Discounting and clinical decision making: physicians, patients, the general public, and the management of asymptomatic abdominal aortic aneurysms.
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.
Höjgård
S
S
Department of Community Medicine, Health Economics and Biostatistics, Malmö, Sweden. soren.hojgard@luche.lu.se
Enemark
U
U
Lyttkens
C H
CH
Lindgren
A
A
Troëng
T
T
Weibull
H
H
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003657:Decision Making; D005194:Family Practice / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*