PhD: The role of time preference in the medical decision making context
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The aim of the thesis is to examine patient and physician time preferences and investigate how these relate to treatment adherence. The existing health economics literature focussed largely on time preference of individuals, especially in regard to health behaviours (smoking, alcohol consumption and obesity). Adherence to medical advice has only been explored in a few small studies. More importantly, such research has largely ignored the role that the doctor plays in guiding the patient through the diagnosis and treatment choices and whether this process is affected by the preferences of the provider as well as those of the patient. This research investigates this link, and its interaction with patient time preferences. A key hypothesis is that, while doctors may prescribe treatments that exhibit exponential discounting and provide the best ‘whole-life’ outcome for the patient (pre-treatment), if the time preference embodied in treatment is sufficiently different from that of the patient adherence is likely to be low and lead to a poorer outcome (post-treatment) than if the doctor had initially prescribed a treatment more closely matching the patient’s time preference.
The first paper compared Scottish GPs’ professional time preferences (for the patient) and private time preferences (for the self). GPs had similar time preferences for themselves and their patients. We also found a large proportion of ’increasingly impatient’ doctors. The second project is a theoretical model exploring time inconsistency with paternalistic doctors. Doctors face an economic screening problem when they can’t tell in advance whether a patient is present-biased. This is extended to an experiment for the final project. Students in the doctor role made treatment recommendations to patients could observe adherence. Present-bias patients will not adhere to the ‘best’ treatment. Participants adapted to non-adherence as predicted by the model, and a performance payment led to stronger adaptation.
Outcome and Translation
Scottish GPs were found to have the same time preferences for themselves as for their patients in a between-sample design. We also found a large proportion of increasingly-impatient doctors, implying they were less willing to wait for treatment benefits as these are moved into the future. The theory model provided the first examination of non-adherence as an outcome of hidden present-bias time preferences, and showed that responding to this non-adherence depends on the welfare effects and probability that a person is present-biased. Finally, the experiment demonstrated that students in the doctor role did not need direct financial incentives to adapt to non-adherence. The adaptation was as predicted by the model. While a performance payment increased the adaptation, it would not be feasible to implement such strong incentives in reality. The experiment showed that providing doctors with information about adherence was sufficient for them to adapt optimally to non-adherence.
PhD Student: Alastair Irvine
Irvine, A. (2018) 'Time preferences and the patient-doctor interaction', PhD Thesis, HERU, University of Aberdeen.
Irvine, A., Pol, M. van der and Phimister, E. (2019) 'A comparison of professional and private time preferences of General Practitioners', Social Science & Medicine, 222, 256-264.
Irvine, A., Pol, M. van der and Phimister, E. (2015) 'The role of time preference in the medical decision making context: a research plan', Scottish Graduate Programme in Economics (SGPE) Residential Methodology Conference, Crieff, 8-9 January 2015.
Irvine, A., Pol, M. van der and Phimister, E. (2015) 'The role of time preference in the medical decision making context', Institute of Applied Health Sciences (IAHS) Summer Symposium Aberdeen University, 25 June 2015.
Irvine, A., Pol, M. van der and Phimister, E. (2016) 'Paternalistic patient-doctor interaction and time inconsistency', Scottish Graduate Programme in Economic's (SGPE) Residential Methodology Conference, Crieff Hydro, Crieff, 6-7 January 2016.
Irvine, A., Pol, M. van der and Phimister, E. (2016) 'Professional and private time preferences of Scottish General Practitioners', Stirling Behavioural Science Centre Annual PhD Student Conference in Behavioural Science, Stirling University, Stirling, 9 June 2016.
Irvine, A., Phimister, E. and Pol, M. van der (2016) 'Professional and private time preferences of Scottish general practitioners', European Health Economics Association Conference, 'Know the Ropes - Balancing Costs and Quality in Health Care', Universität Hamburg, Germany 13-16 July 2016.
Irvine, A., Pol, M. van der and Phimister, E. (2016) 'Time inconsistency and paternalistic patient-doctor interaction', Nordic Health Economists' Study Group Meeting, Centre of Health Economics Research (COHERE), University of Southern Denmark, Odense, Denmark, 17-19 August 2016.
Irvine, A., Pol, M. van der and Phimister, E. (2016) 'Paternalistic patient-doctor interaction and time inconsistency', 4th Workshop in Behavioral and Experimental Health Economics University of Cologne, Cologne, Germany, 8-9 December 2016.
Irvine, A., Pol, M. van der and Phimister, E. (2017) 'A comparison of professional and private time preferences of Scottish GPs', Institute of Applied Health Sciences (IAHS) Postgraduate Research Symposium, University of Aberdeen, Aberdeen, 17 February 2017.
Irvine, A., Pol, M. van der and Phimister, E. (2017) 'Time inconsistency and altruism in the patient-doctor interaction', 4th European Health Economics Association PhD Student-Supervisor and Early Career Researcher Conference, Lausanne, Switzerland, 6-8 September 2017.
Irvine, A., Pol, M. van der and Phimister, E. (2017) 'Improving adherence with an economic model – so what?', School of Medicine, Medical Sciences and Nutrition Postgraduate Research Conference, University of Aberdeen, Aberdeen, 29 November 2017.
Irvine, A. (2018) 'The role of time preference in the medical decision making context', Aberdeen (Uni's) Got Talent, May Festival, (Public Engagement), University of Aberdeen, 25 May 2018.
Irvine, A., Phimister, E. and Pol, M. van der (2018) 'Adaptation to time inconsistent patients – an experiment', 12th European Conference on Health Economics (EuHEA), Maastricht, The Netherlands, 11-14 July 2018.