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Brosig-Koch J, Hennig-Schmidt H, Kairies-Schwarz N, Kokot J, Wiesen D. A new look at physicians' responses to financial incentives: Quality of care, practice characteristics, and motivations. J Health Econ 2024; 94:102862. [PMID: 38401249 DOI: 10.1016/j.jhealeco.2024.102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024]
Abstract
There is considerable controversy about what causes (in)effectiveness of physician performance pay in improving the quality of care. Using a behavioral experiment with German primary-care physicians, we study the incentive effect of performance pay on service provision and quality of care. To explore whether variations in quality are based on the incentive scheme and the interplay with physicians' real-world profit orientation and patient-regarding motivations, we link administrative data on practice characteristics and survey data on physicians' attitudes with experimental data. We find that, under performance pay, quality increases by about 7pp compared to baseline capitation. While the effect increases with the severity of illness, the bonus level does not significantly affect the quality of care. Data linkage indicates that primary-care physicians in high-profit practices provide a lower quality of care. Physicians' other-regarding motivations and attitudes are significant drivers of high treatment quality.
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Affiliation(s)
- Jeannette Brosig-Koch
- Otto von Guericke University Magdeburg and Health Economics Research Center (CINCH) Essen, Germany.
| | | | - Nadja Kairies-Schwarz
- Heinrich-Heine University Düsseldorf, Medical Faculty, Centre for Health and Society (chs) and German Diabetes Center, Leibniz Center for Diabetes Research, Germany.
| | - Johanna Kokot
- University of Hamburg and Hamburg Center for Health Economics, Germany.
| | - Daniel Wiesen
- University of Cologne, Department of Healthcare Management and Center for Social and Economic Behavior (C-SEB), Germany.
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2
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Sperber C, Wiesen D, Karnath H, de Haan B. The neuroanatomy of visual extinction following right hemisphere brain damage: Insights from multivariate and Bayesian lesion analyses in acute stroke. Hum Brain Mapp 2024; 45:e26639. [PMID: 38433712 PMCID: PMC10910281 DOI: 10.1002/hbm.26639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/08/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Multi-target attention, that is, the ability to attend and respond to multiple visual targets presented simultaneously on the horizontal meridian across both visual fields, is essential for everyday real-world behaviour. Given the close link between the neuropsychological deficit of extinction and attentional limits in healthy subjects, investigating the anatomy that underlies extinction is uniquely capable of providing important insights concerning the anatomy critical for normal multi-target attention. Previous studies into the brain areas critical for multi-target attention and its failure in extinction patients have, however, produced heterogeneous results. In the current study, we used multivariate and Bayesian lesion analysis approaches to investigate the anatomical substrate of visual extinction in a large sample of 108 acute right hemisphere stroke patients. The use of acute stroke patient data and multivariate/Bayesian lesion analysis approaches allowed us to address limitations associated with previous studies and so obtain a more complete picture of the functional network associated with visual extinction. Our results demonstrate that the right temporo-parietal junction (TPJ) is critically associated with visual extinction. The Bayesian lesion analysis additionally implicated the right intraparietal sulcus (IPS), in line with the results of studies in neurologically healthy participants that highlighted the IPS as the area critical for multi-target attention. Our findings resolve the seemingly conflicting previous findings, and emphasise the urgent need for further research to clarify the precise cognitive role of the right TPJ in multi-target attention and its failure in extinction patients.
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Affiliation(s)
- Christoph Sperber
- Center of Neurology, Division of NeuropsychologyHertie‐Institute for Clinical Brain Research, University of TübingenTübingenGermany
- Department of NeurologyInselspital, University Hospital BernBernSwitzerland
| | - Daniel Wiesen
- Center of Neurology, Division of NeuropsychologyHertie‐Institute for Clinical Brain Research, University of TübingenTübingenGermany
| | - Hans‐Otto Karnath
- Center of Neurology, Division of NeuropsychologyHertie‐Institute for Clinical Brain Research, University of TübingenTübingenGermany
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Bianca de Haan
- Centre for Cognitive Neuroscience, College of Health and Life Sciences, Brunel University LondonUxbridgeUK
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3
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Byambadalai U, Ma CTA, Wiesen D. Changing preferences: An experiment and estimation of market-incentive effects on altruism. J Health Econ 2023; 92:102808. [PMID: 37738704 DOI: 10.1016/j.jhealeco.2023.102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023]
Abstract
This paper studies how altruistic preferences are changed by markets and incentives. We conduct a laboratory experiment with a within-subject design. Subjects are asked to choose health care qualities for hypothetical patients in monopoly, duopoly, and quadropoly. Prices, costs, and patient benefits are experimental incentive parameters. In monopoly, subjects choose quality by trading off between profits and altruistic patient benefits. In duopoly and quadropoly, subjects play a simultaneous-move game. Uncertain about an opponent's altruism, each subject competes for patients by choosing qualities. Bayes-Nash equilibria describe subjects' quality decisions as functions of altruism. Using a nonparametric method, we estimate the population altruism distributions from Bayes-Nash equilibrium qualities in different markets and incentive configurations. Competition tends to reduce altruism, but duopoly and quadropoly equilibrium qualities are much higher than monopoly. Although markets crowd out altruism, the disciplinary powers of market competition are stronger. Counterfactuals confirm markets change preferences.
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Affiliation(s)
- Undral Byambadalai
- Department of Economics, Boston University, United States; AI Lab, CyberAgent, Inc., Japan.
| | | | - Daniel Wiesen
- Department of Business Administration and Health Care Management, University of Cologne, Germany.
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4
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Rosenzopf H, Sperber C, Wortha F, Wiesen D, Muth A, Klein E, Möller K, Karnath HO. Spatial neglect in the digital age: Influence of presentation format on patients' test behavior. J Int Neuropsychol Soc 2023; 29:686-695. [PMID: 36303420 DOI: 10.1017/s1355617722000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Computerized neglect tests could significantly deepen our disorder-specific knowledge by effortlessly providing additional behavioral markers that are hardly or not extractable from existing paper-and-pencil versions. This study investigated how testing format (paper versus digital), and screen size (small, medium, large) affect the Center of cancelation (CoC) in right-hemispheric stroke patients in the Letters and the Bells cancelation task. Our second objective was to determine whether a machine learning approach could reliably classify patients with and without neglect based on their search speed, search distance, and search strategy. METHOD We compared the CoC measure of right hemisphere stroke patients with neglect in two cancelation tasks across different formats and display sizes. In addition, we evaluated whether three additional parameters of search behavior that became available through digitization are neglect-specific behavioral markers. RESULTS Patients' CoC was not affected by test format or screen size. Additional search parameters demonstrated lower search speed, increased search distance, and a more strategic search for neglect patients than for control patients without neglect. CONCLUSION The CoC seems robust to both test digitization and display size adaptations. Machine learning classification based on the additional variables derived from computerized tests succeeded in distinguishing stroke patients with spatial neglect from those without. The investigated additional variables have the potential to aid in neglect diagnosis, in particular when the CoC cannot be validly assessed (e.g., when the test is not performed to completion).
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Affiliation(s)
- Hannah Rosenzopf
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Christoph Sperber
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Franz Wortha
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Daniel Wiesen
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Annika Muth
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Elise Klein
- University of Paris, LaPsyDÉ, CNRS, Sorbonne Paris Cité, Paris, France
- Leibniz Institut für Wissensmedien, Tuebingen, Germany
| | - Korbinian Möller
- Leibniz Institut für Wissensmedien, Tuebingen, Germany
- Centre for Mathematical Cognition, School of Science, Loughborough University, Loughborough, United Kingdom
- Centre for Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany
| | - Hans-Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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5
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Attema AE, Galizzi MM, Groß M, Hennig-Schmidt H, Karay Y, L'Haridon O, Wiesen D. The formation of physician altruism. J Health Econ 2023; 87:102716. [PMID: 36603361 DOI: 10.1016/j.jhealeco.2022.102716] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
We study how patient-regarding altruism is formed by medical education. We elicit and structurally estimate altruistic preferences using experimental data from a large sample of medical students (N = 733) in Germany at different progress stages in their studies. The estimates reveal substantial heterogeneity in altruistic preferences of medical students. Patient-regarding altruism is highest for freshmen, significantly declines for students in the course of medical studies, and tends to increase again for last year students, who assist in clinical practice. Also, patient-regarding altruism is higher for females and positively associated to general altruism. Altruistic medical students have gained prior practical experience in healthcare, have lower income expectations, and are more likely to choose surgery and pediatrics as their preferred specialty.
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Affiliation(s)
- Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | - Matteo M Galizzi
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, UK.
| | - Mona Groß
- Department of Business Administration and Healthcare Management, University of Cologne, Germany.
| | - Heike Hennig-Schmidt
- Laboratory for Experimental Economics, Department of Economics, University of Bonn, Germany.
| | | | - Olivier L'Haridon
- Center for Research in Economics and Management (CREM), University of Rennes 1, France; Institut Universitaire de France, France.
| | - Daniel Wiesen
- Department of Business Administration and Healthcare Management, University of Cologne, Germany.
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Wiesen D, Bonilha L, Rorden C, Karnath HO. Disconnectomics to unravel the network underlying deficits of spatial exploration and attention. Sci Rep 2022; 12:22315. [PMID: 36566307 PMCID: PMC9789971 DOI: 10.1038/s41598-022-26491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022] Open
Abstract
Spatial attention and exploration are related to a predominantly right hemispheric network structure. However, the areas of the brain involved and their exact role is still debated. Spatial neglect following right hemispheric stroke lesions has been frequently viewed as a model to study these processes in humans. Previous investigations on the anatomical basis on spatial neglect predominantly focused on focal brain damage and lesion-behaviour mapping analyses. This approach might not be suited to detect remote areas structurally spared but which might contribute to the behavioural deficit. In the present study of a sample of 203 right hemispheric stroke patients, we combined connectome lesion-symptom mapping with multivariate support vector regression to unravel the complex and disconnected network structure in spatial neglect. We delineated three central nodes that were extensively disconnected from other intrahemispheric areas, namely the right superior parietal lobule, the insula, and the temporal pole. Additionally, the analysis allocated central roles within this network to the inferior frontal gyrus (pars triangularis and opercularis), right middle temporal gyrus, right temporal pole and left and right orbitofrontal cortices, including interhemispheric disconnection. Our results suggest that these structures-although not necessarily directly damaged-might play a role within the network underlying spatial neglect in humans.
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Affiliation(s)
- Daniel Wiesen
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany.
| | | | | | - Hans-Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, USA
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7
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Hallek M, Ockenfels A, Wiesen D. Behavioral Economics Interventions to Improve Medical Decision-Making. Dtsch Arztebl Int 2022; 119:633-639. [PMID: 35912421 PMCID: PMC9764346 DOI: 10.3238/arztebl.m2022.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 09/30/2021] [Accepted: 04/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND In medicine, a wide gap exists between the medical care that ought to be possible in the light of the current state of medical research and the care that is actually provided. Behavioral biases and noise are two major reasons for this. METHODS We present the findings of a selective literature review and illustrate how interventions based on behavioral economics can help physicians make better decisions and thereby improve treatment outcomes. RESULTS A number of behavioral economics interventions, making use of, for example, default settings, active decision rules, social norms, and self-commitments, may improve physicians' clinical decision-making. Evidence on long-term effects is, however, mostly lacking. CONCLUSION Despite their apparent potential, the application of behavioral economic interventions to improve medical decisionmaking is still in its infancy, particularly in Germany.
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Affiliation(s)
- Michael Hallek
- University Hospital of Cologne, Internal Medicine Clinic I and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO)
| | - Axel Ockenfels
- Cologne University, Department of Economics, Center for Social and Economic Behavior (C-SEB) and Cluster of Excellence ECONtribute
| | - Daniel Wiesen
- Cologne University, Seminar for General Business Administration and Management in Healthcare and Center for Social and Economic Behavior (C-SEB),*Seminar for General Business Administration and Management in Healthcare University of Cologne Albertus-Magnus-Platz 50931 Cologne
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8
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Benke T, Bodner T, Wiesen D, Karnath HO. The Amnestic Syndrome of Posterior Cerebral Artery Infarction. Eur J Neurol 2022; 29:2987-2995. [PMID: 35708171 PMCID: PMC9541518 DOI: 10.1111/ene.15449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Little is known about the character and underlying lesions of ischemic amnesia. We therefore studied episodic memory functions and brain lesions in 84 patients with acute ischemic infarcts in the supply territory of the posterior cerebral artery (PCA). We also aimed to learn how the neural memory systems are organized. METHODS Standard neuropsychological tests were used to assess verbal and figural memory. Patients were split in memory-impaired and memory-intact. Lesions were demarcated, normalized and anatomically labeled, using standard mapping procedures. RESULTS Of the 84 patients more than 80% had an amnestic syndrome, mostly with combined, less often with figural or verbal memory impairment. Amnesia in subjects with left hemispheric lesions was more frequent and more severe, with significantly lower scores on the verbal memory test. Normal performance or figural amnesia were prevalent after right hemispheric lesions. However, no amnesia subtype was strictly tied to left- or right-sided brain damage. Hippocampal and thalamic lesions were common, but 30% of lesions were extrahippocampal located in the ventral occipito-temporal cortex and long occipital white matter tracts. Most amnestic-patients lacked awareness for their memory impairment. CONCLUSIONS Memory impairment is a key clinical manifestation of acute PCA stroke. Amnesia is more frequent and more severe after left stroke, suggesting a left hemisphere dominance of the two memory systems. Domain specific memory appears not strictly lateralized, since deficits in verbal and figural memory were found after lesions of both sides. Extrahippocampal lesions may also cause memory impairment.
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Affiliation(s)
- Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Thomas Bodner
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Daniel Wiesen
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Hans-Otto Karnath
- University of Tübingen, Departments of Cognitive and General Neurology, Tübingen, Germany
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9
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Rosenzopf H, Wiesen D, Basilakos A, Yourganov G, Bonilha L, Rorden C, Fridriksson J, Karnath HO, Sperber C. Mapping the human praxis network: an investigation of white matter disconnection in limb apraxia of gesture production. Brain Commun 2022; 4:fcac004. [PMID: 35169709 PMCID: PMC8833454 DOI: 10.1093/braincomms/fcac004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/19/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Left hemispheric cerebral stroke can cause apraxia, a motor-cognitive disorder characterised by deficits of higher-order motor skills such as the failure to accurately produce meaningful gestures. This disorder provides unique insights into the anatomical and cognitive architecture of the human praxis system. The present study aimed to map the structural brain network that is damaged in apraxia. We assessed the ability to perform meaningful gestures with the hand in 101 patients with chronic left hemisphere stroke. Structural white matter fibre damage was directly assessed by diffusion tensor imaging and fractional anisotropy mapping. We used multivariate topographical inference on tract-based fractional anisotropy topographies to identify white matter disconnection associated with apraxia. We found relevant pathological white matter alterations in a densely connected fronto-temporo-parietal network of short and long association fibres. Hence, the findings suggest that heterogeneous topographical results in previous lesion mapping studies might not only result from differences in study design, but also from the general methodological limitations of univariate topographical mapping in uncovering the structural praxis network. A striking role of middle and superior temporal lobe disconnection, including temporo-temporal short association fibres, was found, suggesting strong involvement of the temporal lobe in the praxis network. Further, the results stressed the importance of subcortical disconnections for the emergence of apractic symptoms. Our study provides a fine-grain view into the structural connectivity of the human praxis network and suggests a potential value of disconnection measures in the clinical prediction of behavioural post-stroke outcome.
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Affiliation(s)
- Hannah Rosenzopf
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Daniel Wiesen
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Grigori Yourganov
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Hans-Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Christoph Sperber
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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10
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Abstract
The static magnetic field of MRI scanners can induce a magneto-hydrodynamic stimulation of the vestibular organ (MVS). In common fMRI settings, this MVS effect leads to a vestibular ocular reflex (VOR). We asked whether - beyond inducing a VOR - putting a healthy subject in a 3T MRI scanner would also alter goal-directed spatial behavior, as is known from other types of vestibular stimulation. We investigated 17 healthy volunteers, all of which exhibited a rightward VOR inside the MRI-scanner as compared to outside-MRI conditions. More importantly, when probing the distribution of overt spatial attention inside the MRI using a visual search task, subjects scanned a region of space that was significantly shifted toward the right. An additional estimate of subjective straight-ahead orientation likewise exhibited a rightward shift. Hence, putting subjects in a 3T MRI-scanner elicits MVS-induced horizontal biases of spatial orienting and exploration, which closely mimic that of stroke patients with spatial neglect.
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Affiliation(s)
- Axel Lindner
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Daniel Wiesen
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Hans-Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Psychology, University of South Carolina, Columbia, United States
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11
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Groß M, Jürges H, Wiesen D. The effects of audits and fines on upcoding in neonatology. Health Econ 2021; 30:1978-1986. [PMID: 33951233 DOI: 10.1002/hec.4272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/06/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Upcoding is a common type of fraud in healthcare. However, how audit policies need to be designed to cope with upcoding is not well understood. We provide causal evidence on the effect of random audits with different probabilities and financial consequences. Using a controlled laboratory experiment, we mimic the decision situation of obstetrics staff members to report birth weights of neonatal infants. Subjects' payments in the experiment depend on their reported birth weights and follow the German non-linear diagnosis-related group remuneration for neonatal care. Our results show that audits with low detection probabilities only reduce fraudulent birth-weight reporting, when they are coupled with fines for fraudulent reporting. For audit policies with fines, increasing the probability of an audit only effectively enhances honest reporting, when switching from detectable to less gainful undetectable upcoding is not feasible. Implications for audit policies are discussed.
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Affiliation(s)
- Mona Groß
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Hendrik Jürges
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Daniel Wiesen
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
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12
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Nestmann S, Wiesen D, Karnath HO, Rennig J. Temporo-parietal brain regions are involved in higher order object perception. Neuroimage 2021; 234:117982. [PMID: 33757908 DOI: 10.1016/j.neuroimage.2021.117982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/26/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022] Open
Abstract
Lesions to posterior temporo-parietal brain regions are associated with deficits in perception of global, hierarchical shapes, but also with impairments in the processing of objects presented under demanding viewing conditions. Evidence from neuroimaging studies and lesion patterns observed in patients with simultanagnosia and agnosia for object orientation suggest similar brain regions to be involved in perception of global shapes and processing of objects in atypical ('non-canonical') orientation. In a localizer experiment, we identified individual temporo-parietal brain areas involved in global shape perception and found significantly higher BOLD signals during the processing of non-canonical compared to canonical objects. In a multivariate approach, we demonstrated that posterior temporo-parietal brain areas show distinct voxel patterns for non-canonical and canonical objects and that voxel patterns of global shapes are more similar to those of objects in non-canonical compared to canonical viewing conditions. These results suggest that temporo-parietal brain areas are not only involved in global shape perception but might serve a more general mechanism of complex object perception. Our results challenge a strict attribution of object processing to the ventral visual stream by suggesting specific dorsal contributions in more demanding viewing conditions.
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Affiliation(s)
- Sophia Nestmann
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, D-72076 Tübingen, Germany
| | - Daniel Wiesen
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, D-72076 Tübingen, Germany
| | - Hans-Otto Karnath
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, D-72076 Tübingen, Germany; Department of Psychology, University of South Carolina, Columbia, USA.
| | - Johannes Rennig
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, D-72076 Tübingen, Germany; Department of Neurosurgery and Core for Advanced MRI, Baylor College of Medicine, Houston, TX, USA
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13
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Abstract
Background. Inappropriate prescribing of antibiotics, which is common in pediatric care, is a key driver of antimicrobial resistance. To mitigate the development of resistance, antibiotic stewardship programs often suggest the inclusion of feedback targeted at individual providers. Empirically, however, it is not well understood how feedback affects individual physicians’ antibiotic prescribing decisions. Also, the question of how physicians’ characteristics, such as clinical experience, relate to antibiotic prescribing decisions and to responses to feedback is largely unexplored. Objective. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians’ antibiotic prescribing decisions in pediatrics. Design. We employed a randomized, controlled framed field experiment, in which German pediatricians (n=73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group (n=39), pediatricians received descriptive feedback in form of an expert benchmark, which allowed them to compare their own prescribing decisions with expert recommendations. The recommendations were elicited in a survey of pediatric department directors (n=20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians’ characteristics were elicited in a comprehensive questionnaire. Results. Providing pediatricians with expert feedback significantly reduced the length of antibiotic therapies by 10% on average. Also, the deviation of pediatricians’ decisions from experts’ recommendations significantly decreased. Antibiotic therapy decisions were significantly related to pediatricians’ clinical experience, risk attitudes, and personality traits. The effect of feedback was significantly associated with physicians’ experience. Conclusion. Our results indicate that descriptive expert feedback can be an effective means to guide pediatricians, especially those who are inexperienced, toward more appropriate antibiotic prescribing. Therefore, it seems to be suitable for inclusion in antibiotic stewardship programs.
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Affiliation(s)
- Kerstin Eilermann
- Cologne Graduate School in Management, Economics, and Social Sciences (CGS), Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Katrin Halstenberg
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- />Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
- />Operations Management Group, Judge Business School, University of Cambridge, Cambridge, UK
| | - Kyriakos Martakis
- />Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
- />Department of International Health, Care and Public Health Research Institute, School CAPHRI, Maastricht University, Maastricht, the Netherlands
- />Department of Pediatric Neurology, University Children’s Hospital (UKGM) and Medical Faculty, Justus Liebig University of Giessen, Giessen, Germany
| | - Bernhard Roth
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
| | - Daniel Wiesen
- Daniel Wiesen, Department of Business Administration and Health Care Management, University of Cologne, Albertus-Magnus-Platz, Cologne, 50923, Germany ()
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14
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Wiesen D, Sperber C, Yourganov G, Rorden C, Karnath HO. Using machine learning-based lesion behavior mapping to identify anatomical networks of cognitive dysfunction: Spatial neglect and attention. Neuroimage 2019; 201:116000. [PMID: 31295567 DOI: 10.1016/j.neuroimage.2019.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Previous lesion behavior studies primarily used univariate lesion behavior mapping techniques to map the anatomical basis of spatial neglect after right brain damage. These studies led to inconsistent results and lively controversies. Given these inconsistencies, the idea of a wide-spread network that might underlie spatial orientation and neglect has been pushed forward. In such case, univariate lesion behavior mapping methods might have been inherently limited in detecting the presumed network due to limited statistical power. By comparing various univariate analyses with multivariate lesion-mapping based on support vector regression, we aimed to validate the network hypothesis directly in a large sample of 203 newly recruited right brain damaged patients. If the exact same correction factors and parameter combinations (FDR correction and dTLVC for lesion size control) were used, both univariate as well as multivariate approaches uncovered the same complex network pattern underlying spatial neglect. At the cortical level, lesion location dominantly affected the temporal cortex and its borders into inferior parietal and occipital cortices. Beyond, frontal and subcortical gray matter regions as well as white matter tracts connecting these regions were affected. Our findings underline the importance of a right network in spatial exploration and attention and specifically in the emergence of the core symptoms of spatial neglect.
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Affiliation(s)
- Daniel Wiesen
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, 72076, Germany
| | - Christoph Sperber
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, 72076, Germany
| | - Grigori Yourganov
- Department of Psychology, University of South Carolina, Columbia, 29208, USA
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, 29208, USA
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, 72076, Germany; Department of Psychology, University of South Carolina, Columbia, 29208, USA.
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15
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Sperber C, Wiesen D, Karnath H. An empirical evaluation of multivariate lesion behaviour mapping using support vector regression. Hum Brain Mapp 2019; 40:1381-1390. [PMID: 30549154 PMCID: PMC6865618 DOI: 10.1002/hbm.24476] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 11/02/2018] [Indexed: 01/14/2023] Open
Abstract
Multivariate lesion behaviour mapping based on machine learning algorithms has recently been suggested to complement the methods of anatomo-behavioural approaches in cognitive neuroscience. Several studies applied and validated support vector regression-based lesion symptom mapping (SVR-LSM) to map anatomo-behavioural relations. However, this promising method, as well as the multivariate approach per se, still bears many open questions. By using large lesion samples in three simulation experiments, the present study empirically tested the validity of several methodological aspects. We found that (i) correction for multiple comparisons is required in the current implementation of SVR-LSM, (ii) that sample sizes of at least 100-120 subjects are required to optimally model voxel-wise lesion location in SVR-LSM, and (iii) that SVR-LSM is susceptible to misplacement of statistical topographies along the brain's vasculature to a similar extent as mass-univariate analyses.
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Affiliation(s)
- Christoph Sperber
- Centre of Neurology, Division of Neuropsychology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Daniel Wiesen
- Centre of Neurology, Division of Neuropsychology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Hans‐Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
- Department of PsychologyUniversity of South CarolinaColumbiaSouth Carolina
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16
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Hennig-Schmidt H, Jürges H, Wiesen D. Dishonesty in health care practice: A behavioral experiment on upcoding in neonatology. Health Econ 2019; 28:319-338. [PMID: 30549123 DOI: 10.1002/hec.3842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/02/2018] [Accepted: 10/23/2018] [Indexed: 06/09/2023]
Abstract
Dishonest behavior significantly increases the cost of medical care provision. Upcoding of patients is a common form of fraud to attract higher reimbursements. Imposing audit mechanisms including fines to curtail upcoding is widely discussed among health care policy-makers. How audits and fines affect individual health care providers' behavior is empirically not well understood. To provide new evidence on fraudulent behavior in health care, we analyze the effect of a random audit including fines on individuals' honesty by means of a novel controlled behavioral experiment framed in a neonatal care context. Prevalent dishonest behavior declines significantly when audits and fines are introduced. The effect is driven by a reduction in upcoding when being detectable. Yet upcoding increases when not being detectable as fraudulent. We find evidence that individual characteristics (gender, medical background, and integrity) are related to dishonest behavior. Policy implications are discussed.
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Affiliation(s)
- Heike Hennig-Schmidt
- National Research University Higher School of Economics, Moscow, Russian Federation
- Laboratory for Experimental Economics, Department of Economics, University of Bonn, Bonn, Germany
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Hendrik Jürges
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Daniel Wiesen
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
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17
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Galizzi MM, Wiesen D. Behavioural experiments in health: An introduction. Health Econ 2017; 26 Suppl 3:3-5. [PMID: 29285870 DOI: 10.1002/hec.3629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Matteo M Galizzi
- London School of Economics, Department of Psychological and Behavioural Science, LSE Behavioural Science Hub, and LSE Health, London, UK
| | - Daniel Wiesen
- Department of Health Care Management, University of Cologne, Cologne, Germany
- Institute of Health and Society, University of Oslo, Oslo, Norway
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18
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Kober SE, Witte M, Ninaus M, Koschutnig K, Wiesen D, Zaiser G, Neuper C, Wood G. Ability to Gain Control Over One's Own Brain Activity and its Relation to Spiritual Practice: A Multimodal Imaging Study. Front Hum Neurosci 2017; 11:271. [PMID: 28596726 PMCID: PMC5442174 DOI: 10.3389/fnhum.2017.00271] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 01/05/2023] Open
Abstract
Spiritual practice, such as prayer or meditation, is associated with focusing attention on internal states and self-awareness processes. As these cognitive control mechanisms presumably are also important for neurofeedback (NF), we investigated whether people who pray frequently (N = 20) show a higher ability of self-control over their own brain activity compared to a control group of individuals who rarely pray (N = 20). All participants underwent structural magnetic resonance imaging (MRI) and one session of sensorimotor rhythm (SMR, 12–15 Hz) based NF training. Individuals who reported a high frequency of prayer showed improved NF performance compared to individuals who reported a low frequency of prayer. The individual ability to control one’s own brain activity was related to volumetric aspects of the brain. In the low frequency of prayer group, gray matter volumes in the right insula and inferior frontal gyrus were positively associated with NF performance, supporting prior findings that more general self-control networks are involved in successful NF learning. In contrast, participants who prayed regularly showed a negative association between gray matter volume in the left medial orbitofrontal cortex (Brodmann’s area (BA) 10) and NF performance. Due to their regular spiritual practice, they might have been more skillful in gating incoming information provided by the NF system and avoiding task-irrelevant thoughts.
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Affiliation(s)
- Silvia E Kober
- Department of Psychology, University of GrazGraz, Austria.,BioTechMed-GrazGraz, Austria
| | - Matthias Witte
- Department of Psychology, University of GrazGraz, Austria
| | - Manuel Ninaus
- Leibniz-Institut für WissensmedienTuebingen, Germany.,LEAD Graduate School and Research Network, Eberhard Karls University TuebingenTuebingen, Germany
| | - Karl Koschutnig
- Department of Psychology, University of GrazGraz, Austria.,BioTechMed-GrazGraz, Austria
| | - Daniel Wiesen
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany
| | - Gabriela Zaiser
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany
| | - Christa Neuper
- Department of Psychology, University of GrazGraz, Austria.,BioTechMed-GrazGraz, Austria.,Laboratory of Brain-Computer Interfaces, Institute for Neural Engineering, Graz University of TechnologyGraz, Austria
| | - Guilherme Wood
- Department of Psychology, University of GrazGraz, Austria.,BioTechMed-GrazGraz, Austria
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19
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Brosig-Koch J, Hennig-Schmidt H, Kairies-Schwarz N, Wiesen D. The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence. Health Econ 2017; 26:243-262. [PMID: 26708170 DOI: 10.1002/hec.3292] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 10/12/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
Mixed payment systems have become a prominent alternative to paying physicians through fee-for-service and capitation. While theory shows mixed payment systems to be superior, causal effects on physicians' behavior when introducing mixed systems are not well understood empirically. We systematically analyze the influence of fee-for-service, capitation, and mixed payment systems on physicians' service provision. In a controlled laboratory setting, we implement an exogenous variation of the payment method. Medical and non-medical students in the role of physicians in the lab (N = 213) choose quantities of medical services affecting patients' health outside the lab. Behavioral data reveal significant overprovision of medical services under fee-for-service and significant underprovision under capitation, although less than predicted when assuming profit maximization. Introducing mixed payment systems significantly reduces deviations from patient-optimal treatment. Although medical students tend to be more patient regarding, our results hold for both medical and non-medical students. Responses to incentive systems can be explained by a behavioral model capturing individual altruism. In particular, we find support that altruism plays a role in service provision and can partially mitigate agency problems, but altruism is heterogeneous in the population. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jeannette Brosig-Koch
- Faculty of Economics and Business Administration, University of Duisburg-Essen, and CINCH - Health Economics Research Center, Essen, Germany
| | - Heike Hennig-Schmidt
- Laboratory for Experimental Economics, University of Bonn, Bonn, Germany
- Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, Norway
| | - Nadja Kairies-Schwarz
- Faculty of Economics and Business Administration, University of Duisburg-Essen, and CINCH - Health Economics Research Center, Essen, Germany
| | - Daniel Wiesen
- Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, Norway
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
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20
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Hennig-Schmidt H, Wiesen D. Other-regarding behavior and motivation in health care provision: An experiment with medical and non-medical students. Soc Sci Med 2014; 108:156-65. [DOI: 10.1016/j.socscimed.2014.03.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/19/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
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21
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Godager G, Wiesen D. Profit or patients' health benefit? Exploring the heterogeneity in physician altruism. J Health Econ 2013; 32:1105-1116. [PMID: 24135614 DOI: 10.1016/j.jhealeco.2013.08.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
This paper investigates physician altruism toward patients' health benefit using behavioral data from Hennig-Schmidt et al.'s (2011) laboratory experiment. In the experiment, medical students in the role of physicians decide on the provision of medical services. The experimental setup allows us to identify the influence of profits and patients' health benefit on the choice of medical treatment. We estimate physician altruism, the weight individuals attach to patients' health benefit, by fitting mixed logit and multinomial logit regression models to the experimental data. Estimation results provide evidence for physician altruism. We find, however, substantial variation in the degree of physician altruism. We also discuss some implications of our results for the design of physician payment schemes in the light of the theoretical literature.
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Affiliation(s)
- Geir Godager
- Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Norway.
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22
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Hennig-Schmidt H, Selten R, Wiesen D. How payment systems affect physicians' provision behaviour--an experimental investigation. J Health Econ 2011; 30:637-46. [PMID: 21683460 DOI: 10.1016/j.jhealeco.2011.05.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 03/18/2011] [Accepted: 05/02/2011] [Indexed: 05/09/2023]
Abstract
Understanding how physicians respond to incentives from payment schemes is a central concern in health economics research. We introduce a controlled laboratory experiment to analyse the influence of incentives from fee-for-service and capitation payments on physicians' supply of medical services. In our experiment, physicians choose quantities of medical services for patients with different states of health. We find that physicians provide significantly more services under fee-for-service than under capitation. Patients are overserved under fee-for-service and underserved under capitation. However, payment incentives are not the only motivation for physicians' quantity choices, as patients' health benefits are of considerable importance as well. We find that patients in need of a high (low) level of medical services receive larger health benefits under fee-for-service (capitation).
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Affiliation(s)
- Heike Hennig-Schmidt
- BonnEconLab – Laboratory for Experimental Economics, University of Bonn, Adenauerallee 24-42, D-53113 Bonn, Germany.
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