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The European Journal of Health Economics

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31.08.2017 | Original Paper

Predicting medical practices using various risk attitude measures

verfasst von: Sophie Massin, Antoine Nebout, Bruno Ventelou

Erschienen in: The European Journal of Health Economics | Ausgabe 6/2018

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Abstract

This paper investigates the predictive power of several risk attitude measures on a series of medical practices. We elicit risk preferences on a sample of 1500 French general practitioners (GPs) using two different classes of tools: scales, which measure GPs’ own perception of their willingness to take risks between 0 and 10; and lotteries, which require GPs to choose between a safe and a risky option in a series of hypothetical situations. In addition to a daily life risk scale that measures a general risk attitude, risk taking is measured in different domains for each tool: financial matters, GPs’ own health, and patients’ health. We take advantage of the rare opportunity to combine these multiple risk attitude measures with a series of self-reported or administratively recorded medical practices. We successively test the predictive power of our seven risk attitude measures on eleven medical practices affecting the GPs’ own health or their patients’ health. We find that domain-specific measures are far better predictors than the general risk attitude measure. Neither of the two classes of tools (scales or lotteries) seems to perform indisputably better than the other, except when we concentrate on the only non-declarative practice (prescription of biological tests), for which the classic money-lottery test works well. From a public health perspective, appropriate measures of willingness to take risks may be used to make a quick, but efficient, profiling of GPs and target them with personalized communications, or interventions, aimed at improving practices.

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The use of the term “predictive power” matches with a common practice in the empirical literature to qualify the existence of a correlation [19, 21, 25]. However, we should notify the reader that “causality” (causal effect of risk attitude on medical practices) is beyond the scope of this paper.

In economic terms, French GPs are not concerned by the financial implications for the Social Security of their medical decisions. Their role of “gatekeeper” has not been associated with significant incentives on their side [48]. One limitation is that the physician has to agree to a national convention which makes it possible for their patients to be reimbursed by the public insurer for their consultations. But the convention is not really constraining in terms of medical practices. Recently, in 2012, a Pay for Performance system was deployed, but with limited impact on practices [49].

These 1568 GPs are part of the national sample (1052 respondents) and two regional oversamples: Burgundy (201 respondents) and Provence-Alpes Cote d’Azur (315 respondents). GPs of the Pays de la Loire oversample were not asked to answer the risk attitude questions because they were asked specific questions on local matters.

The proposed lotteries (therapies) are stylized objects that are not implementable in real life, for obvious practical and ethical reasons.

For space reasons, it was not possible to report the estimates for the control variables. In "Appendix F", we provide, by way of examples, comprehensive estimates for two regressions.

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Titel: Predicting medical practices using various risk attitude measures
verfasst von: Sophie Massin
Antoine Nebout
Bruno Ventelou
Publikationsdatum: 31.08.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: The European Journal of Health Economics / Ausgabe 6/2018
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-017-0925-3

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Predicting medical practices using various risk attitude measures

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