Physician Agency | ScienceGate

I examine physician agency in health care services in the context of the choice between brand-name and generic pharmaceuticals. I examine micro-panel data from Japan, where physicians can legally make profits by prescribing and dispensing drugs. The results indicate that physicians often fail to internalize patient costs, explaining why cheaper generics are infrequently adopted. Doctors respond to markup differentials between the two versions, indicating another agency problem. However, generics' markup advantages are short-lived, which limits their impact on increasing generic adoption. Additionally, state dependence and heterogeneous doctor preferences affected generics' adoption. Policy makers can target these factors to improve static efficiency. (JEL D82, I11, J44, L65)

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Physician agency in China: Evidence from a drug-percentage incentive scheme

Journal of Development Economics ◽

10.1016/j.jdeveco.2019.05.007 ◽

2019 ◽

Vol 140 ◽

pp. 72-89

Author(s):

Bingxiao Wu

Keyword(s):

Incentive Scheme ◽

Physician Agency

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Health Care Reform and Patients' Trust in Physicians in Urban Beijing

The China Quarterly ◽

10.1017/s0305741012000859 ◽

2012 ◽

Vol 211 ◽

pp. 827-843 ◽

Cited By ~ 10

Author(s):

Waikeung Tam

Keyword(s):

Health Care ◽

Information Provision ◽

Urban China ◽

Public Hospitals ◽

Interpersonal Competence ◽

Physician Agency ◽

Media Reports ◽

Self Reported Health Status ◽

High Level ◽

Trust In Physicians

AbstractThe Chinese health care system has experienced profound changes in recent decades, including the retrenchment of government financial support. These changes and their subsequent adverse impacts have prompted the Chinese media and some academics to suggest that patients have a relatively low level of trust in physicians in China today. As the first step in exploring the state of patient trust in physicians in public hospitals in urban China, and its determinants, we conducted a survey of 434 patients from 26 public hospitals in urban Beijing between December 2009 and January 2010. Conducted by the Horizon Research Group, our survey asked the patient respondents how they viewed the physicians they were currently seeing, focusing on the following dimensions of trust: physician agency, technical competence, interpersonal competence, and information provided by physicians. Our survey results show a relatively high level of patients' trust in their physicians. Moreover, our in-patient respondents reported a higher level of trust than out-patient respondents with regard to physician agency, interpersonal competence and information provision. Regression analyses also find that patients' self-reported health status, the level of public hospitals from which they received treatment, the duration of their illness, and the frequency of exposure to negative media reports of physicians and hospitals are important determinants of patients' trust in physicians.

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An Exploration of Knowledge and Attitudes of Medical Students and Rheumatologists to Placebo and Nocebo Effects: Threshold Concepts in Clinical Practice

Journal of Medical Education and Curricular Development ◽

10.1177/2382120520930764 ◽

2020 ◽

Vol 7 ◽

pp. 238212052093076

Author(s):

Mark H Arnold ◽

Damien Finniss ◽

Georgina M Luscombe ◽

Ian Kerridge

Keyword(s):

Clinical Practice ◽

Medical Students ◽

Patient Outcomes ◽

Health Care Professionals ◽

Negative Effects ◽

Knowledge And Attitudes ◽

Practical Ethics ◽

Ethical Status ◽

Physician Agency ◽

Nocebo Effects

Introduction: Understanding placebo and nocebo responses (context/meaning effects [CMEs]) is fundamental to physician agency. Specific instruction in CMEs is often lacking in medical education. Patient–practitioner interactions may challenge medical students’ understanding of biomedical causality and the nexus between this, practical ethics and professionalism across various conceptual and applied aspects of CMEs. This study compared the corpus of knowledge and phronesis related to CMEs between Australian graduate medical students and rheumatologists to gain a sophisticated understanding of this relationship to inform curriculum development. Method: In 2013 and 2014, the authors surveyed third-year medical students undertaking a graduate programme in an Australian medical school and Australian rheumatologists to ascertain their understanding of placebo and nocebo responses. The survey ascertained (1) the alignment of the respondents’ understanding of CMEs with accepted facts and concepts; (2) opinions on the ethical status of CMEs; and (3) responses to 2 scenarios designed to explore matters of biomedical causality, practical ethics and professionalism. Results: There were 88 completed surveys returned, 53 rheumatologists and 35 students. Similar proportions within each group identified CMEs, with most (n = 79/88 [89.8%]) correctly recognising a placebo (rheumatologists: 50 [94.3%], students: 29 [82.9%]) and approximately three-quarters (n = 65/88 [73.9%]) correctly recognising nocebo effects (rheumatologists: 39 [73.6%], students: 26 [74.3%]). Statistically significant differences between practitioners and students were observed in relation to the following: placebo responders and placebo responsiveness; placebos as a ‘diagnostic tool’; placebos usage in clinical practice and research, and nocebo effects. Conclusions: Physicians require an awareness of CMEs and the fact that they arise from and influence the effective agency of health care professionals. Curricular emphasis is needed to permit an honest assessment of the components that influence when, how and why patient outcomes arise, and how one’s agency might have neutral or negative effects but could be inclined towards positive and away from negative patient outcomes.

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Establishing Appropriate Agency Relationships for Providers in China

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958019872348 ◽

2019 ◽

Vol 56 ◽

pp. 004695801987234

Author(s):

Yu Liu ◽

Richard B. Saltman

Keyword(s):

Health Care ◽

Health Care Reform ◽

Financial Incentives ◽

Health Care Facilities ◽

Public Hospitals ◽

Multiple Roles ◽

Chinese Patients ◽

Chinese Government ◽

Physician Agency

Physicians play multiple roles in a health system. They typically serve simultaneously as the agent for patients, for insurers, for their own medical practices, and for the hospital facilities where they practice. Theoretical and empirical results have demonstrated that financial relations among these different stakeholders can affect clinical outcomes as well as the efficiency and quality of care. What are the physicians’ roles as the agents of Chinese patients? The marketization approach of China’s economic reforms since 1978 has made hospitals and physicians profit-driven. Such profit-driven behavior and the financial tie between hospitals and physicians have in turn made physicians more the agents of hospitals rather than of their patients. While this commentary acknowledges physicians’ ethics and their dedication to their patients, it argues that the current physician agency relation in China has created barriers to achieving some of the central goals of current provider-side health care reform efforts. In addition to eliminating existing perverse financial incentives for both hospitals and physicians, the need for which is already agreed upon by numerous scholars, we argue that the success of the ongoing Chinese public hospital reform and of overall health care reform also relies on establishing appropriate physician-hospital agency relations. This commentary proposes 2 essential steps to establish such physician-hospital agency relations: (1) minimize financial ties between senior physicians and tertiary-level public hospitals by establishing a separate reimbursement system for senior physicians, and (2) establishing a comprehensive physician professionalism system underwritten by the Chinese government, professional physician associations, and major health care facilities as well as by physician leadership representatives. Neither of these suggestions is addressed adequately in current health care reform activities.

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