The formation of physician altruism

Attema, Arthur E.; Galizzi, Matteo M.; Groß, Mona; Hennig‐Schmidt, Heike; Karay, Yassin; l’Haridon, Olivier; Wiesen, Daniel

doi:10.1016/j.jhealeco.2022.102716

Cited by 18 publications

(28 citation statements)

References 129 publications

(166 reference statements)

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“…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). …”

supporting

confidence: 65%

“…Even though no subject takes the role of a patient, real patients outside the lab benefit from the subjects' treatment decisions: subjects are informed that the monetary equivalent of the total patient benefit resulting from their decisions is transferred to an organization which has an impact for real patients. Similar mechanisms have been employed in numerous experiments analyzing physician behavior (e.g., Attema et al, 2023;Brosig-Koch et al, 2016;Brosig-Koch, Hennig-Schmidt, et al, 2017;Brosig-Koch et al, 2019;Byambadalai et al, 2021;Di Guida et al, 2019;Hennig-Schmidt et al, 2011;Kesternich et al, 2015;Lagarde & Blaauw, 2017;Martinsson & Persson, 2019;Oxholm et al, 2019Oxholm et al, , 2021Wang et al, 2020). 14 The monetary health benefit was transferred to Christoffel Blindenmission, which uses the money exclusively for surgical treatment of patients with eye cataract (for details of the procedure, see Section 3.2).…”

Section: Patient Benefitmentioning

confidence: 99%

“…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.…”

Section: Absence Of Competitionmentioning

confidence: 99%

“…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.…”

Section: Absence Of Competitionmentioning

confidence: 99%

“…But this contradicts the interpretation of these degrees as innate individual preference parameters. It is an open question as to whether the individual degree of altruism should indeed be interpreted as innate individual preference, particularly since there is evidence suggesting that altruism can be changed in response to external environmental factors (see e.g., Attema et al, 2023).…”

Section: F I G U R E Dmentioning

confidence: 99%

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

Brosig-Koch

Hehenkamp

Kokot³

2023

Health Economics

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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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supporting

confidence: 65%

Section: Patient Benefitmentioning

confidence: 99%

Section: Absence Of Competitionmentioning

confidence: 99%

Section: Absence Of Competitionmentioning

confidence: 99%

Section: F I G U R E Dmentioning

confidence: 99%

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

Brosig-Koch

Hehenkamp

Kokot³

2023

Health Economics

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

et al. 2023

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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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Economics of Healthcare Provider Altruism

Galizzi

Godager

et al. 2023

Handbook of Labor, Human Resources and Population Economics

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We propose a comprehensive overview of the main theoretical notions and empirical findings on altruism among physicians and other healthcare providers. While altruism in the behavioral and experimental economics literature is typically defined as a deviation from purely self-interested behavior, the theoretical health economics literature embeds the notion of physician altruism within the doctor-patient relationship. The altruism of physicians is typically defined as the weight in the doctor's utility function attached to patient's health benefits, besides the self-interested monetary considerations. We broadly group the empirical evidence into three main categories of evidence: evidence from (i) survey and interview data, (ii) prescriptions records, and (iii) behavioral experiments. Across each of those groups of studies and different methods, the evidence generally supports the theoretical notion that physicians behave 'altruistically' in their healthcare decisions. Some studies indicate, however, considerable heterogeneity in physicians' altruistic preferences.1 This article is a revised version of the working paper "Provider altruism in health economics", which appeared in the discussion paper series of the National Institute for Health and Welfare (No. 04/2015). We thank Helena Reisgies for her excellent research assistance.

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The formation of physician altruism

Cited by 18 publications

References 129 publications

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

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

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

Economics of Healthcare Provider Altruism

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