Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120

 

Presentation

Doctor-patient relationship: a game theoretical approach to explain non-adherence to medication

Authors: Charitini Stavropoulou (London School of Economics and Political Science)

Presenter: Charitini Stavropoulou (LSE Health and Social Care)

Discussant: Emilia Simeonova (Columbia University)

Session: Adherence

Room: Classroom G

When: Monday 3:15 p.m. - 4:45 p.m.

BACKGROUND: Behavioral economic models that attempt to represent the doctor-patient relationship have successfully introduced the concept of beliefs into the patient's utility function. A strong assumption is made that there is no conflict between the doctor and the patient during the consultation and that the two parts share the same utility function. However, it is likely that doctors and patients have different agendas, which, when not met, can lead to suboptimal consultation outcomes, such as patient non-adherence to prescribed medication.

AIM: To extend the current behavioral economic models on the doctor-patient relationship into a game theoretical one and to examine whether this approach explains why patients fail to adhere to medication.

METHODOLOGY: We introduce the notion of effort as a new variable in the doctor's utility function. Doctors want to minimize the effort they put into the consultation with each patient in order to be able to see as many patients as possible. On the other hand, they do want to persuade patients to adhere to their recommendations in order to improve health outcomes but also to avoid relapses that would require from the doctor to put more effort in the next consultation. The patient's utility function depends on the actual health outcomes and the anticipation of these outcomes.

RESULTS: The model shows that when dealing with patients with stronger beliefs doctors who put more effort into the first consultation achieve better adherence rates than those who distribute their effort equally between the two consultations, even if the total effort is the same. Evidence from a survey on doctor-patient consultation in hypertension clinic confirms the theoretical expectations.

CONCLUSIONS: The proposed theoretical framework predicts why consultations may end up with sub optimal results, such as non-adherence to medical recommendations and identifies ways in which doctors could strategically lead patients to choose the best treatment. More effort in the initial consultation seems to benefit both the doctor and the patient.