Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Soc Sci Med. 2019 Feb;222:256-264. doi: 10.1016/j.socscimed.2019.01.014. Epub 2019 Jan 12.
In a perfect agency relationship, doctors consider all information and select the patient's 'utility maximising' option given the patient's preferences. The patient's time preferences are important as treatments vary in the timing and length of their benefits. However, doctors often do not have full information on patients' preferences and may apply their own preferences. This has generated empirical interest in estimating doctors' time preferences. However, these studies generally elicit doctors' private preferences (preferences for their own health) rather than professional preferences (preferences for the patient). We hypothesise that private and professional preferences may differ. Professional time preferences may be 'taught' in medical school or learned through repeated interactions with patients. If preferences differ then estimates of doctors' private preferences are less informative for medical decision-making. This study compares private and professional time preferences for health in a national sample of General Practitioners, using a between sample design. Time discounting is explored using exponential and quasi-hyperbolic models. We elicit time preferences using multiple price lists. We find no significant difference between the time preference for the self or the patient. This result holds for axiomatic discounting classification and maximum likelihood estimates. We do not find evidence of present-bias. There are a high proportion of increasingly impatient GPs, potentially implying a maximum 'willingness to wait' for treatment benefits. GPs value the health state differently between themselves or for a patient. These results suggest that we can use estimates of private preferences from doctors to inform medical decision-making.
在理想的代理关系中,医生会考虑所有信息,并根据患者的偏好选择患者的“效用最大化”选项。由于治疗的获益时间和时长不同,患者的时间偏好很重要。然而,医生通常无法全面了解患者的偏好,可能会应用自己的偏好。这引发了人们对估计医生时间偏好的实证研究兴趣。然而,这些研究通常只引出医生的私人偏好(对自己健康的偏好),而不是职业偏好(对患者的偏好)。我们假设私人偏好和职业偏好可能不同。职业时间偏好可能是在医学院“教授”的,也可能是通过与患者的反复互动而习得的。如果偏好不同,那么对医生私人偏好的估计对医疗决策的参考价值就会降低。本研究使用样本间设计,在全国范围内的普通科医生样本中比较了健康的私人和职业时间偏好。使用指数和拟双曲模型来探索时间贴现。我们使用多个价格表来引出时间偏好。我们发现自我和患者的时间偏好之间没有显著差异。这个结果适用于公理贴现分类和最大似然估计。我们没有发现现在偏差的证据。有很大一部分越来越没有耐心的全科医生,这可能意味着他们对治疗获益的最大“等待意愿”。全科医生对自己或患者的健康状况有不同的价值判断。这些结果表明,我们可以使用医生的私人偏好估计来为医疗决策提供信息。