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Plastic surgery or primary care? Altruistic preferences and expected specialty choice of U.S. medical students

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  • Li, Jing

Abstract

Understanding physicians’ decisions when faced with conflicts between their own financial self-interest and patients’ economic or health interests is of key importance in health economics and policy. This issue is especially salient in certain medical specialties where less altruistic behavior of physicians can yield significant financial gains. This study examines experimentally measured altruistic preferences of medical students from schools around the U.S., and whether these preferences predict those students’ expected medical specialty choice. The experimental design consists of a set of computer-based revealed preference decision problems, which ask the experimental subjects to allocate real money between themselves and an anonymous person. These data are used to derive an innovative measure of altruism for each participant. I then examine the association between altruism and expected specialty choice, after controlling for an extensive set of covariates collected from an accompanying survey questionnaire. Medical students with a lower degree of altruism are significantly more likely to choose high-income specialties, conditioning on an extensive set of covariates. This altruism measure is more predictive of income of specialty choice than a wide range of other characteristics, including parental income, student loan amount and Medical College Admission Test (MCAT) score. On the other hand, the altruism measure does not predict choosing primary care specialties. I also find that altruism predicts students’ self-reported likelihood of practicing medicine in an underserved area.

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  • Li, Jing, 2018. "Plastic surgery or primary care? Altruistic preferences and expected specialty choice of U.S. medical students," Journal of Health Economics, Elsevier, vol. 62(C), pages 45-59.
  • Handle: RePEc:eee:jhecon:v:62:y:2018:i:c:p:45-59
    DOI: 10.1016/j.jhealeco.2018.09.005
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    Cited by:

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    2. Wang, Jian & Iversen, Tor & Hennig-Schmidt, Heike & Godager, Geir, 2020. "Are patient-regarding preferences stable? Evidence from a laboratory experiment with physicians and medical students from different countries," European Economic Review, Elsevier, vol. 125(C).
    3. Werbeck, Anna & Wübker, Ansgar & Ziebarth, Nicolas R., 2021. "Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 188(C), pages 1325-1350.
    4. Massimo Finocchiaro Castro & Calogero Guccio & Domenica Romeo, 2024. "Looking inside the lab: a systematic literature review of economic experiments in health service provision," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(7), pages 1177-1204, September.
    5. Susan J. Méndez & Jongsay Yong & Hugh Gravelle & Anthony Scott, 2024. "Medical pricing decisions: Evidence from Australian specialists," Melbourne Institute Working Paper Series wp2024n11, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    6. Finocchiaro Castro, Massimo & Guccio, Calogero & Romeo, Domenica, 2022. "A systematic literature review of 10 years of behavioral research on health services," EconStor Preprints 266248, ZBW - Leibniz Information Centre for Economics.
    7. Ge, Ge & Cheo, Roland & Liu, Rugang & Wang, Jian & Wang, Qiqi, 2023. "Physician beneficence and profit-taking among private for profit clinics in China: A field study using a mystery shopper audit," HERO Online Working Paper Series 2023:6, University of Oslo, Health Economics Research Programme.
    8. Anthony Scott & Peter Sivey, 2022. "Motivation and competition in health care," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1695-1712, August.
    9. Ge Ge & Geir Godager & Jian Wang, 2022. "Exploring physician agency under demand‐side cost sharing—An experimental approach," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1202-1227, June.
    10. Cheo, Roland & Ge, Ge & Liu, Rugang & Wang, Jian & Wang, Qiqi, 2023. "Physician beneficence and profit-taking among private for-profit clinics in China: A field study using a mystery shopper audit," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 107(C).
    11. Godager , Geir & Scott, Anthony, 2023. "Physician Behavior and Health Outcomes," HERO Online Working Paper Series 2023:3, University of Oslo, Health Economics Research Programme.
    12. Attema, Arthur E. & Galizzi, Matteo M. & Groß, Mona & Hennig-Schmidt, Heike & Karay, Yassin & L’Haridon, Olivier & Wiesen, Daniel, 2023. "The formation of physician altruism," Journal of Health Economics, Elsevier, vol. 87(C).
    13. Waibel, Christian & Wiesen, Daniel, 2021. "An experiment on referrals in health care," European Economic Review, Elsevier, vol. 131(C).
    14. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Kokot, Johanna & Wiesen, Daniel, 2020. "Physician performance pay: Experimental evidence," HERO Online Working Paper Series 2020:3, University of Oslo, Health Economics Research Programme.
    15. Byambadalai, Undral & Ma, Ching-to Albert & Wiesen, Daniel, 2023. "Changing preferences: An experiment and estimation of market-incentive effects on altruism," Journal of Health Economics, Elsevier, vol. 92(C).
    16. Cadena, Brian C. & Smith, Austin C., 2022. "Performance pay, productivity, and strategic opt-out: Evidence from a community health center," Journal of Public Economics, Elsevier, vol. 206(C).

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    More about this item

    Keywords

    Physician behavior; Altruism; Specialty choice; Laboratory experiment;
    All these keywords.

    JEL classification:

    • C91 - Mathematical and Quantitative Methods - - Design of Experiments - - - Laboratory, Individual Behavior
    • D64 - Microeconomics - - Welfare Economics - - - Altruism; Philanthropy; Intergenerational Transfers
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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