ABSTRACT
We show that the intuition underlying the supplier-induced demand (SID) hypothesis is reflected in the cheap-talk literature from game theory, and in the credence-good literature from the economics of information. Applying these theories, we conclude that a neoclassical version of the SID hypothesis is only relevant for treatment decisions involving an expensive treatment that is equally effective in curing several states, but efficient in curing only some of these states (in that a cheaper treatment is efficient otherwise). For a simple game involving such a treatment decision, we show that a Nash equilibrium exists where the patient is able to constrain the physician in inducing demand, without the market for the potentially induced treatment failing. This equilibrium allows us to derive comparative statistics and welfare results.
Subject(s)
Game Theory , Health Services Needs and Demand , Information Theory , Physician-Patient Relations , Belgium , Communication , Decision Making , Humans , Models, Theoretical , Patient ParticipationABSTRACT
We present a model of the physician-patient relationship extending on the model by Farley [Farley, P.J., 1986. Theories of the price and quantity of physician services. Journal of Health Economics 5, 315-333] of supplier-induced demand (SID). First, we make a case for the way this model specifies professional ethics, physician competition, and SID itself. Second, we derive predictions from this model, and confront them with the neoclassical model. Finally, we stress the importance of considering how SID affects patient welfare in providing an example where physicians' ability to induce makes patients better off. To evaluate patient welfare, we derive approximations of the patients' welfare loss due to physician market power in both the neoclassical model and the inducement model.
Subject(s)
Health Services Needs and Demand/economics , Physician-Patient Relations , Physicians/psychology , Economic Competition , Humans , Models, EconomicABSTRACT
A reflection is made, on the one hand, on the lack of correlation between the intensity of micturition problems and the volume of the prostate and, on the other hand, on the different therapeutic approaches of irritative or obstructive voiding problems, and finally on the insufficiently convincing activity of Finasteride.
Subject(s)
5-alpha Reductase Inhibitors , Finasteride/therapeutic use , Prostatic Hyperplasia/drug therapy , Dihydrotestosterone/metabolism , Finasteride/adverse effects , Finasteride/pharmacology , Humans , Male , Prostate/metabolism , Prostatic Hyperplasia/metabolismABSTRACT
Urinary incontinence in females has been evaluated in a prospective series of 408 patients by comparing the clinical diagnosis and the subsequent urodynamic findings. The presenting symptoms or combination of symptoms were shown to have only a limited diagnostic predictive value as measured by urodynamic diagnostic criteria. The symptom of stress incontinence was a sensitive detector of genuine stress incontinence (94% sensitivity) but was not very specific (65%). The symptoms of urgency and urge incontinence were found to have limited sensitivity (62%) and specificity (47%) in the detection of detrusor instability. Even patients with isolated complaints of stress incontinence have an incidence of detrusor instability of 52%, whereas 76% of those with a history of isolated urgency and urge incontinence had detrusor instability. An urodynamic evaluation should be performed on most female patients suffering from urinary incontinence and is essential for patients who are being considered for surgery of stress incontinence.
