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.

医患关系对患者的健康结果起着重要作用，但人们对这种关系知之甚少，这也是医疗保健服务中的一个主要问题。积极的关系可以提高医疗效果，但消极的关系可能会导致医疗效果下降。不信任、护理质量低下以及健康结果较差是患者可能不完全信任医生的建议，因此可能不会遵守治疗建议。没有动力去努力进行仔细的诊断因此，关系双方的信任失败可能会导致更糟糕的健康结果，该赠款资助了一个项目，该项目使用经济理论和决策实验来更好地理解这种关系，并开发和测试干预措施。该项目在三个领域做出了贡献：1）该模型改编自“信任良好”文献和喜剧演员，认为患者无法观察医生的诊断精度是主要原因。他们的不信任背后进一步预示着。患者的不信任会阻止医生承担更好的诊断和治疗的费用，因此该模型扩大了可信度良好的市场中消费者和专家卖家之间的标准互动，包括消费者对产品/服务选择的积极参与——即患者可以参与。即使他们不是诊断专家，也可以选择自己的医疗方法。 2) 该项目设计了一个医患“实验模型”，能够描述和隔离医患关系中的关键要素，然后进行实验室和在线实验。这些实验首次积极纳入患者的决策，强调了诊断不确定性在塑造患者依从性并从而改变市场均衡方面的重要性。 3) 这项研究测试了一项普遍提出的干预措施：“a”。 “公共评级系统”供患者对医生进行评分，这可以提高声誉并对医生的护理质量产生积极影响。该部分通过提供声誉如何加强医患关系和改善健康结果的因果证据来补充之前的卫生经济学实证研究。该奖项反映了 NSF法定使命，并通过使用基金会的智力优点和更广泛的影响审查标准进行评估，被认为值得支持。