GPs' shifting agencies in choice of treatment

Earlier studies have shown that general practitioners' (GPs) prescription choices are influenced by effect, patient costs and costs to society, patient attitude and own experience. This study builds on this knowledge and explores how prescription behaviour is affected when choices are made in different contexts, where the conflicting roles as agents for the patient and agents for society are stressed. A total of 309 Danish GPs were randomly allocated to one of three versions of a web-based questionnaire, which included a discrete choice experiment. Mixed logit models in willingness to pay (WTP) space were estimated with and without accounting for stated attribute non-attendance. Results show that the GP's role as agent for his patients is clearly strengthened in the presence of national recommendations. In contrast, when recommendations are not present and when GPs face a patient who is currently taking an expensive albeit effective medication, the GP takes on his role as agent for society. We find no evidence of status quo bias in such a setting, with a majority of GPs opting for a medication which offers less certainty about effectiveness at lower cost.