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

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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.