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Agency in health care: lessons for economists from sociologists
American Journal of Economics and Sociology, The, April, 1994 by Mandy Ryan
Sociologists have also been concerned with the importance of information and patient involvement in the medical decision-making process. For example, Haug and Lavin (1981) noted that 95% of the respondents in their study felt that they had a right to medical information and Waitzkin (1984) argued that "patients almost always want as much information as possible." Studies have shown that patients desire information on the nature and cause of their illness, its seriousness, treatment plans, results of tests, process and after-effects of tests, how they are progressing, and whether their illness is terminal (Ley, 1967; Mathews, 1983).
Larsson et al. (1989) looked at patient involvement in decision-making in surgical and orthopaedic practice. They sampled 666 patients on the waiting list for an operation and concluded that: "patients' information needs when facing surgery relate to three issues; possible complications, precise nature of the operation as such, and nature and consequences of anaesthetic procedures." Several studies have also found that patients tend to be more dissatisfied with the information they receive from their doctor than with any other aspect of their health care (Waitzkin, 1972). This is further evidence that information giving is an important argument in the patient's utility function.
Beisecker et al. (1990) attempted to investigate patients' motives for seeking information. He was concerned with whether such information was required to make medical decisions. He found that, whilst patients appeared to want information, they placed the responsibility for medical decision-making on the doctor.
The results of these studies are important when looking at the nature of the patient's utility function. They suggest that information and involvement in the decision-making process are not synonymous, and attempts by economists to look at their importance need to take this into account.
The second question, "what do doctors want from the doctor-patient relationship?" will now be addressed. As has been seen, economic research into the nature of the doctor's utility function is limited. What research is available has tended to concentrate on the trade-offs that doctors make between income and leisure, and the way in which the behavior of doctors is constrained by medical ethics, discretionary power and patients' economic welfare.
Sociologists have given some consideration to the doctor's utility function in examining the nature of the medical consultation. Tuckett (1976) argued that this consultation creates a whole world of "power" for the doctor: "Through various devices, such as making patients wait, the white coat, the filling in of forms, and other administrative procedures, the patient and doctor are marked as one of different status." Such a view was echoed by Lazurus (1988) who observed that doctors control medical knowledge, technology, rules of behavior, and patients' access to treatment. All of these factors combine to reinforce the "power" that comes from the gap in information between doctor and patient.
