Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...
Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ... Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 14/2012Title: Patients’ decision making processAuthors: Ippoliti R. 1 ; Falavigna G. 2 ;Type: Original articleKeywords: Patient; Decision making process; Physician; Clinical Research;AbstractObject: this work tries to solve some open issues related to the patients’ decision makingprocess and their choice of the medical center for hospitalization among severalsuppliers of medical treatments;Methodology: taking behavioral bibliography into consideration, a decision making processis proposed;Results: this paper suggests that people’s choice are more reactive to the way in which amessage could be given (i.e. physicians’ framing strategy) than to the content of thatinformation;Conclusions: according to the gravitational behavior model, the physicians’ approach caninduce an overestimation of the net benefit from going to the hospital located inthe other region, higher than the net loss of consuming a quality level differentfrom the desired one in the residential one.1 S.S.A. SVILUPPO E PROMOZIONE SCIENTIFICAA.O. “SS. Antonio e Biagio e Cesare Arrigo” di AlessandriaTel: 0131.206818E-mail: rippoliti@ospedale.al.it;* Corresponding author2 CNR-CERIS;Via Real Collegio, 3010024 Moncalieri (Torino), ItalyTel.: 011.6824941, Fax: 011.6824966e-mail: g.falavigna@ceris.cnr.it1
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 14/20121. Decision making processLet us imagine a patient, a sick person who needs appropriate care. Obviously, assuming thatthere is an information gap, this person will go to his/her general practitioner in order toreceive appropriate medical treatment. An exchange of information occurs. On one side, thepatient shows the symptoms of that disease whereas, on the other side, the practitioner makesa diagnosis.According to Arrow (1963), medical care is the realm of uncertainty as well as ofasymmetrical information among parties, i.e. physicians and patients. Indeed, the generalpractitioner could be thought of as the link between medical care demand and supply. Thepractitioners’ medical knowledge is higher than the patients’ but, the former might not beable to make specific diagnoses or prescribe appropriate treatments since that knowledge, aswell as their personal experience, is general. In other words, a practitioner might be able torecognize and prescribe appropriate medical treatment only for simple cases, similarly towhat wise old men did in bygone ages. According to Pauly (1978), this is exactly the idea of“irreducible uncertainty” that is the state of general uncertainty about the initial health statusand effects of treatments, by both patients and physicians. This means that the generalpractitioner might easily order patients to undergo specific examinations in order to make abetter diagnosis. That is to say, a practitioner might easily delegate to another physician thepatient’s diagnosis, the prescription of medical treatment and its performance, as well as thechoice about potential hospitalization. 3In view of this, might patients be able to perceive a wrong diagnosis? In other words,considering the existence of this uncertainty, might a patient recognize the inappropriatenessof a prescription? Also, how could the choice of the medical center for hospitalization bedetermined by the patient?The relationship between patient and physician is based on the trust the latter puts in theformer’s diagnosis and relative prescription. According to the behavioral approach, this trustmight be based on the patient’s previous experience. 4 In other words, if the previousprescription was effective, there will be trust in the physician’s suggestions; otherwise, if the3 To see the issue from another prospective, this might be a case of defensive medicine. Indeed, according to Danzon (2000),this delegation process might be thought of as a case in which the physician conducts procedures to be protected againstlitigation.4 Jolls et al. (1998) suggest that the probabilities will often be affected by how “available” other instances are and,considering the available medical options, by the previous medical events. Indeed, taking asymmetrical information intoaccount, McGuire (2000) suggests that the medical outcome (i.e. patients’ health) could be one of the patients’ key indicatorsof physicians’ effort.2
- Page 98 and 99: Azienda Ospedaliera Nazionale“SS.
- Page 100 and 101: Azienda Ospedaliera Nazionale“SS.
- Page 102 and 103: Azienda Ospedaliera Nazionale“SS.
- Page 104 and 105: Azienda Ospedaliera Nazionale“SS.
- Page 106 and 107: Azienda Ospedaliera Nazionale“SS.
- Page 108 and 109: Azienda Ospedaliera Nazionale“SS.
- Page 110 and 111: Azienda Ospedaliera Nazionale“SS.
- Page 112 and 113: Azienda Ospedaliera Nazionale“SS.
- Page 114 and 115: Azienda Ospedaliera Nazionale“SS.
- Page 116 and 117: Azienda Ospedaliera Nazionale“SS.
- Page 118 and 119: Azienda Ospedaliera Nazionale“SS.
- Page 120 and 121: Azienda Ospedaliera Nazionale“SS.
- Page 122 and 123: Azienda Ospedaliera Nazionale“SS.
- Page 124 and 125: Azienda Ospedaliera Nazionale“SS.
- Page 126 and 127: Azienda Ospedaliera Nazionale“SS.
- Page 128 and 129: Azienda Ospedaliera Nazionale“SS.
- Page 130 and 131: Azienda Ospedaliera Nazionale“SS.
- Page 132 and 133: Azienda Ospedaliera Nazionale“SS.
- Page 134 and 135: Azienda Ospedaliera Nazionale“SS.
- Page 136 and 137: Azienda Ospedaliera Nazionale“SS.
- Page 138 and 139: Azienda Ospedaliera Nazionale“SS.
- Page 140 and 141: Azienda Ospedaliera Nazionale“SS.
- Page 142 and 143: Azienda Ospedaliera Nazionale“SS.
- Page 144 and 145: Azienda Ospedaliera Nazionale“SS.
- Page 146 and 147: Azienda Ospedaliera Nazionale“SS.
- Page 150 and 151: Azienda Ospedaliera Nazionale“SS.
- Page 152 and 153: Azienda Ospedaliera Nazionale“SS.
- Page 154 and 155: Azienda Ospedaliera Nazionale“SS.
- Page 156 and 157: Azienda Ospedaliera Nazionale“SS.
- Page 158 and 159: Azienda Ospedaliera Nazionale“SS.
- Page 160 and 161: Azienda Ospedaliera Nazionale“SS.
- Page 162 and 163: Azienda Ospedaliera Nazionale“SS.
- Page 164 and 165: Azienda Ospedaliera Nazionale“SS.
- Page 166 and 167: Azienda Ospedaliera Nazionale“SS.
- Page 168 and 169: Azienda Ospedaliera Nazionale“SS.
- Page 170 and 171: Azienda Ospedaliera Nazionale“SS.
- Page 172 and 173: Azienda Ospedaliera Nazionale“SS.
- Page 174 and 175: Azienda Ospedaliera Nazionale“SS.
- Page 176 and 177: Azienda Ospedaliera Nazionale“SS.
- Page 178 and 179: Azienda Ospedaliera Nazionale“SS.
- Page 180 and 181: Azienda Ospedaliera Nazionale“SS.
- Page 182 and 183: Azienda Ospedaliera Nazionale“SS.
- Page 184 and 185: Azienda Ospedaliera Nazionale“SS.
- Page 186 and 187: Azienda Ospedaliera Nazionale“SS.
- Page 188 and 189: Azienda Ospedaliera Nazionale“SS.
- Page 190 and 191: Azienda Ospedaliera Nazionale“SS.
- Page 192 and 193: Azienda Ospedaliera Nazionale“SS.
- Page 194 and 195: Azienda Ospedaliera Nazionale“SS.
- Page 196 and 197: Azienda Ospedaliera Nazionale“SS.
<strong>Azienda</strong> <strong>Ospedaliera</strong> Nazionale“SS. Antonio e Biagio e Cesare Arrigo”<strong>Working</strong> <strong>Paper</strong> <strong>of</strong> <strong>Public</strong> <strong>Health</strong>nr. 14/<strong>2012</strong>Title: Patients’ decision making processAuthors: Ippoliti R. 1 ; Falavigna G. 2 ;Type: Original articleKeywords: Patient; Decision making process; Physician; Clinical Research;AbstractObject: this work tries to solve some open issues related to the patients’ decision makingprocess and their choice <strong>of</strong> the medical center for hospitalization among severalsuppliers <strong>of</strong> medical treatments;Methodology: taking behavioral bibliography into consideration, a decision making processis proposed;Results: this paper suggests that people’s choice are more reactive to the way in which amessage could be given (i.e. physicians’ framing strategy) than to the content <strong>of</strong> thatinformation;Conclusions: according to the gravitational behavior model, the physicians’ approach caninduce an overestimation <strong>of</strong> the net benefit from going to the hospital located inthe other region, higher than the net loss <strong>of</strong> consuming a quality level differentfrom the desired one in the residential one.1 S.S.A. SVILUPPO E PROMOZIONE SCIENTIFICAA.O. “SS. Antonio e Biagio e Cesare Arrigo” di AlessandriaTel: 0131.206818E-mail: rippoliti@ospedale.al.it;* Corresponding author2 CNR-CERIS;Via Real Collegio, 3010024 Moncalieri (Torino), ItalyTel.: 011.6824941, Fax: 011.6824966e-mail: g.falavigna@ceris.cnr.it1