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

 

Presentation

Asymmetric Information and Asymmetric Awareness: The Impact of Patient Information Search, Education and Health Insurance Coverage on Patient-Physician Relationship and Consumer Satisfaction

Authors: Yang Xie (University of Iowa); Hong Liu (Central University of Finance and Economics, Beijing)

Presenter: Yang Xie (University of Iowa)

Discussant: Sherman Folland (Oakland University)

Session: Patient's Role

Room: Geneen Auditorium

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

Background

The Information asymmetry between physician and patient is shrinking as patients receive more and better information on disease and treatments through public health education, internet and TV, etc. and as the population have better education attainment. However, controversies exist over how additional health information affects patient-physician relationship and treatment decision making. Also literature suggests conflicting theories regarding how managed care penetration affects patient-physician relationship.

Conceptual framework

We created a new conceptual framework which allows non-uniformed information asymmetry. The key element of the framework is the 'awareness' patients have towards their own information set. We then drew hypotheses on how different levels of information asymmetry and awareness affect the patient-physician interaction and lead to different outcomes in terms of optimal treatment decision from this 'awareness' framework.

Objective

To examine whether searching for more health information affects patient's trust towards the physician.

To examine the spillover effect between patient's knowledge stock - education, and knowledge flow - information search on patient-physician relationship

To examine how different physician practice setting (type of insurance reimbursement) affects patient-physicians relationship

Data

Community Tracking Study (CTS) 2000-2001 Household Surveys. N = 14,339

2001 Area Resource File (ARF) is linked to the CTS Household Survey by state and county.

Key Variable Empirical Definitions

Dependent variable: patient's trust in his/her physician.

Key independent variable:

  • Patient's information search from non-physician sources. * Patient education: binary variable, education levels (schooling ? 12 years) and high education levels (schooling>12 years) * Interaction variables between the education and whether patients did any search to identify how the interaction affect the patient trust are constructed: (1) high education + information search; (2) high education + no information search; (3) low education + information search; (4) low education + no information search. * Health insurance coverage is constructed as dummy variables: uninsured, HMOs, Medicaid and Medicare

Methodological issues

The correlation between patient information search and patient trust towards their physicians is a simultaneous process.

Solution: IV analysis; 'market-level information search' variables used as IV,

Conclusions

Patients with higher (at least some college) education and conducted no information search are the most trusting compared with the omitted group (no college education, no information search), then the higher education-information search group.

Compared with health insurance from employment or self-purchase, uninsured patients, Medicaid patients and patients in HMOs all have lower trust scores, with the uninsured patients being the least trusting.

Minority groups are significantly less likely to trust their physicians than Caucasians.

Older patients and higher-income patients are more likely to trust their physicians.

More trust leads to higher satisfaction.