Experimental evidence of physician social preferences

Abstract

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.

Who benefits from quality competition in health care? A theory and a laboratory experiment on the relevance of patient characteristics

“…19 19 Physician altruism is a common assumption in health economics models (see, e.g., Allard et al., 2011; Ellis & McGuire, 1986; McGuire, 2000). This assumption has been supported by previous laboratory research (see, e.g., Attema et al., 2023; Brosig‐Koch, Hennig‐Schmidt, et al., 2017; Godager & Wiesen, 2013; Li et al., 2017, 2022). …”

“…While these considerations imply that our sample allows identifying behavioral regularities with regard to medical service provision, we are careful with drawing conclusions with regard to specific effect sizes.17 However, as pointed out by a reviewer, medical students may care more about patients' outcome than students in other disciplines. The ranking would then be more open.18 Starting with Hennig-Schmidt et al (2011), similar or equivalent mechanisms have been employed in several behavioral experiments in health analyzing medical service provision.19 Physician altruism is a common assumption in health economics models (see, e.g.,Allard et al, 2011;Ellis & McGuire, 1986;McGuire, 2000).This assumption has been supported by previous laboratory research (see, e.g.,Attema et al, 2023;Brosig-Koch, Hennig-Schmidt, et al, 2017;Godager & Wiesen, 2013;Li et al, 2017Li et al, , 2022.20 More specifically, we obtain that q H (α) = q H maximizes utility U H (q; α) for α ≥ 1/3, while q L (α) = q L maximizes U L (q; α) for α ≥ 13/23.21 The assumption of separability represents a standard assumption in the literature when the choice of treatment quality is examined (see, e.g.,Ellis, 1998).22 Notice that, for the case of profit-maximizing physicians, (α 1 , α 2 ) = (0, 0), our duopoly model of quality competition is similar to the Bertrand model of price competition. However, unlike the Bertrand model, our model has a discrete strategy set Q and allows for customer-oriented firm objectives.23 As opposed to explicit collusion, tacit collusion refers to cooperative behavior between competitors that do not explicitly communicate with each other or exchange information otherwise.24 For between-subject analyses, we employ Mann-Whitney U tests.…”

“…Thirdly, comparing patient benefit in the experiment across states of health, the benefit is weakly higher for high-severity patients than for low-severity patients. Given that a pool of subjects usually shows a substantial heterogeneity in the subjects' degree of altruism (e.g., Attema et al, 2023;Brosig-Koch, Hennig-Schmidt, et al, 2017;Godager & Wiesen, 2013;Li et al, 2017Li et al, , 2022, all these inequalities should hold strictly, once averages across subjects are considered.…”

“…It implies that, on average, subjects seem to care not only about their own profit but also-to some extent-about patients' benefit. Our assumption of physician altruism may account for this (see, e.g., Attema et al, 2023;Brosig-Koch, Hennig-Schmidt, et al, 2017;Godager & Wiesen, 2013;Li et al, 2017Li et al, , 2022.…”

Medical occupation preference under the influence of the COVID‐19 pandemic: The role of risk and altruistic preferences

“…In addition, we demonstrate that the external shock of the pandemic appears to have exacerbated the preference gap between prospective medical and nonmedical workers. Our results would suggest that policymakers need to carefully consider the potential efficiency consequences of the medical resource allocation post pandemic, and address potential equity concerns between medical and nonmedical workers' financial recompense (Li et al, 2022;Sen, 2018).…”