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 - 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. 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.
    2. 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.
    3. Bruno S. Frey, 1997. "Not Just for the Money," Books, Edward Elgar Publishing, number 1183.
    4. Neil Bruce & Michael Waldman, 1990. "The Rotten-Kid Theorem Meets the Samaritan's Dilemma," The Quarterly Journal of Economics, Oxford University Press, vol. 105(1), pages 155-165.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. Jack, William, 2005. "Purchasing health care services from providers with unknown altruism," Journal of Health Economics, Elsevier, vol. 24(1), pages 73-93, January.
    11. Nancy Folbre & Robert Goodin, 2004. "Revealing Altruism," Review of Social Economy, Taylor & Francis Journals, vol. 62(1), pages 1-25.
    12. Siciliani, Luigi, 2009. "Paying for performance and motivation crowding out," Economics Letters, Elsevier, vol. 103(2), pages 68-71, May.
    13. Susan Rose-Ackerman, 1996. "Altruism, Nonprofits, and Economic Theory," Journal of Economic Literature, American Economic Association, vol. 34(2), pages 701-728, June.
    14. Damien Bazin & Jérôme Ballet, 2006. "Positive Ethics in Economics," Post-Print halshs-00727583, HAL.
    15. 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.
    16. 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.
    17. Geoffrey M. Hodgson, 2008. "An institutional and evolutionary perspective on health economics," Cambridge Journal of Economics, Oxford University Press, vol. 32(2), pages 235-256, March.
    18. 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.
    19. Jon Elster, 1998. "Emotions and Economic Theory," Journal of Economic Literature, American Economic Association, vol. 36(1), pages 47-74, March.
    20. 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.
    21. 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.
    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. Florence JANY-CATRICE, 2020. "Une économie politique des mesures d’impact social," CIRIEC Working Papers 2014, CIRIEC - Université de Liège.
    2. Nicolas da Silva, 2021. "The Industrialization of "Liberal Medicine" in France. A Labor Quality Conventions Approach," Post-Print hal-03185634, HAL.
    3. 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.
    4. 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.

    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. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. Khalil, Elias L., 2004. "What is altruism?," Journal of Economic Psychology, Elsevier, vol. 25(1), pages 97-123, February.
    8. 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.
    9. Seema Kacker & Tin Aung & Dominic Montagu & David Bishai, 2021. "Providers preferences towards greater patient health benefit is associated with higher quality of care," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 271-294, September.
    10. Kevin E. Pflum, 2015. "Physician Incentives and Treatment Choice," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 24(4), pages 712-751, October.
    11. Elias Asproudis, 2011. "Revisiting environmental groups and members’ behaviour: budget, size and (im)pure altruism," Environmental Economics and Policy Studies, Springer;Society for Environmental Economics and Policy Studies - SEEPS, vol. 13(2), pages 139-156, June.
    12. 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.
    13. Bassi, Matteo & Pagnozzi, Marco & Piccolo, Salvatore, 2014. "Optimal contracting with altruism and reciprocity," Research in Economics, Elsevier, vol. 68(1), pages 27-38.
    14. Olivella, Pau & Siciliani, Luigi, 2017. "Reputational concerns with altruistic providers," Journal of Health Economics, Elsevier, vol. 55(C), pages 1-13.
    15. Godager, Geir & Hennig-Schmidt, Heike & Iversen, Tor, 2016. "Does performance disclosure influence physicians’ medical decisions? An experimental study," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 36-46.
    16. Yaping Wu & David Bardey & Yijuan Chen & Sanxi Li, 2021. "Health care insurance policies When the provider and patient may collude," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 525-543, March.
    17. Simona Grassi & Ching-to Albert Ma, 2016. "Information acquisition, referral, and organization," RAND Journal of Economics, RAND Corporation, vol. 47(4), pages 935-960, November.
    18. Cox, Donald & Eser, Zekeriya & Jimenez, Emmanuel, 1998. "Motives for private transfers over the life cycle: An analytical framework and evidence for Peru," Journal of Development Economics, Elsevier, vol. 55(1), pages 57-80, February.
    19. Fang, Hai & Rizzo, John A., 2009. "Competition and physician-enabled demand: The role of managed care," Journal of Economic Behavior & Organization, Elsevier, vol. 72(1), pages 463-474, October.
    20. Olivier Thevenon & Philippe Batifoulier, 2003. "L'éthique (médicale) est elle soluble dans le calcul économique?," Post-Print hal-00442960, HAL.

    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.

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

    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 hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.