CAPÍTULO IV. PLAN DE NEGOCIOS PARA UNA EMPRESA VIRTUAL
4.5. Análisis Económico
The health sector has long offered a challenging venue for applied economists. Arrow recognized this in the early 1960s. Following the tradition of Arrow I have focused the discussion here on markets for health services and health insurance. Health economists have become habituated to dealing with institutions and facts that raise questions about the usefulness of applying the neoclassical model to health care markets. The nature of the physician-patient interaction in the presence of insurance is at the heart of many of the most challenging problems in health policy and health economics. The first empirical studies in health economics came face to face with the issue of characterizing the doctor-patient interaction and it remains a central problem in health economics. The application of standard principal-agent models has produced an increasingly sophisticated ability to describe doctor-patient interactions and to develop refutable hypotheses about parameters that affect price, quantity and quality outcomes. Nevertheless, observed demand and supply response in markets for physician services are incompletely understood. The case of public reporting of physician performance in CABG surgery offers a vivid example of the limited ability of the standard model to explain market behavior.
Behavioral economics offers some concepts and analytical tools that fit well with the institutions of the health sector. The doctor-patient decision-making context of limited information, a noisy health production function, fear, anxiety, insurance coverage and trust is well suited to the concerns of behavioral economics. I have attempted to highlight how relatively simple models of the physician-patient interactions can be extended using ideas from behavioral economics to enrich the ability to understand and develop
empirical models of health care markets. The issues identified go to the core concerns of health economics. These include: how information affects equilibrium quality in health care markets, how physician competition might affect prices and quantities, what produces persistent variations in treatment patterns across markets and the associated welfare losses, and what explains racial and ethnic disparities in health care use? I have emphasized the role of behavioral economics in extending positive models of health care markets. Behavioral economics offers direction for addressing long standing impasses in positive health economics.
There are also important normative implications. Clearly, if doctors and patients make the types of context specific choices and cognitive errors described here demand functions can no longer be given the normative interpretations that are common even in health economics (Rice, 1998). Critics of the use of standard demand models in health care have clearly and persuasively raised the limits to the use of normative models. They have also failed to offer new approaches to understanding such behavior
One direction pointed to by Thaler and Sunstein (2003) is to use cost benefit analysis of alternate polices that aim to account for the type of cognitive errors described here. Cost effectiveness is widely applied in health care to make efficiency judgments about competing medical practices and policies. There are however a variety of difficulties in applying these tools in the context of trying to account for consumer preferences for making welfare judgments (Garber, 2000).
Another interesting approach is known as case based decision theory (Gilboa and Schmeidler 2004). In this case the normative analysis is conducted by assessing whether a policy action results in a reduction in the type of decision making “errors” that serve to undermine the types of expected utility models frequently used in health economics.
Thus policies that reduce distortions in decision making would be viewed as “welfare improving”. These are new ideas and to date there is no clear path toward a new normative approach that might be applied in fields such as health economics.
The policy implications stemming from the application of behavioral economics in analyzing health care markets are potentially profound. Two cornerstones of recent U.S. health policy are: 1) the presumption that increasing the availability of information to consumers will result in improved quality of care, and 2) that more choice of health plans and providers will inevitably make consumers better off. Examining the basic laboratory and psychological research used in behavioral economics immediately raises challenges to these policy fundamentals. I have attempted to identify some specific areas where these ideas might have particular import for on-going policy debates. I expect that a sustained program of research involving the ideas of behavioral economics applied to
health care markets will likely result in at least some intelligent modification of these articles of faith.
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