Experiments in Health Economics

Einleitung / Introduction

Providing physicians with the option to use decision support to gather additional information for therapy decisions can have a positive impact on quality of care, patient outcomes, and costs by ensuring that patients receive the care they need. However, a prerequisite for exploiting these positive effects is that healthcare providers make use of decision support options in order to make more appropriate decisions. We study how capacity constraints affect physicians’ willingness to gather additional information supporting their therapy decisions. Further, we examine how capacity constraints affect the utilization of additionally gathered information and the appropriateness of physicians’ therapy decisions.

Methode / Method

Using a controlled framed field experiment with German pediatricians (n=247), we exogenously vary the extent to which physicians’ capacity is constrained. In our experiment, pediatricians make decisions on the length of antibiotic therapies for 40 pediatric routine cases. We use a between-subject design to vary two treatment parameters in our experiment: Availability of decision support and information gathering costs. For each case, subjects first make an initial decision on the length of antibiotic therapy. Depending on the experimental condition they are assigned to, subjects then either (i) decide whether they want to use decision support before making the final therapy decision for that case, (ii) automatically get decision support, or (iii) do not have the option to use decision support. We vary the level of information gathering costs, which reflect the fraction of available capacities that is needed to use decision support. If a subject decides to use decision support or automatically receives support, he or she is given the opportunity to adjust his or her initial therapy decision for this case.

Ergebnisse / Results

Our behavioral results evidence that physicians’ willingness to gather additional information that supports decision making decreases as capacity constraints increase. However, the utilization of the information gathered is not affected by increasing constraints. We also find that capacity constraints have a statistically significant and clinically relevant impact on the appropriateness of therapy decisions and thus on the quality of care. This is especially the case for physicians with little clinical experience.

Zusammenfassung / Conclusion

Our results suggest that decreasing the extent to which capacity is constrained can be an effective way to enhance the utilization of decision support and thus help improve the appropriateness of therapy decisions. Implications of our findings for the management of healthcare organizations are discussed.

AutorInnen

Kerstin Eilermann, Bayer AG, Department of Market Access

Bernd Roth, University of Cologne and Cologne University Hospital, Department of Pediatrics

Anna Katharina Stirner, University of Cologne, Department of Business Administration and Health Care Management

Daniel Wiesen, University of Cologne, Department of Business Administration and Health Care Management

Einleitung / Introduction

Discrimination against doctors is important but scantly studied. I report a field experiment which observes that customers discriminate against Black and Asian doctors when they choose healthcare providers, and that this can be substantially reduced by supplying information on physician quality. I evaluate customer preferences in the field with an online platform where cash-paying consumers can shop and book a provider for medical procedures based on a novel experimental paradigm. Actual paying customers evaluate doctor options they know to be hypothetical to be matched with a customized menu of real doctors, preserving incentives. Racial discrimination reduces patient willingness-to-pay for Black and Asian doctors by 12.7% and 8.7% of the average colonoscopy price respectively; customers are willing to travel 100-250 miles to see a white doctor instead of a Black doctor, and somewhere between 50-100 to 100-250 miles to see a white doctor instead of an Asian doctor. Providing signals of doctor quality reduces this willingness-to-pay racial gap by about 90%. Willingness-to-pay penalties on minority doctors are multiples of actual average racial quality differences and even the difference between doctors in highest and lowest quality levels. This field evidence shifts the focus beyond traditional taste-based and statistical discrimination to include behavioral mechanisms like biased beliefs and deniable prejudice. Discrimination against Black doctors are higher for non-college-graduate customers and residents in zipcodes that voted for the 2020 presidential candidate on the political right.  Actual booking behavior allows cross-validation of incentive compatibility of the stated preference elicitation.

Einleitung / Introduction

Stem cell transplants are used to treat blood cancer. While 25% of patients can be transplanted with the stem cell donation of a relative, the majority of patients depend on other voluntary donors. However, the chance of a match between donor and patient is very modest, so that a large pool of registered donors is needed. Current efforts to increase the donor pool, such as public advertisement and organized recruitment events, are insufficient; 10% of patients in need do not find a suitable donor. In this study, we explore the power of changing the choice frame of registration to increase the pool of potential donors.

Methode / Method

We conduct a combined online and field experiment. In the online experiment, an interactive decision game is adapted for the context of stem cell donor registration. We compare registration rates for two different choice-defaults and two information treatments. In the second part, these same participants are asked whether they want to actually register with a German donor center or not. Here, we replicate the different choice-defaults from the online experiment for the participants to request a registration link and additionally implement a treatment where participants receive buccal swab registration sets to the participation addresses a priori.

Ergebnisse / Results

From March to September 2022, a total of 309 subjects participated in the experiment. Preliminary results indicate that both the default treatments and the information treatments have an effect on registration decisions in the lab. Exploratory analyses will refer to the influence of personal characteristics and dynamics within the simulated decision game.

Zusammenfassung / Conclusion

Our results help to improve the design for stem-cell donor registration decision, possibly increasing registration rates. In addition, we contribute to the experimental literature on donation behavior as our unique setup allows us to measure the external validity of decisions in laboratory experiments.

AutorInnen

Simon Reif

Harald Tauchmann

Daniel Wiesen

Einleitung / Introduction

Risk and time preferences influence individuals’ decisions and subsequently behaviors. There is mixed evidence that these preferences differ across domains (domain specificity) and additionally, there is evidence that personal characteristics may explain differences in these preferences between individuals.

Methode / Method

Using Multiple Price Lists (MPLs) for hypothetical financial, incentivized financial, and health domains in a within-subject design we systematically assess whether we find evidence for domain specificity in a large student sample, both for structurally estimated parameters as well as using Switching Points (SPs). Furthermore, we assess the influence of personal characteristics on these structural parameters for the health domain.

Ergebnisse / Results

Our findings indicate that there is domain specificity for both risk and time parameters and that only few personal characteristics can reliably explain differences in risk and time preferences for the health domain.

AutorInnen

Olaf Karasch, University of Cologne

Andre Hofmeyr, University of Cape Town

Dirk Müller, University Hospital Cologne

Helena Reisgies, University of Cologne

Stephanie Stock, University Hospital Cologne

Daniel Wiesen, University of Cologne