GPs’ shifting agencies in choice of treatment

Pedersen, Line Bjørnskov; Riise, Julie; Hole, Arne Risa; Gyrd-Hansen, Dorte

doi:10.1080/00036846.2013.854305

Cited by 12 publications

(12 citation statements)

References 23 publications

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“…As referred to in Section 2, GPs could within their authorised room for decision-making, put more weight on their role as a patients' advocate relative to other concerns when the interests of society are well taken care of through regulations and other features of the system. A recent study on GPs shows that the GPs' role as agent for their patients is clearly strengthened in the presence of national recommendations that to a large degree ensure cost effectiveness (Pedersen et al, 2014). …”

Section: Discussionmentioning

confidence: 99%

“…Perfect agency is, however, difficult to define when the GP faces two principals with often conflicting goals, and typically leaves GPs with dilemmas that can be difficult to solve in daily decision-making situations (Coast, 2001). Perhaps as a consequence, more recent literature shows that the relative weight put on the two roles shifts depending on which of the two principals' concerns are best attended to in the institutional setting the doctors are operating within (Pedersen et al, 2014).…”

Section: Dual Agencymentioning

confidence: 99%

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GPs' implicit prioritization through clinical choices – evidence from three national health services

Riise

Hole

Gyrd‐Hansen

et al. 2016

Journal of Health Economics

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We present results from an extensive discrete choice experiment, which was conducted in three countries (Norway, Scotland, and England) with the aim of disclosing stated prescription behaviour in different decision making contexts and across different cost containment cultures. We show that GPs in all countries respond to information about societal costs, benefits and effectiveness, and that they make trade-offs between them. The UK GPs have higher willingness to accept costs when they can prescribe medicines that are cheaper or more preferred by the patient, while Norwegian GPs tend to have higher willingness to accept costs for attributes regarding effectiveness or the doctors' experience. In general there is a substantial amount of heterogeneity also within each country. We discuss the results from the DCE in the light of the GPs' two conflicting agency roles and what we know about the incentive structures and cultures in the different countries.2

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Section: Discussionmentioning

confidence: 99%

Section: Dual Agencymentioning

confidence: 99%

GPs' implicit prioritization through clinical choices – evidence from three national health services

Riise

Hole

Gyrd‐Hansen

et al. 2016

Journal of Health Economics

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“…Fourteen of the studies assessed healthcare professional decision making about therapy and disease management [19][20][21][22][23][24][25][26][27][28][29][30][31][32], twelve assessed preferences for organisation characteristics of primary care practices [33][34][35][36][37][38][39][40][41][42][43][44], seven assessed the relative influence of implementation and knowledge translation strategies [45][46][47][48][49][50], and two assessed preferences for information and communication technologies [51,52].…”

Section: Purpose Of Dcementioning

confidence: 99%

“…The most common attribute used in the DCEs assessing physician preferences for therapy and disease was cost [19,20,22,28,29,31], including both cost of the intervention [20,22,28,29,31] and direct cost to the patient [19,20,29,31]. Other frequently used attributes included patient preferences [19-21, 31, 38, 53], Fig.…”

Section: Choice Task Designmentioning

confidence: 99%

Systematic review and validity assessment of methods used in discrete choice experiments of primary healthcare professionals

2020

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Introduction Discrete choice experiments (DCEs) have been used to measure patient and healthcare professionals preferences in a range of settings internationally. Using DCEs in primary care is valuable for determining how to improve rational shared decision making. The purpose of this systematic review is to assess the validity of the methods used for DCEs assessing the decision making of healthcare professionals in primary care. Main body A systematic search was conducted to identify articles with original data from a discrete choice experiment where the population was primary healthcare professionals. All publication dates from database inception to 29th February 2020 were included. A data extraction and validity assessment template based on guidelines was used. After screening, 34 studies met the eligibility criteria and were included in the systematic review. The sample sizes of the DCEs ranged from 10 to 3727. The published DCEs often provided insufficient detail about the process of determining the attributes and levels. The majority of the studies did not involve primary care healthcare professionals outside of the research team in attribute identification and selection. Less than 80% of the DCEs were piloted and few papers investigated internal or external validity. Conclusions For findings to translate into improvements in rational shared decision making in primary care DCEs need to be internally and externally valid and the findings need to be able to be communicated to stakeholders in a way that is understandable and relevant.

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“…In their model of physician behavior, Chandra and Skinner [ 15 ] assume that medical care—although not payed for by the patient—is always subject to constraints, for example, to a lack of resources or ethical norms against spending too many resources. A qualitative study by Hassell et al [ 16 ], a survey by Tilburt et al [ 17 ], and a discrete choice experiment by Pedersen et al [ 18 ] all indicate that physicians take into account the costliness of their services and the scarcity of available resources for treating patients. We analyze physician behavior when an insurer finances medical service provision.…”

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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GPs’ shifting agencies in choice of treatment

Cited by 12 publications

References 23 publications

GPs' implicit prioritization through clinical choices – evidence from three national health services

GPs' implicit prioritization through clinical choices – evidence from three national health services

Systematic review and validity assessment of methods used in discrete choice experiments of primary healthcare professionals

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

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