PhD: Applying economic methods to optimise self-management

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Chronic conditions are illnesses that have no cure and for which current care can only control symptoms. In Scotland, it is estimated that nearly 40% of the population lives with at least one chronic condition. Self-management of chronic conditions occurs when the patient acts as the primary decision-maker in the treatment of her/his condition. This PhD thesis uses econometric analysis of secondary data to investigate the effect of preferences and personality on self-management of chronic conditions. From an economic perspective, the decision to self-manage can be described as an investment in health because it incurs immediate costs to produce future health. A key economic factor that affects an individual’s intertemporal decision-making is time preference, which describes an individual’s propensity for immediate benefits over delayed ones. Furthermore, future health is inherently uncertain, and individuals’ risk preference may also be an important factor affecting the type and quantity of self-management activities adopted. Beyond classic economic models, this thesis also explores the effect of health on individuals’ time preference, which is often assumed to be exogenous. 


Outcome and Translation

This thesis produced several important novel findings. First, it was found that the time discount rate was associated with maintained physical activity participation but not healthy eating or low-risk alcohol consumption. Second, economic insecurity, defined as the anxiety produced from an unsafe financial future, was associated with smoking in women and physical activity in men. Finally, to investigate whether health itself may influence perceptions of the future, the effect of a lagged health shock was modelled as a proxy for the time discount rate. It was found that a health shock led women to become more future-oriented whilst the opposite occurred amongst men. Overall, it is concluded that the findings of this thesis could be used in the development of policy and interventions to support uptake and adherence of self-management regimes for people with long-term conditions.


Student: Laura Dysart

Supervisors: Paul McNamee and Marjon van der Pol (HERU)


Dysart, L. (2018) 'Health over time: an investigation into the relationship between the future and health behaviours for people with long-term conditions', PhD Thesis, HERU, University of Aberdeen.


Dysart, L., McNamee, P. and Pol, M. van der (2015) 'Exploration of the effect of time preference on change in self-management behaviours in older adults with at least one chronic health condition [poster]', 2nd European Health Economics Association (EuHEA) PhD Student - Supervisor Conference, Paris-Dauphine University, Paris, France, 2-4 September 2015.

Dysart, L., McNamee, P. and Pol, M. van der (2016) 'The role of time preference on healthy lifestyle choices in older adults living with chronic health conditions', European Health Economics Association Conference, 'Know the Ropes - Balancing Costs and Quality in Health Care', Universität Hamburg, Germany 13-16 July 2016.

Dysart, L., McNamee, P. and Pol, M. van der (2016) 'Health shocks and endogenous time discounting', 3rd European Health Economics Association (EuHEA) PhD Student-Supervisor and Early Career Researcher Conference, Universitat Internacional de Catalunya, Barcelona, Spain, 7-9 September 2016.

Dysart, L., McNamee, P. and Pol, M. van der (2017) 'Health shocks and endogenous time discounting', Institute of Applied Health Sciences (IAHS) Postgraduate Research Symposium, University of Aberdeen, Aberdeen, 17 February 2017.

Dysart, L., McNamee, P. and Pol, M. van der (2018) 'Economic insecurity and health behaviours in older adults', 39th Nordic Health Economists’ Study Group (NHESG) Meeting, University of Tromsø, Norway, 22-24 August 2018.