance of diagnostic uncertainty in shaping the patient’s compliance and thus changing the market equilibrium. 3) This study tests a commonly-proposed intervention: ‘a public rating system’ for patients to rate doctors, which can enhance reputation and positively impact physician’s quality of care. This component complements prior empirical study in health economics by providing causal evidence on how reputation can strengthen the patient-physician relationship and improve health outcomes.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

患者 - 物理学的关系在患者的健康结果中起着重要作用。但是，这种关系知之甚少，并且构成了医疗服务的主要关注点。虽然积极的关系可以提高医疗治疗的有效性，但负面关系可以导致不信任，质量较低的护理和较差的健康结果。一个常见的问题是，患者可能无法完全信任医生的建议，因此可能无法遵守治疗建议。如果医生预计患者将不合规，那么医生几乎没有动力努力开发仔细的诊断和有效治疗方案。关系双方的信任失败会导致健康状况较差。该赠款资助了一个使用经济理论和决策实验来更好地理解这种关系的项目，并开发和测试干预措施，并有可能提高对患者/医师关系的信任。该项目在三个领域做出了贡献。 1）该模型改编自“信任良好”文献，并假设患者无法观察医生的诊断精度是他们不信任的主要原因。它进一步预测，患者的不信任会阻止医生产生更好的诊断和治疗费用。该模型扩大了债权人良好市场中消费者和专家卖家之间的标准互动，包括消费者积极参与产品/服务选择 - 即，即使他们不是诊断专家，患者也可以参与选择自己的医疗治疗。 2）该项目设计了一个患者doctor的“实验模型”，该模型可以在医生/患者关系中的关键要素进行表征和隔离，然后进行实验室和在线实验以验证模型预测。这些实验是第一个结合患者积极决策的实验，强调了诊断不确定性在塑造患者合规性并改变市场均衡的重要性。 3）这项研究测试了一种普遍提出的干预措施：患者对医生进行评分的“公共评级系统”，可以增强声誉并积极影响身体的护理质量。该组成部分通过提供有关声誉如何加强患者 - 物理学关系并改善健康结果的催化证据来弥补健康经济学的先前实证研究。该奖项反映了NSF的法定任务，并被认为是通过基金会的知识分子和更广泛影响的评估标准来评估通过评估而被认为是珍贵的。