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Do expert patients get better treatment than others? Agency discrimination and statistical discrimination in obstetrics

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  • Grytten, Jostein
  • Skau, Irene
  • Sørensen, Rune
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    Abstract

    We address models that can explain why expert patients (obstetricians, midwives and doctors) are treated better than non-experts (mainly non-medical training). Models of statistical discrimination show that benevolent doctors treat expert patients better, since experts are better at communicating with the doctor. Agency theory suggests that doctors have an incentive to limit hospital costs by distorting information to non-expert patients, but not to expert patients. The hypotheses were tested on a large set of data, which contained information about the highest education of the parents, and detailed medical information about all births in Norway during the period 1967-2005 (Medical Birth Registry). The empirical analyses show that expert parents have a higher rate of Caesarean section than non-expert parents. The educational disparities were considerable 40 years ago, but have become markedly less over time. The analyses provide support for statistical discrimination theory, though agency theory cannot be totally excluded.

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    Bibliographic Info

    Article provided by Elsevier in its journal Journal of Health Economics.

    Volume (Year): 30 (2011)
    Issue (Month): 1 (January)
    Pages: 163-180

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    Handle: RePEc:eee:jhecon:v:30:y:2011:i:1:p:163-180

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    Web page: http://www.elsevier.com/locate/inca/505560

    Related research

    Keywords: Statistical discrimination Agency theory Caesarean section Expert patients Disparities;

    References

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    1. Epstein, Andrew J. & Nicholson, Sean, 2009. "The formation and evolution of physician treatment styles: An application to cesarean sections," Journal of Health Economics, Elsevier, vol. 28(6), pages 1126-1140, December.
    2. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, vol. 18(4), pages 473-490, August.
    3. Dennis J. Aigner & Glen G. Cain, 1977. "Statistical theories of discrimination in labor markets," Industrial and Labor Relations Review, ILR Review, Cornell University, ILR School, vol. 30(2), pages 175-187, January.
    4. Lin, Herng-Ching & Xirasagar, Sudha & Kao, Senyeong, 2004. "Association of hospital ownership with patient transfers to outpatient care under a prospective payment system in Taiwan," Health Policy, Elsevier, vol. 69(1), pages 11-19, July.
    5. Darren Grant, 2008. "Physician Financial Incentives and Cesarean Delivery: New Conclusions from the Healthcare Cost and Utilization Project," Working Papers 0801, Sam Houston State University, Department of Economics and International Business.
    6. Leone, Tiziana & Padmadas, Sabu S. & Matthews, Zoë, 2008. "Community factors affecting rising caesarean section rates in developing countries: An analysis of six countries," Social Science & Medicine, Elsevier, vol. 67(8), pages 1236-1246, October.
    7. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-96, December.
    8. Arima, Yuzo & Guthrie, Brandon L. & Rhew, Isaac C. & De Roos, Anneclaire J., 2009. "The impact of the First Steps prenatal care program on birth outcomes among women receiving Medicaid in Washington State," Health Policy, Elsevier, vol. 92(1), pages 49-54, September.
    9. Brown, Iii, H. Shelton, 2007. "Lawsuit activity, defensive medicine, and small area variation: the case of cesarean sections revisited," Health Economics, Policy and Law, Cambridge University Press, vol. 2(03), pages 285-296, July.
    10. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
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    Cited by:
    1. Jon H. Fiva, & Torbjørn Hægeland & Marte Rønning & Astri Syse, 2013. "Access to treatment and educational inequalities in cancer survival," Discussion Papers 735, Research Department of Statistics Norway.

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