Discounting and clinical decision making: Physicians, patients, the general public, and the management of asymptomatic abdominal aortic aneurysms

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Discounting and clinical decision making: Physicians, patients, the general public, and the management of asymptomatic abdominal aortic aneurysms

Author Info

S. Höjgård
U. Enemark (Institute for Public Health - Health Economics, Odense University, Denmark)
C. H. Lyttkens
A. Lindgren (Department of Mathematical Statistics, Lund University, Sweden)
T. Troëng (Kirurgkliniken Blekingesjukhuset, Sweden)
H. Weibull (Praktikertjänst AB, Stockholm, Sweden)

Abstract

Clinical decisions often entail in intertemporal trade-off. Moreover, they often involve physicians of different specialities. In an experiment dealing with the management of small asymptomatic abdominal aortic aneurysms (a clinically relevant problem) we find that specialists in internal medicine exhibit higher implicit discount rates than vascular surgeons, general practitioners, and actual and prospective patients. Several personal characteristics expected to be directly related to pure time-preference and risk aversion (gender, smoking habits, age, place of employment) have the hypothesised effects. Additionally, financial incentives appear to affect the estimated implicit discount rates of physicians, but are unlikely to have caused the inter-group differences. Differences in discount rates could lead to variations in clinical practice, which may conflict with equality of treatment or equal access to health care. Copyright © 2002 John Wiley & Sons, Ltd.

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Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 11 (2002)
Issue (Month): 4 ()
Pages: 355-370
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Handle: RePEc:wly:hlthec:v:11:y:2002:i:4:p:355-370

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Horowitz, John K & Carson, Richard T, 1990. " Discounting Statistical Lives," Journal of Risk and Uncertainty, Springer, vol. 3(4), pages 403-13, December.
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Lowenstein, George & Prelec, Drazen, 1991. "Negative Time Preference," American Economic Review, American Economic Association, vol. 81(2), pages 347-52, May.
Kiefer, Nicholas M, 1988. "Economic Duration Data and Hazard Functions," Journal of Economic Literature, American Economic Association, vol. 26(2), pages 646-79, June. [Downloadable!] (restricted)
John A. Cairns & Marjon M. Van Der Pol, 1997. "Saving future lives. A comparison of three discounting models," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 341-350.
Jianakoplos, Nancy Ammon & Bernasek, Alexandra, 1998. "Are Women More Risk Averse?," Economic Inquiry, Oxford University Press, vol. 36(4), pages 620-30, October.
Powell, Melanie & Ansic, David, 1997. "Gender differences in risk behaviour in financial decision-making: An experimental analysis," Journal of Economic Psychology, Elsevier, vol. 18(6), pages 605-628, November. [Downloadable!] (restricted)

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