Doctoral Dissertation Research in Economics: The Doctor/Patient Relationship: Theory and Experiments

医患关系对患者的健康结局起着至关重要的作用。然而，人们对这种关系知之甚少，这构成了医疗保健服务中的一个主要问题。虽然积极的关系可以提高医疗的有效性，但消极的关系可能会导致不信任、较低的护理质量和更糟糕的健康结果。一个常见的问题是，患者可能不完全信任医生的建议，因此可能无法遵守治疗建议。如果医生预计病人会不顺从，那么医生就没有动力努力工作来制定仔细的诊断和有效的治疗方案。因此，双方信任的失败可能会导致更糟糕的健康结果。这笔赠款资助了一个项目，该项目使用经济学理论和决策实验来更好地理解这种关系，并开发和测试有可能改善患者/医生关系信任的干预措施。该项目在三个方面做出了贡献。1)该模型改编自《信誉良好》文献，并假设患者无法观察医生的诊断精度是他们不信任的主要原因。它进一步预测，患者的不信任将使医生不愿承担更好的诊断和治疗的成本。因此，该模型扩展了信用良好市场中消费者和专家卖家之间的标准互动，包括消费者积极参与产品/服务选择-即患者即使不是诊断方面的专家，也可以参与选择自己的医疗治疗。2)本项目设计了一个能够表征和隔离医患关系中的关键要素的医患“实验模型”，并进行了实验室和在线实验，以验证模型预测。这些实验首次纳入了患者的主动决策，突显了诊断不确定性在塑造患者依从性方面的重要性，从而改变了市场均衡。3)这项研究测试了一种普遍提出的干预措施：让患者对医生进行评级的“公共评级系统”，这可以提高医生的声誉，并对医生的护理质量产生积极影响。这一部分是对先前健康经济学实证研究的补充，提供了声誉如何加强医患关系和改善健康结果的因果证据。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

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.