IDEAS home Printed from https://ideas.repec.org/p/hal/journl/hal-01385938.html
   My bibliography  Save this paper

Medical altruism in mainstream health economics: theoretical and political paradoxes

Author

Listed:
  • Philippe Batifoulier

    (EconomiX - EconomiX - UPN - Université Paris Nanterre - CNRS - Centre National de la Recherche Scientifique)

  • Nicolas da Silva

Abstract

In the field of healthcare, ethical considerations are omnipresent. The problem is that it is not clear how to introduce professional ethics within the frontiers demarcated by economic rationality. In mainstream economics, medical altruism is defined as the inclusion of the patient's welfare in the doctor's utility function. This definition presents two serious problems that we develop in this paper. The first problem is that mainstream theory does not propose a model of authentic altruism because it reduces otherness to a source of utility like any other. The second problemis that ethical and altruistic (instrumental or otherwise) behaviour should not be conflated. By reducing ethics to altruism, mainstream theory prevents any genuine discussion of medical ethics. Then, the thesis of the paper is that the attempt tointroduce altruism into the standard framework creates theoretical paradoxes that create policy dilemmas

Suggested Citation

  • Philippe Batifoulier & Nicolas da Silva, 2014. "Medical altruism in mainstream health economics: theoretical and political paradoxes," Post-Print hal-01385938, HAL.
    • Handle: RePEc:hal:journl:hal-01385938
    DOI: 10.1080/00346764.2014.927727
    Note: View the original document on HAL open archive server: https://hal.parisnanterre.fr/hal-01385938
    as

    Download full text from publisher

    File URL: https://hal.parisnanterre.fr/hal-01385938/document
    Download Restriction: no
    File URL: https://libkey.io/10.1080/00346764.2014.927727?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Levy-Garboua, Louis & Meidinger, Claude & Rapoport, Benoit, 2006. "The Formation of Social Preferences: Some Lessons from Psychology and Biology," Handbook on the Economics of Giving, Reciprocity and Altruism, in: S. Kolm & Jean Mercier Ythier (ed.), Handbook of the Economics of Giving, Altruism and Reciprocity, edition 1, volume 1, chapter 7, pages 545-613, Elsevier.
    2. Bruno S. Frey, 1997. "Not Just for the Money," Books, Edward Elgar Publishing, number 1183.
    3. Robert G. Evans, 1974. "Supplier-Induced Demand: Some Empirical Evidence and Implications," International Economic Association Series, in: Mark Perlman (ed.), The Economics of Health and Medical Care, chapter 10, pages 162-173, Palgrave Macmillan.
    4. John A. Rizzo & Richard J. Zeckhauser, 2003. "Reference Incomes, Loss Aversion, and Physician Behavior," The Review of Economics and Statistics, MIT Press, vol. 85(4), pages 909-922, November.
    5. Becker, Gary S, 1981. "Altruism in the Family and Selfishness in the Market Place," Economica, London School of Economics and Political Science, vol. 48(189), pages 1-15, February.
    6. Eric Delattre & Brigitte Dormont, 2003. "Fixed fees and physician‐induced demand: A panel data study on French physicians," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 741-754, September.
    7. Jack, William, 2005. "Purchasing health care services from providers with unknown altruism," Journal of Health Economics, Elsevier, vol. 24(1), pages 73-93, January.
    8. Neil Bruce & Michael Waldman, 1990. "The Rotten-Kid Theorem Meets the Samaritan's Dilemma," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 105(1), pages 155-165.
    9. Batifoulier, Philippe & Braddock, Louise & Latsis, John, 2013. "Priority setting in health care: from arbitrariness to societal values," Journal of Institutional Economics, Cambridge University Press, vol. 9(1), pages 61-80, March.
    10. Susan Rose-Ackerman, 1996. "Altruism, Nonprofits, and Economic Theory," Journal of Economic Literature, American Economic Association, vol. 34(2), pages 701-728, June.
    11. Damien J. A. Bazin & Jérôme Ballet, 2006. "Positive Ethics in Economics," Post-Print halshs-00727583, HAL.
    12. Woodward, Robert S. & Warren-Boulton, Frederick, 1984. "Considering the effects of financial incentives and professional ethics on `appropriate' medical care," Journal of Health Economics, Elsevier, vol. 3(3), pages 223-237, December.
    13. Philippe Batifoulier & Jean-Paul Domin & Maryse Gadreau, 2011. "Market Empowerment of the Patient: The French Experience," Review of Social Economy, Taylor & Francis Journals, vol. 69(2), pages 143-162.
    14. Geoffrey M. Hodgson, 2008. "An institutional and evolutionary perspective on health economics," Cambridge Journal of Economics, Cambridge Political Economy Society, vol. 32(2), pages 235-256, March.
    15. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    16. Liu, Ting & Ma, Ching-to Albert, 2013. "Health insurance, treatment plan, and delegation to altruistic physician," Journal of Economic Behavior & Organization, Elsevier, vol. 85(C), pages 79-96.
    17. Jérôme Ballet & Sébastien Barillot & Damien Bazin & François-Régis Mahieu, 2005. "Taking Moral Motivations into Consideration: An Internalist Point of View," Journal of Interdisciplinary Economics, , vol. 16(3), pages 271-287, April.
    18. Jon Elster, 1998. "Emotions and Economic Theory," Journal of Economic Literature, American Economic Association, vol. 36(1), pages 47-74, March.
    19. Khalil, Elias L., 2004. "What is altruism?," Journal of Economic Psychology, Elsevier, vol. 25(1), pages 97-123, February.
    20. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
    21. Hodgson, Geoffrey M., 2009. "Towards an alternative economics of health care," Health Economics, Policy and Law, Cambridge University Press, vol. 4(1), pages 99-114, January.
    22. David Bardey & Romain Lesur, 2006. "Optimal regulation of health system with induced demand and 'ex post' moral hazard," Annals of Economics and Statistics, GENES, issue 83-84, pages 279-293.
    23. Nancy Folbre & Robert Goodin, 2004. "Revealing Altruism," Review of Social Economy, Taylor & Francis Journals, vol. 62(1), pages 1-25.
    24. John C. Harsanyi, 1955. "Cardinal Welfare, Individualistic Ethics, and Interpersonal Comparisons of Utility," Journal of Political Economy, University of Chicago Press, vol. 63, pages 309-309.
    25. Siciliani, Luigi, 2009. "Paying for performance and motivation crowding out," Economics Letters, Elsevier, vol. 103(2), pages 68-71, May.
    26. Hausman, Daniel M & McPherson, Michael S, 1993. "Taking Ethics Seriously: Economics and Contemporary Moral Philosophy," Journal of Economic Literature, American Economic Association, vol. 31(2), pages 671-731, June.
    27. Roy J. Ruffin & Duane E. Leigh, 1973. "Charity, Competition, and the Pricing of Doctors' Services," Journal of Human Resources, University of Wisconsin Press, vol. 8(2), pages 212-222.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Nicolas da Silva, 2021. "The Industrialization of "Liberal Medicine" in France. A Labor Quality Conventions Approach," Post-Print hal-03185634, HAL.
    2. Florence Jany‐Catrice, 2022. "A political economy of social impact measurement," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 93(2), pages 267-291, June.
    3. Philippe Batifoulier & Rainer Diaz-Bone, 2022. "Perspectives on the economics and sociology of health. Contributions from the institutionalist approach of economics of convention -an introduction," CEPN Working Papers hal-03584852, HAL.
    4. Florence JANY-CATRICE, 2020. "Une économie politique des mesures d’impact social," CIRIEC Working Papers 2014, CIRIEC - Université de Liège.
    5. Philippe Batifoulier & Nicolas da Silva & Victor Duchesne, 2019. "The dynamics of conventions: the case of the French Social Security System," Post-Print hal-01994383, HAL.
    6. Philippe Batifoulier & Bruno Boidin & Jean-Paul Domin & Amandine Rauly, 2021. "La théorie économique à l’épreuve de la covid-19. Une lecture d’économie politique de la santé [Economic theory and covid-19. A reading by the political economy of health]," Revue de la Régulation - Capitalisme, institutions, pouvoirs, Association Recherche et Régulation, vol. 29.
    7. Philippe Batifoulier & Nicolas Da Silva, 2016. "Is physician behavior too serious a business to be left to economics? Reply to medical altruism in mainstream health economics: theoretical and political paradoxes," Review of Social Economy, Taylor & Francis Journals, vol. 74(2), pages 222-227, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Philippe Batifoulier & Nicolas Da Silva, 2014. "The economic behaviour of doctors: medical altruism without an ethic?," EconomiX Working Papers 2014-9, University of Paris Nanterre, EconomiX.
    2. Philippe Batifoulier & Nicolas Da Silva, 2014. "The economic behaviour of doctors: medical altruism without an ethic?," EconomiX Working Papers 2014-9, University of Paris Nanterre, EconomiX.
    3. Galina Besstremyannaya & Sergei Golovan, 2019. "Physician’s altruism in incentive contracts: Medicare’s quality race," CINCH Working Paper Series 1903, Universitaet Duisburg-Essen, Competent in Competition and Health.
    4. Godager, Geir & Wiesen, Daniel, 2013. "Profit or patients’ health benefit? Exploring the heterogeneity in physician altruism," Journal of Health Economics, Elsevier, vol. 32(6), pages 1105-1116.
    5. Anthony Scott & Peter Sivey, 2022. "Motivation and competition in health care," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1695-1712, August.
    6. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Wiesen, Daniel, 2016. "Physician performance pay: Evidence from a laboratory experiment," Ruhr Economic Papers 658, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    7. Jasmin Kantarevic & Boris Kralj, 2016. "Physician Payment Contracts in the Presence of Moral Hazard and Adverse Selection: The Theory and Its Application in Ontario," Health Economics, John Wiley & Sons, Ltd., vol. 25(10), pages 1326-1340, October.
    8. Kverndokk, Snorre & Rose, Adam, 2008. "Equity and Justice in Global Warming Policy," International Review of Environmental and Resource Economics, now publishers, vol. 2(2), pages 135-176, October.
    9. Marc Daube & David Ulph, 2016. "Moral Behaviour, Altruism and Environmental Policy," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 63(2), pages 505-522, February.
    10. Philippe Batifoulier & Nicolas Da Silva, 2016. "Is physician behavior too serious a business to be left to economics? Reply to medical altruism in mainstream health economics: theoretical and political paradoxes," Review of Social Economy, Taylor & Francis Journals, vol. 74(2), pages 222-227, June.
    11. Attema, Arthur E. & Galizzi, Matteo M. & Groß, Mona & Hennig-Schmidt, Heike & Karay, Yassin & L’Haridon, Olivier & Wiesen, Daniel, 2023. "The formation of physician altruism," Journal of Health Economics, Elsevier, vol. 87(C).
    12. Wilson, Nicholas, 2018. "Altruism in preventive health behavior: At-scale evidence from the HIV/AIDS pandemic," Economics & Human Biology, Elsevier, vol. 30(C), pages 119-129.
    13. Hennig-Schmidt, Heike & Wiesen, Daniel, 2014. "Other-regarding behavior and motivation in health care provision: An experiment with medical and non-medical students," Social Science & Medicine, Elsevier, vol. 108(C), pages 156-165.
    14. Wallis, Joe, 2006. "Evaluating economic theories of NPOs: A survey, a case study and some new directions for socio-economics," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 35(6), pages 959-979, December.
    15. Anthony Scott & Peter Sivey, 2017. "Motivation and Competition in Health Care," Melbourne Institute Working Paper Series wp2017n05, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    16. Khalil, Elias L., 2004. "What is altruism?," Journal of Economic Psychology, Elsevier, vol. 25(1), pages 97-123, February.
    17. Jeannette Brosig‐Koch & Heike Hennig‐Schmidt & Nadja Kairies‐Schwarz & Daniel Wiesen, 2017. "The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence," Health Economics, John Wiley & Sons, Ltd., vol. 26(2), pages 243-262, February.
    18. Brosig-Koch, Jeannette & Groß, Mona & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Wiesen, Daniel, 2021. "Physicians' incentives, patients' characteristics, and quality of care: A systematic experimental comparison of fee-for-service, capitation, and pay for performance," Ruhr Economic Papers 923, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    19. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2012. "Quality competition with profit constraints," Journal of Economic Behavior & Organization, Elsevier, vol. 84(2), pages 642-659.
    20. Philippe Batifoulier, 2014. "De l’aléa moral du patient aux inégalités d’accès aux soins," EconomiX Working Papers 2014-7, University of Paris Nanterre, EconomiX.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:hal:journl:hal-01385938. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: CCSD (email available below). General contact details of provider: https://hal.archives-ouvertes.fr/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.