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Patients' free choice of physicians is not always good.

ABSTRACT: We present a model of learning in healthcare markets. Hospitals have junior physicians with low and senior physicians with high ability. Junior physicians turn senior if they treat enough patients. Patients face heterogeneous costs for waiting if a physician's capacity is utilized. Hospitals choose to either allocate patients to physicians randomly or let patients choose their physicians. In a monopolistic market, the hospital always chooses the welfare-maximizing allocation system. In a competitive market, inefficiencies may arise due to two externalities. If patients are free to choose their physician, the marginal patient neither internalizes her impact on other patients' waiting costs nor the learning of junior physicians.

SUBMITTER: Li X

PROVIDER: S-EPMC9292273 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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Patients' free choice of physicians is not always good.

Li Xinyu X Li Xinyu X Waibel Christian C

Health economics 20210812 11

We present a model of learning in healthcare markets. Hospitals have junior physicians with low and senior physicians with high ability. Junior physicians turn senior if they treat enough patients. Patients face heterogeneous costs for waiting if a physician's capacity is utilized. Hospitals choose to either allocate patients to physicians randomly or let patients choose their physicians. In a monopolistic market, the hospital always chooses the welfare-maximizing allocation system. In a competi ...[more]

PMID: 34387018

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Project description:BackgroundNowadays, patients are seeking physician information more frequently via the internet. Physician-rating websites (PRWs) have been recognized as the most convenient way to gain insight and detailed information about specific physicians before receiving consultation. However, little is known about how the information provided on PRWs may affect patients' decisions to seek medical advice.ObjectiveThis study aimed to examine whether the physicians' online efforts and their reputation have a relationship with patients' choice of physician on PRWs.MethodsA model, based on social exchange theory, was developed to analyze the factors associated with the number of online patients. A 3-wave data collection exercise, covering 4037 physicians on China's Good Doctor website, was conducted during the months of February, April, and June 2017. Increases in consultation in a 60-day period were used as the dependent variable, whereas 2 series of data were analyzed using linear regression modeling. The fixed-effect model was used to analyze the 3-wave data.ResultsThe adjusted R2 value in the linear regression models were 0.28 and 0.27, whereas in the fixed-effect model, it was .30. Both the linear regression and fixed-effect models yielded a good fit. A positive effect of physicians' effort on the aggregated number of online patients was identified in all models (R2=0.30 and R2=0.37 in 2 regression models; R2=0.23 in fixed effect model; P<.001). The proxies of physicians' reputations indicated different results, with total number of page views of physicians' homepages (R2=0.43 and R2=0.46; R2=0.16; P<.001) and number of votes received (R2=0.33 and R2=0.27; R2=0.43; P<.001) being seen as positive. Virtual gifts were not significant in all models, whereas thank-you messages were only significant in the fixed-effect model (R2=0.11; P=.02). The effort made by physicians online is positively associated with their aggregated number of patients consulted, whereas the effect of a physician's reputation remains uncertain. The control effect of a physician's title and hospital's level was not significant in all linear regressions.ConclusionsBoth the effort and reputation of physicians online contribute to the increased number of online patients' consultation; however, the influence of a physician's reputation varies. This may imply that physicians' online effort and reputation are critical in attracting patients and that strategic manipulation of physician profiles is worthy of study. Practical insights are also discussed.

Project description:IntroductionSelf-injectable calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) auto-injectors and non-CGRP oral medications are currently available for migraine prevention in Japan. This study elicited the preferences for self-injectable CGRP mAbs and non-CGRP oral medications and determined differences in the relative importance of auto-injector attributes for patients and physicians in Japan.MethodsJapanese adults with episodic (EM) or chronic (CM) migraine and physicians who treat migraine completed an online discrete choice experiment (DCE), asking participants to choose a hypothetical treatment they preferred between two self-injectable CGRP mAb auto-injectors and a non-CGRP oral medication. The treatments were described by seven treatment attributes, with attribute levels varying between questions. DCE data were analyzed using a random-constant logit model to estimate relative attribution importance (RAI) scores and predicted choice probabilities (PCP) of CGRP mAb profiles.ResultsA total of 601 patients (79.2% with EM, 60.1% female, mean age: 40.3 years) and 219 physicians (mean length of practice: 18.3 years) completed the DCE. About half (50.5%) of patients favored CGRP mAb auto-injectors, while others were skeptical of (20.2%) or averse (29.3%) to them. Patients most valued needle removal (RAI = 33.8%), shorter injection duration (RAI = 32.1%), and auto-injector base shape and need for skin pinching (RAI = 23.2%). Most physicians (87.8%) favored auto-injectors over non-CGRP oral medications. Physicians most valued less-frequent dosing RAI = 32.7%), shorter injection duration (30.4%), and longer storage outside the fridge (RAI = 20.3%). A profile comparable to galcanezumab showed a higher likelihood of being chosen by patients (PCP = 42.8%) than profiles comparable to erenumab (PCP = 28.4%) and fremanezumab (PCP = 28.8%). The PCPs of the three profiles were similar among physicians.ConclusionMany patients and physicians preferred CGRP mAb auto-injectors over non-CGRP oral medications and preferred a treatment profile similar to galcanezumab. Our results may encourage physicians in Japan to consider patient preferences when recommending migraine preventive treatments.

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Patients' free choice of physicians is not always good.

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Patients' free choice of physicians is not always good.

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