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

医患关系在患者的健康结局中起着重要作用。 然而，人们对这种关系知之甚少，这是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，但消极的关系会导致不信任，低质量的护理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。 如果医生预料到病人会不顺从，那么医生就没有什么动力去努力制定一个仔细的诊断和有效的治疗方案。因此，关系双方的信任失败可能导致更糟糕的健康结果。这笔赠款资助了一个项目，该项目使用经济理论和决策实验来更好地了解这种关系，并开发和测试有可能改善患者/医生关系信任的干预措施。该项目在三个方面作出贡献。 1)该模型改编自“信任良好”的文献，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，患者的不信任将阻止医生承担更好的诊断和治疗费用。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，以包括消费者对产品/服务选择的积极参与-即患者可以参与选择自己的医疗方法，即使他们不是诊断专家。2)该项目设计了一个患者-医生“实验模型”，使医生/患者关系中的关键要素的表征和隔离，然后进行实验室和在线实验，以验证模型的预测。这些实验是第一个纳入患者主动决策的实验，突出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：“公共评级系统”，让患者对医生进行评级，这可以提高声誉并对医生的护理质量产生积极影响。这一部分补充了以前在卫生经济学的实证研究，通过提供因果证据的声誉如何可以加强医患关系和改善health outcomes.This奖项反映了NSF的法定使命，并已被认为是值得通过使用基金会的智力价值和更广泛的影响审查标准进行评估的支持。

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.