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

  • Grytten, Jostein
  • Skau, Irene
  • Sørensen, Rune
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    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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    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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    3. 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.
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    5. 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.
    6. Andrew Epstein & Sean Nicholson, 2005. "The Formation and Evolution of Physician Treatment Styles: An Application to Cesarean Sections," NBER Working Papers 11549, National Bureau of Economic Research, Inc.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
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