Asymetries informationnelles et comportement medical

by Lise Rochaix

Doctoral thesis in Sciences économiques

Under the supervision of ROBERT LAUNOIS.

defended on 1986

in Rennes 1 .

  • Alternative Title

    Information asymmetry in the market for physicians' services


  • Abstract

    The information asymmetry prevailing between the physician and his patient forms the basis of the physician's power to influence the demand for his own services. The potential discretionary power varies according to the prevailing institutional setting : demand inducement versus demand discouragement (respectively in fee for service system and salary capitation system). Understanding the limits imposed on this discretionary power, is essential to policy - makers anxious to ensure a more socially optimal allocation of limited health care resources. An integrated approach of the physician-patient interaction is defined here with a "conditional" demand function based on the idea that the physician "proposes" and the patient "disposes". The model investigates the potential market constraint that patients may impose on physicians'by "voting with their feet" : they form prior expectations about the level of severity of their illness and are willing to seek a second opinion if the gap between their prior expectations and their doctor's message about the severity level is too wide. The standard search problem is adapted here to suit the special characteristics of health care : search costs, for example, are increasing in severity and may become prohibitive for emergency cases. Information asymmetry is introduced in terms of a differential in uncertainty about the severity of illness between the physician and the patient. Furthermore, patients are uncertain about the accuracy of their physician's treatment recommendation. Physicians are also affected by the uncertainty about their patient's consent to treatment. The predictions of the model show that it is enough for a small number of patients to be informed for physicians to be effectively constrained in their treatment choi- ces. The hypotheses and predictions are tested by means of a simulation of the market which also considers the impact of two policies : an increase in the physician-population ratio and any information campaign.


  • Abstract

    Le medecin est au coeur du processus d'allocation des ressources de sante. Ainsi, 50 a 80 % de ces ressources relevent de sa competence. L'etude du medecin en tant qu'agent economique, de ses objectifs et de ses contraintes est indispensable a une comprehension profonde des systemes de sante et donc une condition de reussite de politiques de sante visant a une plus grande efficacite. L'asymetrie d'information existant entre le patient et le medecin confere a ce dernier un pouvoir discretionnaire potentiel lui permettant de gonfler artificiellement la demande de services medicaux. L'objet de cette these est d'analyser les fondements et manifestations de ce pouvoir et d'evaluer les systemes de controle et d'incitations qui tentent d'accroitre l'efficacite du processus d'allocation des ressources auquel le medecin participe. A cette fin est elabore un modele micro-economique de l'interaction medecinpatient base sur les developpements recents de la theorie de l'information et de l'incertain. La notion d'asymetrie d'information est integree dans le modele sous forme d'une inegalite entre medecin et patient face a l'incertitude quant a l'etat de sante initial du patient. Dans le cadre institutionnel d'une regulation des prix par un tiers, sont analysees les decisions du medecin (le choix d'intensite de traitement prescrit) et celles du patient (consentement refus du traitement), et l'impact, sur la strategie du medecin d'une incertitude quant au consentement du patient. Les predictions du modele, verifiees par une simulation, indiquent qu'il suffit qu'un petit nombre de patients soient informes pour que la contrainte de marche joue et conduise le medecin a prescrire plus "juste". Sont finalement abordees dans une perspective internationale, les reformes visant a optimaliser les decisions des agents des systemes de sante.

Consult library

Version is available as a paper

Where is this thesis?

  • Library : Bibliothèque universitaire Droit Economie Gestion (Besançon).
  • Available on site in the applicant institution
  • Odds : DRO.RENN.1986.9
  • Library : Université de Rennes I. Service commun de la documentation. Section sciences juridiques, politiques, économiques et de gestion.
  • Available for PEB
  • Library : Université de Rennes I. Service commun de la documentation. Section sciences juridiques, politiques, économiques et de gestion.
  • Available for PEB
  • Odds : TGRENN1986/29
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