GPs' implicit prioritization through clinical choices – evidence from three national health services

• Published in: Journal of health economics Vol. 49; pp. 169 - 183
• Main Authors: Riise, Julie, Hole, Arne Risa, Gyrd-Hansen, Dorte, Skåtun, Diane
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-09-2016; Elsevier Sequoia S.A
• Subjects: Benefit cost analysis; Choice Behavior; Containment; Cost containment; Cost control; Costs; Cultural differences; Culture; Decision making; Discrete choice; Discrete choice experiments; Drugs; England; Family physicians; GPs; Health administration; Health care expenditures; Health services; Heterogeneity; Humans; Medical personnel; National Health Programs; Norway; Physicians; Practice Patterns, Physicians; Prescription behaviour; Prescription Drugs; Prioritization; Scotland; Studies; England; Scotland; United Kingdom > UK; Norway; ANE, Norway; British Isles, England; British Isles, Scotland; Prioritization; Discrete choice experiments; GPs; Prescription behaviour; Cost containment
• ISSN: 0167-6296; 1879-1646
• DOI: 10.1016/j.jhealeco.2016.07.001

We present results from an extensive discrete choice experiment, which was conducted in three countries (Norway, Scotland, and England) with the aim of disclosing stated prescription behaviour in different decision making contexts and across different cost containment cultures. We show that GPs in all countries respond to information about societal costs, benefits and effectiveness, and that they make trade-offs between them. The UK GPs have higher willingness to accept costs when they can prescribe medicines that are cheaper or more preferred by the patient, while Norwegian GPs tend to have higher willingness to accept costs for attributes regarding effectiveness or the doctors' experience. In general, there is a substantial amount of heterogeneity also within each country. We discuss the results from the DCE in the light of the GPs' two conflicting agency roles and what we know about the incentive structures and cultures in the different countries.