Practice variation Flashcards
(15 cards)
how does the supply side influence treatment decisions
The surgeons at one hospital may be particularly good compared to surgeons at other hospitals, and thus surgical treatment may be preferred to radiation and chemotherapy for men treated at that institution
The technology available for treatment may also vary across institutions
what factors influence the treatment in theh category demand side:
price, income, and tastes. given the large variation in medical treatments, the roles of price and income in medicine .
prices do not vary significantly across people and income has little role to play in clinical decisions
give an example of how situational factors could influence treatment choice decision.
such as contextual or behavioral influences
. A patient may have preferred radiation to surgery, but the urologist on call that day happened to talk the man into surgery. The tragic or salient death of a man during surgery the previous week may lead a primary care physician to refer her next patient in similar condition to a radiation oncologist instead. The lengthy wait for a radiation appointment relative to surgery may lead a patient to choose surgery.
which of the 3 factors is the most important for explaining treatment decision choices.
Demand-side factors may be important in explaining treatment differences between rich and poor regions, but they may be less important within rich or poor regions.
Supply-side factors may explain a good share of the differences between one region and another, or even between countries. For example, prostate can- cer guidelines vary within and between countries
Situational factors may explain a good deal about why one man gets surgery and another gets radiation, but are likely to be a much smaller part of regional variations in care.
what does the gray area medicine means
The result is that when the same patient walks into two physicians’ offices, what that patient receives may differ widely.
example : the frequency of follow-up for medical care. In regions of the country that spend more on health care, patients are seen back more frequently and receive more screening tests and discretionary inter- ventions of unproven benefit relative to low-spending regions
do patients have a particular preference which befits the treatment
type II :the former denoting treatments highly effective for some but not for all (e.g. cardiac stents),
type III technologies: treatments with uncertain clinical value (e.g. ICU days among chronically ill patients).
The difficulty in understanding treatment choices is not just empirical; it is conceptual as well explain this
What the patient wants to receive (demand) may not be the same as what the physician wants to deliver (supply). It is difficult to bring thisin balance
is there variation in patient preferences in treatment decision? Give an example with prostat cancer
Preferences for different health outcomes (e.g. length vs. quality of life) differ across people.
Example localized prostate cancer: some men prefer to live with symptom-free cancer under conservative management, while others prefer treatment given its potential associated complications
age and disease severity may explain some of this variation .
Some of the remaining variation is owing to idiosyncratic factors.
give a short example
example, prostate cancer patients report wildly unstable preferences for different health states that violate basic utility rank order assumptions
is it important to understand the motivation of physicians in treatment decision choices/
the demand-side model simplified physicians to be perfect agents, supply-side models typically simplify patients to be comatose, uninformed, or unable to go elsewhere.
In that setting, physicians maximize their utility, unconstrained by patient demands.
what is physician induced demand
a physician providing care that a fully informed patient would not choose for himself.
what is the difference when a patient get full reimburse and another patient gets poor reimbursement
the effect is clear: many physicians will not even see patients who have Medicaid or no insurance. For patients who are well insured, however, the differences are more difficult to discern.
In the Medicare population, for example, fees are similar nationally, yet care differs across patients and regions. .
can you show how the specialty of the physician matters for treatment choice.
zie tekening achter medical workforce tekeningen
which are the specific behavioral factors ( in situational factors ) who influences treatment decision choice
availabilty heuristic ; suggests that a physician who has just seen a patient with influenza may be more likely to make the diagnosis of influenza
2. Framing, Choice, and Risk: For example, if a physician faces a growing number of treatment choices, all of which are plausible for a patient, the task of choosing one becomes increasingly difficult.
Status Quo and Confirmation Bias
Status quo bias refers to the fact that people tend not to change their behavior unless the incentive to change is strong.
Channel Factors
Channel factors may also play an important role in determining treatment choice. A channel factor is something that affects perceived benefits and costs towards pursuing a particular choic
read the conclusion of the chapter who ordered that treatment
The geographic variations literature demonstrates that despite nationally stan- dardized training, physicians in different geographic locations can make markedly dif- ferent treatment decisions for patients with similar clinical profiles. This was the first evidence to suggest that providers of medical care may not, as a profession, systemati- cally choose the clinically optimal treatment path for patients. Where early literature in health economics mostly focused on the possibility of physician-induced demand— which concerned quantity more so than choice—we attempt to decompose potential explanations for variations in treatment choice.
In general, the literature points to the importance of supply-side incentives over demand-side factors in driving treatment choice. Our views are largely consistent with this paradigm. Yet traditional demand factors such as preferences and patient characteristics are undoubtedly still relevant, and behavioral influences are only begin- ning to be understood. In the end, one of the ultimate goals of understanding how treatment choices are made is to inform policies that move physician and patient choices towards the social optimum, even as our framework for thinking about treat- ment choice still rests largely on models of local (i.e. individual) optimum.
The challenges are numerous, owing to the peculiarities of medicine. In this world where the very definition of optimality rests on numerous endogenous determinants, where the supplier who judges relative merits of treatments is the same supplier who directly benefits (or loses) from the decision, and where the appropriateness of patients for any given treatment is, at best, open to interpretation and, at worst, completely unknown, understanding the determinants of treatment choice will be an ever-evolving task.
