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Finocchiaro Castro M, Guccio C, Romeo D. Looking inside the lab: a systematic literature review of economic experiments in health service provision. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01662-y. [PMID: 38212554 DOI: 10.1007/s10198-023-01662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
Experimental economics is, nowadays, a well-established approach to investigate agents' behavior under economic incentives. In the last decade, a fast-growing number of studies have focused on the application of experimental methodology to health policy issues. The results of that stream of literature have been intriguing and strongly policy oriented. However, those findings are scattered between different health-related topics, making it difficult to grasp the overall state-of-the-art. Hence, to make the main contributions understandable at a glance, we conduct a systematic literature review of laboratory experiments on the supply of health services. Of the 1248 articles retrieved from 2011, 56 articles published in peer-review journals have met our inclusion criteria. Thus, we have described the experimental designs of each of the selected papers and we have classified them according to their main area of interest.
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Affiliation(s)
- Massimo Finocchiaro Castro
- Department of Law, Economics and Humanities, Mediterranean University of Reggio Calabria, Reggio Calabria, Italy
- Health Econometrics and Data Group, University of York, York, UK
- Institute for Corruption Studies, Illinois State University, Normal, USA
| | - Calogero Guccio
- Department of Economics and Business, University of Catania, Corso Italia 55, 95123, Catania, Italy.
- Health Econometrics and Data Group, University of York, York, UK.
- Institute for Corruption Studies, Illinois State University, Normal, USA.
| | - Domenica Romeo
- Department of Economics and Business, University of Catania, Corso Italia 55, 95123, Catania, Italy
- Health Econometrics and Data Group, University of York, York, UK
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Chen Y, Liu TX, Shan Y, Zhong S. The emergence of economic rationality of GPT. Proc Natl Acad Sci U S A 2023; 120:e2316205120. [PMID: 38085780 PMCID: PMC10740389 DOI: 10.1073/pnas.2316205120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
As large language models (LLMs) like GPT become increasingly prevalent, it is essential that we assess their capabilities beyond language processing. This paper examines the economic rationality of GPT by instructing it to make budgetary decisions in four domains: risk, time, social, and food preferences. We measure economic rationality by assessing the consistency of GPT's decisions with utility maximization in classic revealed preference theory. We find that GPT's decisions are largely rational in each domain and demonstrate higher rationality score than those of human subjects in a parallel experiment and in the literature. Moreover, the estimated preference parameters of GPT are slightly different from human subjects and exhibit a lower degree of heterogeneity. We also find that the rationality scores are robust to the degree of randomness and demographic settings such as age and gender but are sensitive to contexts based on the language frames of the choice situations. These results suggest the potential of LLMs to make good decisions and the need to further understand their capabilities, limitations, and underlying mechanisms.
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Affiliation(s)
- Yiting Chen
- Department of Economics, Lingnan University, Hong Kong, China HKG
| | - Tracy Xiao Liu
- Department of Economics, School of Economics and Management, National Center for Economic Research at Tsinghua University, Tsinghua University, Beijing100084, China
| | - You Shan
- Department of Economics, School of Economics and Management, Tsinghua University, Beijing100084, China
| | - Songfa Zhong
- Department of Economics, Hong Kong University of Science and Technology, Hong Kong, China HKG
- Department of Economics, National University of Singapore, Singapore117570, Singapore
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Byambadalai U, Ma CTA, Wiesen D. Changing preferences: An experiment and estimation of market-incentive effects on altruism. JOURNAL OF HEALTH ECONOMICS 2023; 92:102808. [PMID: 37738704 DOI: 10.1016/j.jhealeco.2023.102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023]
Abstract
This paper studies how altruistic preferences are changed by markets and incentives. We conduct a laboratory experiment with a within-subject design. Subjects are asked to choose health care qualities for hypothetical patients in monopoly, duopoly, and quadropoly. Prices, costs, and patient benefits are experimental incentive parameters. In monopoly, subjects choose quality by trading off between profits and altruistic patient benefits. In duopoly and quadropoly, subjects play a simultaneous-move game. Uncertain about an opponent's altruism, each subject competes for patients by choosing qualities. Bayes-Nash equilibria describe subjects' quality decisions as functions of altruism. Using a nonparametric method, we estimate the population altruism distributions from Bayes-Nash equilibrium qualities in different markets and incentive configurations. Competition tends to reduce altruism, but duopoly and quadropoly equilibrium qualities are much higher than monopoly. Although markets crowd out altruism, the disciplinary powers of market competition are stronger. Counterfactuals confirm markets change preferences.
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Affiliation(s)
- Undral Byambadalai
- Department of Economics, Boston University, United States; AI Lab, CyberAgent, Inc., Japan.
| | | | - Daniel Wiesen
- Department of Business Administration and Health Care Management, University of Cologne, Germany.
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Cartwright E, Guo Y, Wei L, Xue L. Medical occupation preference under the influence of the COVID-19 pandemic: The role of risk and altruistic preferences. HEALTH ECONOMICS 2023; 32:2390-2407. [PMID: 37421642 DOI: 10.1002/hec.4733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/10/2023] [Accepted: 06/24/2023] [Indexed: 07/10/2023]
Abstract
We examine the influence of the COVID-19 pandemic on medical occupation preference, focusing on Wuhan, China. We conducted a survey of 5686 respondents in China regarding the influence of the COVID-19 pandemic on medical occupation preference. We also conducted a complimentary survey in the UK with 1198 respondents, as well as a field experiment in Wuhan with 428 first and second-year medical students. We find a significant negative impact of the pandemic on the willingness to let a loved one choose a medical occupation. Individuals who were heavily influenced by the pandemic, that is, Wuhan residents, especially medical workers, express significantly lower medical occupation preference. Further analysis from Sobel-Goodman mediation tests reveals that around half of the total negative effect can be mediated by enhanced risk aversion and reduced altruism. The UK survey and the field experiment with medical students in Wuhan reinforce these findings. Our results suggest a shift in medical workers' risk- and altruistic-preferences has led to a reduced medical occupation preference. Non-medical workers and students who are more altruistic and risk-seeking are more likely to choose a medical occupation.
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Affiliation(s)
- Edward Cartwright
- Department of Economics and Marketing, De Montfort University, Leicester, UK
| | - Yiting Guo
- Economics and Management School, Wuhan University, Wuhan, China
| | - Lijia Wei
- Economics and Management School, Wuhan University, Wuhan, China
| | - Lian Xue
- Economics and Management School, Wuhan University, Wuhan, China
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Zhang Y, Lin X, Li X, Han Y. The impacts of altruism levels on the job preferences of medical students: a cross-sectional study in China. BMC MEDICAL EDUCATION 2023; 23:538. [PMID: 37501080 PMCID: PMC10375683 DOI: 10.1186/s12909-023-04490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/30/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Rational allocation of human resources for health is crucial for ensuring public welfare and equitable access to health services. Understanding medical students' job preferences could help develop effective strategies for the recruitment and retention of the health workforce. Most studies explore the relationship between extrinsic incentives and job choices through discrete choice experiments (DCEs). Little attention has been paid to the influence of intrinsic altruism on job choice. This study aimed to explore the heterogeneous preferences of medical students with different levels of altruism regarding extrinsic job attributes. METHODS We conducted an online survey with 925 medical students from six hospitals in Beijing from July to September 2021. The survey combined job-choice scenarios through DCEs and a simulation of a laboratory experiment on medical decision-making behavior. Behavioral data were used to quantify altruism levels by estimating altruistic parameters based on a utility function. We fit mixed logit models to estimate the effects of altruism on job preference. RESULTS All attribute levels had the expected effect on job preferences, among which monthly income (importance weight was 30.46%, 95% CI 29.25%-31.67%) and work location (importance weight was 22.39%, 95% CI 21.14%-23.64%) were the most salient factors. The mean altruistic parameter was 0.84 (s.d. 0.19), indicating that medical students' altruism was generally high. The subgroup analysis showed that individuals with higher altruism levels had a greater preference for non-financial incentives such as an excellent work environment, sufficient training and career development opportunities, and a light workload. The change in the rate of the uptake of a rural position by individuals with lower levels of altruism is sensitive to changes in financial incentives. CONCLUSIONS Medical students' altruism was generally high, and those with higher altruism paid more attention to non-financial incentives. This suggests that policymakers and hospital managers should further focus on nonfinancial incentives to better motivate altruistic physicians, in addition to appropriate economic incentive when designing recruitment and retention interventions. Medical school administrations could attach importance to the promotion of altruistic values in medical education.
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Affiliation(s)
- Yue Zhang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Xing Lin
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Xing Li
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Youli Han
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
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Brosig-Koch J, Hehenkamp B, Kokot J. Who benefits from quality competition in health care? A theory and a laboratory experiment on the relevance of patient characteristics. HEALTH ECONOMICS 2023. [PMID: 37147773 DOI: 10.1002/hec.4689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Abstract
We study how competition between physicians affects the provision of medical care. In our theoretical model, physicians are faced with a heterogeneous patient population, in which patients systematically vary with regard to both their responsiveness to the provided quality of care and their state of health. We test the behavioral predictions derived from this model in a controlled laboratory experiment. In line with the model, we observe that competition significantly improves patient benefits as long as patients are able to respond to the quality provided. For those patients, who are not able to choose a physician, competition even decreases the patient benefit compared to a situation without competition. This decrease is in contrast to our theoretical prediction implying no change in benefits for passive patients. Deviations from patient-optimal treatment are highest for passive patients in need of a low quantity of medical services. With repetition, both, the positive effects of competition for active patients as well as the negative effects of competition for passive patients become more pronounced. Our results imply that competition can not only improve but also worsen patient outcome and that patients' responsiveness to quality is decisive.
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Affiliation(s)
- Jeannette Brosig-Koch
- Otto von Guericke University Magdeburg and Health Economics Research Center (CINCH) Essen, Magdeburg, Germany
| | | | - Johanna Kokot
- University of Hamburg, Hamburg Center for Health Economics (HCHE), Hamburg, Germany
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Griebenow M. Should physicians team up to treat chronic diseases? JOURNAL OF HEALTH ECONOMICS 2023; 89:102740. [PMID: 36930998 DOI: 10.1016/j.jhealeco.2023.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
This paper studies referral strategy and effort provision of a primary care physician and a specialist who are responsible for the treatment of chronically ill patients who can be in a mild or severe condition. Two organizational settings are compared, a team in which physicians cooperate and solo practices in which they do not. Team care is strictly superior to solo practice care if the difference in expected treatment costs between disease severities is relatively larger for the primary care physician. Otherwise, solo practice care is weakly superior to team care under reasonable assumptions.
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Affiliation(s)
- Malte Griebenow
- Universität Hamburg, Department of Socioeconomics and Hamburg Center for Health Economics, Esplanade 36, 20354 Hamburg, Germany.
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Ammi M, Fooken J, Klein J, Scott A. Does doctors' personality differ from those of patients, the highly educated and other caring professions? An observational study using two nationally representative Australian surveys. BMJ Open 2023; 13:e069850. [PMID: 37094898 DOI: 10.1136/bmjopen-2022-069850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES Personality differences between doctors and patients can affect treatment outcomes. We examine these trait disparities, as well as differences across medical specialities. DESIGN Retrospective, observational statistical analysis of secondary data. SETTING Data from two data sets that are nationally representative of doctors and the general population in Australia. PARTICIPANTS We include 23 358 individuals from a representative survey of the general Australian population (with subgroups of 18 705 patients, 1261 highly educated individuals and 5814 working in caring professions) as well as 19 351 doctors from a representative survey of doctors in Australia (with subgroups of 5844 general practitioners, 1776 person-oriented specialists and 3245 technique-oriented specialists). MAIN OUTCOME MEASURES Big Five personality traits and locus of control. Measures are standardised by gender, age and being born overseas and weighted to be representative of their population. RESULTS Doctors are significantly more agreeable (a: standardised score -0.12, 95% CIs -0.18 to -0.06), conscientious (c: -0.27 to -0.33 to -0.20), extroverted (e: 0.11, 0.04 to 0.17) and neurotic (n: 0.14, CI 0.08 to 0.20) than the general population (a: -0.38 to -0.42 to -0.34, c: -0.96 to -1.00 to -0.91, e: -0.22 to -0.26 to -0.19, n: -1.01 to -1.03 to -0.98) or patients (a: -0.77 to -0.85 to -0.69, c: -1.27 to -1.36 to -1.19, e: -0.24 to -0.31 to -0.18, n: -0.71 to -0.76 to -0.66). Patients (-0.03 to -0.10 to 0.05) are more open than doctors (-0.30 to -0.36 to -0.23). Doctors have a significantly more external locus of control (0.06, 0.00 to 0.13) than the general population (-0.10 to -0.13 to -0.06) but do not differ from patients (-0.04 to -0.11 to 0.03). There are minor differences in personality traits among doctors with different specialities. CONCLUSIONS Several personality traits differ between doctors, the population and patients. Awareness about differences can improve doctor-patient communication and allow patients to understand and comply with treatment recommendations.
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Affiliation(s)
- Mehdi Ammi
- School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada
- Centre for the Business and Economics of Health, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Jill Klein
- Melbourne Business School and Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute: Applied Economic and Social Research, The University of Melbourne, Parkville, Victoria, Australia
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Li W, Leng Z, Yi J, Zhong S. A multifaceted poverty reduction program has economic and behavioral consequences. Proc Natl Acad Sci U S A 2023; 120:e2219078120. [PMID: 36867687 PMCID: PMC10013832 DOI: 10.1073/pnas.2219078120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/29/2023] [Indexed: 03/05/2023] Open
Abstract
This paper examines the causal impact of poverty reduction interventions on the social preferences of the poor. A multifaceted poverty reduction program in China provides a setting for the use of a fuzzy regression discontinuity design. The design compares households with base-year income just below a preset criterion, who were more likely to receive the program treatment, with households just above the criterion. Five years after the program's launch, we conducted a lab-in-the-field experiment to measure the distributional preferences of household heads. Combining quasi-random variation from program rules with administrative census and experimental data, we find both economic and behavioral consequences of the program: It increased household income by 50% 5 y later, increased consistency with utility maximization by household heads, and increased their efficiency preference while reducing selfishness and leaving equality preference unchanged. Our findings advance scientific understanding of social preferences formation and highlight a broad perspective in evaluating poverty reduction interventions.
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Affiliation(s)
- Wenchao Li
- School of Economics and Management, Tongji University, Shanghai200092, China
| | - Zhiming Leng
- School of Business, Jishou University, Jishou416000, China
| | - Junjian Yi
- China Center of Economic Research, National School of Development, Peking University, Beijing100871, China
| | - Songfa Zhong
- Department of Economics, National University of Singapore, 117570Singapore, Singapore
- Division of Social Science, New York University, Abu Dhabi, United Arab Emirates
- Center for Behavioral Institutional Design, New York University, Abu Dhabi, United Arab Emirates
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Attema AE, Galizzi MM, Groß M, Hennig-Schmidt H, Karay Y, L'Haridon O, Wiesen D. The formation of physician altruism. JOURNAL OF HEALTH ECONOMICS 2023; 87:102716. [PMID: 36603361 DOI: 10.1016/j.jhealeco.2022.102716] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
We study how patient-regarding altruism is formed by medical education. We elicit and structurally estimate altruistic preferences using experimental data from a large sample of medical students (N = 733) in Germany at different progress stages in their studies. The estimates reveal substantial heterogeneity in altruistic preferences of medical students. Patient-regarding altruism is highest for freshmen, significantly declines for students in the course of medical studies, and tends to increase again for last year students, who assist in clinical practice. Also, patient-regarding altruism is higher for females and positively associated to general altruism. Altruistic medical students have gained prior practical experience in healthcare, have lower income expectations, and are more likely to choose surgery and pediatrics as their preferred specialty.
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Affiliation(s)
- Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | - Matteo M Galizzi
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, UK.
| | - Mona Groß
- Department of Business Administration and Healthcare Management, University of Cologne, Germany.
| | - Heike Hennig-Schmidt
- Laboratory for Experimental Economics, Department of Economics, University of Bonn, Germany.
| | | | - Olivier L'Haridon
- Center for Research in Economics and Management (CREM), University of Rennes 1, France; Institut Universitaire de France, France.
| | - Daniel Wiesen
- Department of Business Administration and Healthcare Management, University of Cologne, Germany.
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11
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Catholic Ownership, Physician Leadership and Operational Strategies: Evidence from German Hospitals. Healthcare (Basel) 2022; 10:healthcare10122538. [PMID: 36554062 PMCID: PMC9777963 DOI: 10.3390/healthcare10122538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Previous research has revealed that Catholic hospitals are more likely follow a strategy of horizontal diversification and maximization of the number of patients treated, whereas Protestant hospitals follow a strategy of horizontal specialization and focus on vertical differentiation. However, there is no empirical evidence pertaining to this mechanism. We conduct an empirical study in a German setting and argue that physician leadership mediates the relationship between ownership and operational strategies. The study includes the construction of a model combining data from a survey and publicly available information derived from the annual quality reports of German hospitals. Our results show that Catholic hospitals opt for leadership structures that ensure operational strategies in line with their general values, i.e., operational strategies of maximizing volume throughout the overall hospital. They prefer part-time positions for chief medical officers, as chief medical officers are identified to foster strategies of maximizing the overall number of patients treated. Hospital owners should be aware that the implementation of part-time and full-time leadership roles can help to support their strategies. Thus, our results provide insights into the relationship between leadership structures at the top of an organization, on the one hand, and strategic choices, on the other.
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Abstract
Physicians routinely face trade-offs among their own interests, the interests of their patients, and society’s interest in preserving medical resources. To manage these trade-offs, society relies on both traditional professional ethics and bureaucratic monitoring and control. Our results—that physicians are twice as likely to be altruistic as all other samples but indistinguishable from the general population in terms of equality–efficiency orientation—suggest that professional norms can meaningfully contribute to physicians putting patients first and highlight the importance of nurturing these norms of physician professionalism. However, our findings also suggest that policymakers may not rely on physician professionalism to ensure an efficient allocation of medical resources. Physicians’ professional ethics require that they put patients’ interests ahead of their own and that they should allocate limited medical resources efficiently. Understanding physicians’ extent of adherence to these principles requires understanding the social preferences that lie behind them. These social preferences may be divided into two qualitatively different trade-offs: the trade-off between self and other (altruism) and the trade-off between reducing differences in payoffs (equality) and increasing total payoffs (efficiency). We experimentally measure social preferences among a nationwide sample of practicing physicians in the United States. Our design allows us to distinguish empirically between altruism and equality–efficiency orientation and to accurately measure both trade-offs at the level of the individual subject. We further compare the experimentally measured social preferences of physicians with those of a representative sample of Americans, an “elite” subsample of Americans, and a nationwide sample of medical students. We find that physicians’ altruism stands out. Although most physicians place a greater weight on self than on other, the share of physicians who place a greater weight on other than on self is twice as large as for all other samples—32% as compared with 15 to 17%. Subjects in the general population are the closest to physicians in terms of altruism. The higher altruism among physicians compared with the other samples cannot be explained by income or age differences. By contrast, physicians’ preferences regarding equality–efficiency orientation are not meaningfully different from those of the general sample and elite subsample and are less efficiency oriented than medical students.
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13
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Ge G, Godager G, Wang J. Exploring physician agency under demand-side cost sharing-An experimental approach. HEALTH ECONOMICS 2022; 31:1202-1227. [PMID: 35373436 PMCID: PMC9325440 DOI: 10.1002/hec.4489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
The assumption of patient-regarding physicians has been widely adopted in the health economics literature. Physicians' patient-regarding preferences are often described as the concern for the health benefits of medical treatments, and thus closely related to the norms and ethics of the medical profession. In this paper, we ask whether physicians' patient-regarding preferences include a concern for their patient's consumption opportunities alongside patient's health benefits. To identify and quantify physicians' preferences, we design and conduct an incentivized laboratory experiment where choices determine separately the health benefits and the consumption opportunities of a real patient admitted to the nearest hospital. We find strong evidence that future physicians care about their patients' consumption opportunities.
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Affiliation(s)
- Ge Ge
- Department of Health Management and Health EconomicsUniversity of OsloOsloNorway
| | - Geir Godager
- Department of Health Management and Health EconomicsUniversity of OsloOsloNorway
- Health Services Research UnitAkershus University HospitalOsloNorway
| | - Jian Wang
- Department of Health Management and Health EconomicsUniversity of OsloOsloNorway
- Dong Fureng Institute of Economic and Social Development, Wuhan UniversityWuhanChina
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14
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Correcting for Random Budgets in Revealed Preference Experiments. GAMES 2022. [DOI: 10.3390/g13020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Experiments on revealed preference often use budget sets that are randomly and independently drawn according to some criteria for each participant. However, this means that the budget sets faced by different individuals are not the same. This paper proposes a method to control for these differences. In particular, we control for the “power” of different budget sets by examining the consistency of an individual’s choices relative to some simulated baseline behavior conditional on budgets faced by the individual. We apply this methodology to two existing experimental datasets. Our results show that failure to account for this variation results in a bias when looking directly at measures of choice consistency and the sign of this bias depends on the measure being used. However, controlling for this variation does not change the correlation between measures of choice consistency and observable demographic characteristics like income and education.
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15
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Berduzco-Torres N, Medina P, San-Martín M, Delgado Bolton RC, Vivanco L. Non-academic factors influencing the development of empathy in undergraduate nursing students: a cross-sectional study. BMC Nurs 2021; 20:245. [PMID: 34876108 PMCID: PMC8653543 DOI: 10.1186/s12912-021-00773-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Empathy is described as a core competence of nursing. There is abundant research evidence supporting that empathy varies according to personal characteristics and targeted training. The aim of this study was to characterize non-academic factors (personal and environmental) influencing the development of empathy in undergraduate nursing studies who are not receiving a targeted training in empathetic abilities in their nursing schools. METHODS A cross-sectional study was performed in the three nursing schools located in Cusco city, Peru (two private and one public). The Jefferson Scales of Empathy, Attitudes toward Physician-Nurse Collaboration, and Lifelong Learning, the Emotional Loneliness Scale for Adults, and the Scale of Life Satisfaction, were applied as the main measures. Also, information regarding gender, nursing school, and age, were collected. After psychometric properties were assessed, all measures were used in the development of a multivariate regression model to characterize factors of influence in empathy. RESULTS In a sample composed by 700 undergraduate nursing students (72 males and 628 females), a multivariate linear regression model was created. This model explained the 53% of variance of empathy and fitted all conditions necessary for inference estimations. Teamwork abilities, loneliness, age, sex, subjective well-being, and nursing school, appeared as factors influencing the development of empathy in patients' care. CONCLUSIONS Findings have indicated that, in absence of a targeted training, individual characteristics and characteristics associated with social and family environments play an important role of influence in the development of empathy in nursing students. These findings are also in consonance with others previously reported in different cultural settings including high-, middle- and low-income countries.
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Affiliation(s)
- Nancy Berduzco-Torres
- Universidad Nacional San Antonio Abad del Cusco, Av. de La Cultura 773, 08000, Cusco, Peru
| | - Pamela Medina
- Universidad Nacional San Antonio Abad del Cusco, Av. de La Cultura 773, 08000, Cusco, Peru
| | | | - Roberto C Delgado Bolton
- Hospital Universitario San Pedro, C/Piqueras 98, 26006, Logroño, Spain
- Centro Nacional de Documentación en Bioética, C/Piqueras 98, 26006, Logroño, Spain
- Centro de Investigación Biomédica de La Rioja (CIBIR), C/ Piqueras 98, La Rioja, 26006, Logroño, Spain
| | - Luis Vivanco
- Centro Nacional de Documentación en Bioética, C/Piqueras 98, 26006, Logroño, Spain.
- Centro de Investigación Biomédica de La Rioja (CIBIR), C/ Piqueras 98, La Rioja, 26006, Logroño, Spain.
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16
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Hardardottir H, Gerdtham UG, Wengström E. Parameterizing standard measures of income and health inequality using choice experiments. HEALTH ECONOMICS 2021; 30:2531-2546. [PMID: 34291532 DOI: 10.1002/hec.4395] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/28/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
When measuring inequality using conventional inequality measures, ethical assumptions about distributional preferences are often implicitly made. In this paper, we ask whether the ethical assumptions underlying the concentration index for income-related health inequality and the Gini index for income inequality are supported in a representative sample of the Swedish population using an internet-based survey. We find that the median subject has preferences regarding income-related health inequality that are in line with the ethical assumptions implied by the concentration index, but put higher weight on the poor than what is implied by the Gini index of income inequality. We find that women and individuals with a poorer health status put higher weight on the poor than men and healthier individuals. Ethically flexible inequality measures, such as the s-Gini index and the extended concentration index, imply that researchers have to choose from a toolbox of infinitely many inequality indices. The results of this paper are indicative of which indices (i.e. which parameter values) reflect the views of the population regarding how inequality should be defined.
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Affiliation(s)
| | - Ulf-G Gerdtham
- Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Erik Wengström
- Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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17
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Southworth E, Gleason SH. COVID 19: A Cause for Pause in Undergraduate Medical Education and Catalyst for Innovation. HEC Forum 2021; 33:125-142. [PMID: 33481144 PMCID: PMC7821447 DOI: 10.1007/s10730-020-09433-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
As the world held its breath for news surrounding COVID-19 and hunkered down amidst stay-at-home orders, medical students across the U.S. wondered if they would be called to serve on the front lines of the pandemic. Medical school administrators faced the challenge of protecting learners while also minimizing harm to their medical education. This balancing act raised critical questions in medical education as institutions reacted to changing guidelines. COVID-19 has punctuated already contentious areas of medical education and has forced institutions and organizations to take quick action. From the perspectives of a recent medical school graduate and current resident (ES) and a practicing clinician-educator (SHG), we examine the pandemic's impact on undergraduate medical education through an ethical lens. First, we explore the value of medical education, what drives this value, and how COVID-19 may alter it. We next consider student choice and how shifts toward utilitarianism in healthcare during a pandemic may affect learning and career exploration. Then, we inquire how access to technology may impact the experience of medical students from diverse backgrounds and varied institutions during a rapid shift to socially distanced learning. We identify vulnerabilities for students at several phases of the journey: premedical, preclinical, clinical, and preparation for residency. Finally, we address the hidden curriculum of COVID-19, its potential erosion of empathy among current medical students, and possible long-term consequences for future physicians and patients.
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Affiliation(s)
- Elizabeth Southworth
- Department of Obstetrics and Gynecology, University of Michigan L4001 Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0276, USA.
| | - Sara H Gleason
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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18
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Brendel F, Einhaus L, Then F. Resource scarcity and prioritization decisions in medical care: A lab experiment with heterogeneous patient types. HEALTH ECONOMICS 2021; 30:470-477. [PMID: 33184985 DOI: 10.1002/hec.4192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
During the COVID-19 pandemic, health care systems around the world have received additional funding, while at other times, financial support has been lowered to consolidate public spending. Such budget changes likely affect provision behavior in health care. We study how different degrees of resource scarcity affect medical service provision and, in consequence, patients' health. In a controlled lab environment, physicians are paid by capitation and allocate limited resources to several patients. This implies a trade-off between physicians' profits and patients' health benefits. We vary levels of resource scarcity and patient characteristics systematically and observe that most subjects in the role of physician devote a relatively stable share of budget to patient treatment, implying that they provide fewer services when they face more severe budget constraints. Average patient benefits decrease in proportion to physician budgets. The majority of subjects chooses an allocation that leads to equal patient benefits as opposed to allocating resources efficiently.
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Affiliation(s)
- Franziska Brendel
- Faculty of Economics and Business Administration, University of Duisburg-Essen, Essen, Germany
| | - Lisa Einhaus
- Faculty of Economics and Business Administration, University of Duisburg-Essen, Essen, Germany
- CINCH-Health Economics Research Center, University of Duisburg-Essen, Essen, Germany
| | - Franziska Then
- Faculty of Economics and Business Administration, University of Duisburg-Essen, Essen, Germany
- CINCH-Health Economics Research Center, University of Duisburg-Essen, Essen, Germany
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19
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Baugh RF, Hoogland MA, Baugh AD. The Long-Term Effectiveness of Empathic Interventions in Medical Education: A Systematic Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:879-890. [PMID: 33244286 PMCID: PMC7685355 DOI: 10.2147/amep.s259718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/17/2020] [Indexed: 06/09/2023]
Abstract
The Association of American Medical Colleges recognizes that empathy is an important part of providing excellent patient care and lists empathy as a Core Entrustable Professional Attribute for physicians. This study is a review of the literature focusing on studies with an educational intervention to promote empathy and at least one year follow-up data. After reviewing the 4910 abstracts retrieved from PubMed, PsycInfo, Cochrane, Web of Science, CINAHL, and Embase; the coauthors selected 61 articles for full-text review and completed a medical education research study quality instrument (MERSQI) to ensure all selected studies scored at least 7 or above. Five studies from the US and seven international studies met our inclusion criteria and formed the basis for the study. Few longitudinal studies with a post-intervention follow-up exist to confirm or disprove the effectiveness and durability of empathy training. Of the published studies that do conduct long-term follow-up, study design and measures used to test empathy are inconsistent. Despite the high degree of heterogeneity, the overwhelming majority demonstrated declining empathy over time. Little evidence was identified to support the ability to augment the empathy of physician trainees in sustained fashion. A model is presented which explains the observed changes. Alternative solutions are proposed, including the selection of more prosocial candidates.
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Affiliation(s)
- Reginald F Baugh
- Admissions, University of Toledo College of Medicine and Life Sciences, Toledo, OH43623, USA
| | - Margaret A Hoogland
- Library, University of Toledo College of Medicine and Life Sciences, Toledo, OH43623, USA
| | - Aaron D Baugh
- Pulmonary, Critical Care, Allergy, Sleep Medicine, University of California San Francisco Medical Center, San Francisco, CA94131, USA
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20
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Berduzco-Torres N, Medina P, Choquenaira-Callañaupa B, San-Martín M, Delgado Bolton RC, Vivanco L. Family Loneliness: Its Effects in the Development of Empathy, Teamwork and Lifelong Learning Abilities in Medical Students. Front Psychol 2020; 11:2046. [PMID: 33013515 PMCID: PMC7461979 DOI: 10.3389/fpsyg.2020.02046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/23/2020] [Indexed: 12/26/2022] Open
Abstract
CONTEXT Family offers an important source of social support where individuals acquire social abilities that are necessary to create positive human relationships. This influence has been discussed by different sociological and psychological theories along the life span of individuals. In medicine, empathy, teamwork, and lifelong learning have been described as specific elements of professionalism that have special importance in the interaction with patients and in physicians' well-being at the workplace. This study was performed with the aim of demonstrating the following hypothesis: In the absence of specific training in empathy and teamwork and lifelong learning abilities, their development in medical students is associated with the students' perception of loneliness from their family environment. METHODS A cross-sectional study was performed in the only two medical schools of Cusco (Peru), one private and the other public. Jefferson Scales of Empathy, Teamwork, and Lifelong Learning were used as the main measures. Mother-son and father-son relationships and family loneliness were measured to characterize the family environment. In addition, information related to sex, medical school, academic achievements, and place of origin were collected to control possible biases. Comparative, correlation, and multiple regression analyses were performed among the variables studied. RESULTS In a sample of 818 medical students, differences by school appeared in empathy, teamwork, lifelong learning, and family loneliness. In addition, family loneliness showed an inverse correlation with empathy, teamwork, and learning measures. While having a positive relationship with the mother was associated with a greater development of empathy and learning abilities in the entire sample, a similar effect was observed in father-son relationships, but only in the private medical school group. Finally, in the public medical group, a multiple regression model explained 43% of the variability of empathy based on a lineal relationship with teamwork (p < 0.001), lifelong learning (p < 0.001), and family loneliness (p < 0.001). CONCLUSION These findings confirm how family loneliness is detrimental to the development of medical professionalism. Also, they support the important role that the family, and especially parents, plays in the development of empathy, teamwork, and abilities in medical students. Finally, these findings highlighted important differences among students enrolled in public and private medical schools.
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Affiliation(s)
- Nancy Berduzco-Torres
- Escuela Profesional de Enfermería, Universidad Nacional San Antonio Abad del Cusco, Cusco, Peru
| | - Pamela Medina
- Escuela Profesional de Enfermería, Universidad Nacional San Antonio Abad del Cusco, Cusco, Peru
| | | | - Montserrat San-Martín
- Departamento de Estadística e Investigación Operativa, Universidad de Granada, Melilla, Spain
| | - Roberto C Delgado Bolton
- Servicio de Medicina Nuclear, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
- Plataforma de Bioética y Educación Médica, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
- Centro Nacional de Documentación en Bioética, Fundacion Rioja Salud, Logroño, Spain
| | - Luis Vivanco
- Plataforma de Bioética y Educación Médica, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
- Centro Nacional de Documentación en Bioética, Fundacion Rioja Salud, Logroño, Spain
- Area de Salud, Nutrición y Bioética, Fundación Universitaria Iberoamericana (FUNIBER), Barcelona, Spain
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21
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Lee YS, Song HS, Kim H, Chae Y. Altruistic decisions are influenced by the allocation of monetary incentives in a pain-sharing game. PLoS One 2019; 14:e0213104. [PMID: 30840681 PMCID: PMC6402679 DOI: 10.1371/journal.pone.0213104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/14/2019] [Indexed: 01/10/2023] Open
Abstract
Background Altruistic behavior is essential to the sustainability of society, but our current understanding of its underlying motivation is limited. In addition to the intrinsic motives to help others, based on empathy, extrinsic motives such as monetary incentives and social reputation influence prosociality. The purpose of this study was to examine the underlying motivations of prosocial behavior under constant or increasing extrinsic motivation settings. Methods An experimental task, Altruistic Pain Sharing, was developed in which the participants were asked to share the other participants’ pain. In the session with monetary incentives, the incentives were given either constantly (CONSTANT condition) or proportionally (INCREASING condition), to the amount of shared pain. In addition, monetary incentives were not provided in the NO session. The participants experienced different amounts of mechanical pain at the beginning of the task and chose the number of pain stimulations to share, based on their experiences. Results Compared to the NO session, the INCREASING session exhibited a rise in the mean of shared pain, but not the CONSTANT session. Furthermore, there was a distinct tendency to receive less pain than the other participant in the CONSTANT session, and a tendency to receive more pain than the other participant in the INCREASING session. Conclusion Prosocial behavior was influenced by the presence, as well as the form, of the extrinsic monetary incentives. Our study shows that rewards incentivize individuals to demonstrate a higher level of prosocial behavior, implying that prosocial behavior is itself a mixture of intrinsic and extrinsic motivations, and that an effectively designed rewards system may function to enhance prosocial behavior.
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Affiliation(s)
- Ye-Seul Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, Republic of Korea
| | - Hyun-Seo Song
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hackjin Kim
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- * E-mail:
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22
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Kim HB, Choi S, Kim B, Pop-Eleches C. The role of education interventions in improving economic rationality. Science 2019; 362:83-86. [PMID: 30287661 DOI: 10.1126/science.aar6987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/28/2018] [Accepted: 08/22/2018] [Indexed: 11/03/2022]
Abstract
Schooling rewards people with labor market returns and nonpecuniary benefits in other realms of life. However, there is no experimental evidence showing that education interventions improve individual economic rationality. We examine this hypothesis by studying a randomized 1-year financial support program for education in Malawi that reduced absence and dropout rates and increased scores on a qualification exam of female secondary school students. We measure economic rationality 4 years after the intervention by using lab-in-the-field experiments to create scores of consistency with utility maximization that are derived from revealed preference theory. We find that students assigned to the intervention had higher scores of rationality. The results remain robust after controlling for changes in cognitive and noncognitive skills. Our results suggest that education enhances the quality of economic decision-making.
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Affiliation(s)
- Hyuncheol Bryant Kim
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA.
| | - Syngjoo Choi
- Department of Economics, Seoul National University, Seoul, Republic of Korea.
| | - Booyuel Kim
- KDI School of Public Policy and Management, Sejong, Republic of Korea.
| | - Cristian Pop-Eleches
- School of International and Public Affairs, Columbia University, New York, NY, USA.
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23
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Li J. Plastic surgery or primary care? Altruistic preferences and expected specialty choice of U.S. medical students. JOURNAL OF HEALTH ECONOMICS 2018; 62:45-59. [PMID: 30273781 DOI: 10.1016/j.jhealeco.2018.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 06/08/2023]
Abstract
Understanding physicians' decisions when faced with conflicts between their own financial self-interest and patients' economic or health interests is of key importance in health economics and policy. This issue is especially salient in certain medical specialties where less altruistic behavior of physicians can yield significant financial gains. This study examines experimentally measured altruistic preferences of medical students from schools around the U.S., and whether these preferences predict those students' expected medical specialty choice. The experimental design consists of a set of computer-based revealed preference decision problems, which ask the experimental subjects to allocate real money between themselves and an anonymous person. These data are used to derive an innovative measure of altruism for each participant. I then examine the association between altruism and expected specialty choice, after controlling for an extensive set of covariates collected from an accompanying survey questionnaire. Medical students with a lower degree of altruism are significantly more likely to choose high-income specialties, conditioning on an extensive set of covariates. This altruism measure is more predictive of income of specialty choice than a wide range of other characteristics, including parental income, student loan amount and Medical College Admission Test (MCAT) score. On the other hand, the altruism measure does not predict choosing primary care specialties. I also find that altruism predicts students' self-reported likelihood of practicing medicine in an underserved area.
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Affiliation(s)
- Jing Li
- Weill Cornell Medical College, Cornell University, United States.
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