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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 14/20122. DiscussionThis paper has described the decisional process of a patient. According to their personalexperience and/or the experience of somebody close to them, there could be anoverestimation (or underestimation) of the expected output of the medical treatment, whichmakes it possible to estimate that there is a net benefit from going to the hospital located inthe other region (i.e. gravitational behavior model). On the one hand, there is a perception ofwhat your home medical system could be whereas, on the other hand, there is the perceptionof what another system could be. Even if there is an information gap, the physician’sapproach might trigger this perception, pushing sick people to move towards a better place,i.e. towards a place where the reputation of the medical care system is better. This is exactlythe key hypothesis of the patients’ decisional process: the physician’s approach is themotivating factor of the patient’s perception, that is to say an approach that might validate (ornot) the reputation of a medical care facility and start (or not) a mobility process. Accordingto the gravitational behavior model, the physicians’ approach can induce an overestimation ofthe net benefit from going to the hospital located in the other region, higher than the net lossof consuming a quality level different from the desired one in the residential one.Starting from that decisional process, there could be a potential development in an empiricalanalysis aimed at supporting the main result of this work: the (positive) role ofpharmaceutical clinical research in the patients’ mobility process, i.e. the choice of a medicalfacility to receive hospitalization. Obviously, considering the specific national background,also the (negative) role of political influence could be analyzed to better support the proposeddecision making process based on people’s perception.BibliographyAppelbaum P.S. (2002) Clarifying the Ethics of Clinical Research: A path toward Avoidingthe Therapeutic Misconception. American Journal of Bioethics, 2(2):22-23Appelbaum P.S., Roth L.H., Lidz C., Benson P., Winslade W. (1987) False Hope and BestData: Consent to Research and the Therapeutic Misconception. Hasting Center Report, April:20-24instead of saying “that hospital is fantastic, they make laparoscopic cholecystectomy in a beautiful way…”.Obviously, this approach is coherent with the idea of people affected by bounded rationality (i.e. technicallanguage).7
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 14/2012Arrow, K.J. (1963). "Uncertainty and the Welfare Economics of Medical Care". AmericanEconomic Review, 53 (5)., pp. 941-973.Daugherty C.K. (1999) Impact of Therapeutic Research on Informed Consent and the Ethicsof Clinical Trials: A Medical Oncology Perspective. Journal of Clinical Oncology,17(5):1601-1617Emanuel E.J. (1995) A phase I Trial on the Ethics of Phase I Trials. Journal of ClinicalOncology, 13(5):1049-1051Freedman B. (1990) Cohort-Specific Consent: An Honest Approach to Phase I ClinicalCancer Studies. IRB, 12(1):5-7Ippoliti R. (2010). “The market of human experimentation”. European Journal of Law andEconomics, DOI: 10.1007/s10657-010-9190-y.Jolls C., Sunstein C.R., Thaler R. (1998). A Behavioral Approach to Law and Economics;Stanford Law Review, Vol. 50, May 1998.Kahneman D. and Tversky A. (1979). “Prospect Theory: An Analysis of Decision UnderRisk”, Econometrica, 47(2), pp. 263-291.McGuire T.G. (2000), “Physician Agency” in: A.J. Culyer and J.P. Newhouse, Handbook ofHealth Economics, volume 1, chapter 9, pp. 461-536, Elsevier Science B.V..Miller M. (2000) Phase I Cancer Trials: A collusion of Misunderstanding. Hasting CenterReport, 30(4):34-42Pauly M.V. (1978), “Is medical care different?” in: Greenberg ed., Competition in the HealthCareSector: Past, Present and Future (Aspen System Corporation).Sankar P. (2004). “Communication and Miscommunication in Informed Consent toResearch”. Medical Anthropology Quarterly, Vol. 18, Issue 4, pp. 429-446.Danzon, P.M. (2000), “Liability for medical malpractice”, in: A.J. Culyer and J.P. Newhouse,eds., Handbook of Health Economics (Elsevier, Amsterdam) chapter 26.8
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