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

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  • S. Höjgård
  • U. Enemark
  • C. H. Lyttkens
  • A. Lindgren
  • T. Troëng
  • H. Weibull

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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  • S. Höjgård & U. Enemark & C. H. Lyttkens & A. Lindgren & T. Troëng & H. Weibull, 2002. "Discounting and clinical decision making: Physicians, patients, the general public, and the management of asymptomatic abdominal aortic aneurysms," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 355-370, June.
    • Handle: RePEc:wly:hlthec:v:11:y:2002:i:4:p:355-370
    DOI: 10.1002/hec.674
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    References listed on IDEAS

    as
    1. John A. Cairns, 1994. "Valuing future benefits," Health Economics, John Wiley & Sons, Ltd., vol. 3(4), pages 221-229, July.
    2. John Cairns, 1992. "Discounting and health benefits: Another Perspective," Health Economics, John Wiley & Sons, Ltd., vol. 1(1), pages 76-79, April.
    3. Donald A. Redelmeier & Daniel N. Heller, 1993. "Time Preference in Medical Decision Making and Cost - Effectiveness Analysis," Medical Decision Making, , vol. 13(3), pages 212-217, August.
    4. 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.
    5. Gretchen B. Chapman & Arthur S. Elstein, 1995. "Valuing the Future," Medical Decision Making, , vol. 15(4), pages 373-386, October.
    6. Jan Abel Olsen, 1994. "Persons vs years: Two ways of eliciting implicit weights," Health Economics, John Wiley & Sons, Ltd., vol. 3(1), pages 39-46, January.
    7. Lowenstein, George & Prelec, Drazen, 1991. "Negative Time Preference," American Economic Review, American Economic Association, vol. 81(2), pages 347-352, May.
    8. Cairns, John & Van der Pol, Marjon, 1997. "Constant and decreasing timing aversion for saving lives," Social Science & Medicine, Elsevier, vol. 45(11), pages 1653-1659, December.
    9. Amiram Gafni & George W. Torrance, 1984. "Risk Attitude and Time Preference in Health," Management Science, INFORMS, vol. 30(4), pages 440-451, April.
    10. Kiefer, Nicholas M, 1988. "Economic Duration Data and Hazard Functions," Journal of Economic Literature, American Economic Association, vol. 26(2), pages 646-679, June.
    11. Eckerlund, Ingemar & Håkansson, Stefan, 1989. "Variations in resource utilization--The role of medical practice and its economic impact," Social Science & Medicine, Elsevier, vol. 28(2), pages 165-173, January.
    12. Jianakoplos, Nancy Ammon & Bernasek, Alexandra, 1998. "Are Women More Risk Averse?," Economic Inquiry, Western Economic Association International, vol. 36(4), pages 620-630, October.
    13. Ulrika Enemark & Carl H. Lyttkens & Thomas Troëng & Henrik Weibull & Jonas Ranstam, 1998. "Implicit Discount Rates of Vascular Surgeons in the Management of Abdominal Aortic Aneurysms," Medical Decision Making, , vol. 18(2), pages 168-177.
    14. Ainslie, George, 1991. "Derivation of "Rational" Economic Behavior from Hyperbolic Discount Curves," American Economic Review, American Economic Association, vol. 81(2), pages 334-340, May.
    15. Michael Parsonage & Henry Neuburger, 1992. "Discounting and health benefits," Health Economics, John Wiley & Sons, Ltd., vol. 1(1), pages 71-76, April.
    16. Horowitz, John K & Carson, Richard T, 1990. "Discounting Statistical Lives," Journal of Risk and Uncertainty, Springer, vol. 3(4), pages 403-413, December.
    17. Cropper, Maureen L & Aydede, Sema K & Portney, Paul R, 1992. "Rates of Time Preference for Saving Lives," American Economic Review, American Economic Association, vol. 82(2), pages 469-472, May.
    18. 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, July.
    19. Cropper, Maureen L & Aydede, Sema K & Portney, Paul R, 1994. "Preferences for Life Saving Programs: How the Public Discounts Time and Age," Journal of Risk and Uncertainty, Springer, vol. 8(3), pages 243-265, May.
    20. Olsen, Jan Abel, 1993. "On what basis should health be discounted?," Journal of Health Economics, Elsevier, vol. 12(1), pages 39-53, April.
    21. Jan Abel Olsen, 1993. "Time preferences for health gains: An empirical investigation," Health Economics, John Wiley & Sons, Ltd., vol. 2(3), pages 257-265, October.
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    1. Simon Jean-Baptiste Combes & Alain Paraponaris & Yann Videau, 2019. "French GPs’ Willingness to Delegate Tasks: May Financial Incentives Balance Risk Aversion?," Working Papers halshs-02071522, HAL.
    2. Stefan A. Lipman & Arthur E. Attema, 2024. "A systematic review of unique methods for measuring discount rates," Journal of Risk and Uncertainty, Springer, vol. 69(2), pages 145-189, October.
    3. Irvine, Alastair & van der Pol, Marjon & Phimister, Euan, 2019. "A comparison of professional and private time preferences of General Practitioners," Social Science & Medicine, Elsevier, vol. 222(C), pages 256-264.

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