International Research Collaborative for Health Economic Experiments

Knowledge about how policy changes affect the behavior of those who make medical decisions in the health sector is required when developing health policies. The aim of this project was to contribute with such knowledge by conducting experiments. Economic laboratory experiments have been carried out, in which the participants in the experiments receive payment dependent on the choices they make in the experiment. A randomized field experiment was also conducted, which enabled us to investigated whether physicians' treatment of patients (prescription of medicines) is influenced by providing information to doctors that their quality of treatment will be assessed by a third party in the near future. The results indicate that doctors' current treatment of patients will change if the doctors are told that a quality assessment will take place in the near future. In the case of services provided by general medical practitioners, patients can choose which physician they want to consult, and patients can switch doctors if they are not satisfied. In such a situation, doctors in the same area are in a competitive situation, where decisions made by a physician can affect the number of patients requesting this physician?s services. One of the project's contributions explores new models for strategic behavior in medical markets where treatment decisions can affect demand for physician services. We contribute with new knowledge on how individuals adapt to changes in the competitive situation. In addition, we provide new knowledge on the accuracy of statistical methods for analyzing these type of strategic choices. An important question in the health sector is whether patients should pay out-of-pocket for receiving health care and, if so, how large the out-of-pocket payments should be. In one of the contributions from the project, we contributed with new knowledge relevant to the discussion of how large the out-of-pocket payments should be. We show that medical students care about the level of patient's out-of-pocket payments, and that the amount of out-of-pocket payment influence the doctor's choice of treatment.

Prosjektet ble utformet for å svare på uttalte målsetninger om å initiere forskning med stor vekt på faglig fornyelse ved å prøve ut nye og dristige ideer. Et av resultatene tyder på at legenes behandling av pasienter endres dersom legene får vite at kvalitetsvurdering vil skje i framtiden. Vi bidrar med ny kunnskap om hvordan individer tilpasser seg ved økt konkurranse, resultatene tyder på at beslutningstakere opptrer mer rasjonelt ved økt konkurranse. Et viktig spørsmål er hvorvidt pasienter bør betale egenandeler for helsetjenester og, i så fall, hvor store egenandeler bør være. Vi bidrar med ny kunnskap som er relevant for denne diskusjonen. Vi viser at medisinstudenter bryr seg om nivået på pasientens egenbetaling, og at størrelsen på egenandelen påvirker valg av behandling. Resultatene fra prosjektet har relevans for utvikling av helsepolitikk, og utforming av kvalitetssikringssystemer i helsesektoren.

The need for evidence-based policy has been an important rationale for addressing research questions concerning physician behavior. The aim of this project is to contribute with new knowledge on physician behavior that is necessary in order to design and implement payment systems and market regulations to encourage improvements in cost control, cost efficiency and quality in the provision of medical care. This knowledge is of fundamental importance for society: Many countries are experiencing rapidly incr easing health care expenditures and an even faster expenditure growth is expected in the near future due to population aging. In addition, there is an increasing consumer awareness of health issues, and consumers' expectations for the quality of services are rising. In the health economic literature, assumptions regarding physician altruism are necessary to address numerous research questions related to health insurance, provider payment and physicians' decisions of treatment and referral. In spite of i ts considerable importance there is little empirical knowledge on physician altruism. This proposal is an answer to the call for researchers to conduct more thorough empirical analysis on physician altruism in order to provide reliable policy recommendati ons. We will generate data by means of carefully conducted economic experiments where causal inference has a high degree of realism. To enhance the project's quality and feasibility, an international group comprising carefully selected, world-class resear chers is established. By applying new methods and addressing research questions which are of substantial importance to policymakers as well as to researchers at the frontier in health economic research, it is highly likely that the research group will pro vide important contributions by publications in high ranking journals.