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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

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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  • Grytten, Jostein & Skau, Irene & Sørensen, Rune, 2011. "Do expert patients get better treatment than others? Agency discrimination and statistical discrimination in obstetrics," Journal of Health Economics, Elsevier, vol. 30(1), pages 163-180, January.
  • Handle: RePEc:eee:jhecon:v:30:y:2011:i:1:p:163-180
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    2. Chen, Stacey H. & Chen, Jennjou & Chuang, Hongwei & Lin, Tzu-Hsin, 2023. "Physicians Treating Physicians: Relational and Informational Advantages in Treatment and Survival," IZA Discussion Papers 16048, Institute of Labor Economics (IZA).
    3. Zamora, Paula & Mantilla, César & Blanco, Mariana, 2021. "Price discrimination in informal labor markets in Bogotá: an audit experiment during the 2018 FIFA World Cup," Journal for Labour Market Research, Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany], vol. 55, pages 1-6.
    4. Amy Finkelstein & Petra Persson & Maria Polyakova & Jesse M. Shapiro, 2022. "A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise," American Economic Review: Insights, American Economic Association, vol. 4(4), pages 507-526, December.
    5. Aleksandr Proshin & Alexandre Cazenave-Lacroutz & Zeynep Or & Lise Rochaix, 2018. "Impact of Diagnosis Related Group Refinement on the Choice Between Scheduled Caesarean Section and Normal Delivery: Recent Evidence from France," Working Papers halshs-01812107, HAL.
    6. Fiva, Jon H. & Hægeland, Torbjørn & Rønning, Marte & Syse, Astri, 2014. "Access to treatment and educational inequalities in cancer survival," Journal of Health Economics, Elsevier, vol. 36(C), pages 98-111.
    7. David Card & Alessandra Fenizia & David Silver, 2019. "The Health Impacts of Hospital Delivery Practices," NBER Working Papers 25986, National Bureau of Economic Research, Inc.
    8. Erin M. Johnson & M. Marit Rehavi, 2016. "Physicians Treating Physicians: Information and Incentives in Childbirth," American Economic Journal: Economic Policy, American Economic Association, vol. 8(1), pages 115-141, February.
    9. Jostein Grytten & Lars Monkerud & Irene Skau & Anne Eskild & Rune J. Sørensen & Ola Didrik Saugstad, 2017. "Saving Newborn Babies – The Benefits of Interventions in Neonatal Care in Norway over More Than 40 Years," Health Economics, John Wiley & Sons, Ltd., vol. 26(3), pages 352-370, March.
    10. Elisabeth Artmann & Hessel Oosterbeek & Bas van der Klaauw, 2022. "Do Doctors Improve the Health Care of Their Parents? Evidence from Admission Lotteries," American Economic Journal: Applied Economics, American Economic Association, vol. 14(3), pages 164-184, July.
    11. Grytten, Jostein & Skau, Irene & Sørensen, Rune, 2017. "The impact of the mass media on obstetricians’ behavior in Norway," Health Policy, Elsevier, vol. 121(9), pages 986-993.
    12. Jakobsson, Niklas & Kotsadam, Andreas & Syse, Astri & Øien, Henning, 2016. "Gender bias in public long-term care? A survey experiment among care managers," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 126-138.
    13. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    14. Jostein Grytten & Irene Skau & Rune Sørensen, 2013. "Do Mothers Decide? The Impact of Preferences in Healthcare," Journal of Human Resources, University of Wisconsin Press, vol. 48(1), pages 142-168.
    15. David Card & Alessandra Fenizia & David Silver, 2018. "The Health Effects of Cesarean Delivery for Low-Risk First Births," NBER Working Papers 24493, National Bureau of Economic Research, Inc.

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