A Closer Look at Patient-Physician Relationship at “Internet Ageâ€: From a Principal-Agent Model Perspective
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Abstract
Background: Patient-physician relationship is intrinsically complicated. Physicians have professional medical knowledge that is in most cases unavailable and incomprehensible to patients. The wide spread popularity of Internet have made its marks in this complicated relationship. ‘Internet informed’ patients are exposed to more medical information than ever before which changes the dynamics between the patient-physician encounter. This “Internet Age†presents advantages and challenges to patient-physician relationship, physician practices and public health promotion programs.
Several practical questions have been addressed, such as the time and reasons for the information seeking, physician’s reactions towards the seeking, quality of information, etc. However, the more essential questions of the impact of Internet information on clinical outcomes have rarely been addressed. The literature has called for studies that directly investigate the uncertainty about the effect of the Internet on patient-physician relationship, the impact of Internet information on individual medical decision-making and effects on public health outcomes (Gerber 2001).
Objective: We take up the challenge of developing a theoretical model to capture the mechanism behind the issues. Specifically, we investigate if and how Internet information potentially affects clinical outcomes and the associated costs and benefits. Conditions will be generated and tested with empirical data and simulations such as under which health care costs are increased and when clinical outcomes can be improved.
Methods: Information asymmetry and unaligned objectives between physicians and patients fits the classic principal agent model. Following Jelovac (2001), our model starts with discrete case assuming that the patient’s illness is either curable or incurable. The patient does not fully understand the severity while the doctor’s diagnosis helps convey the severity of the illness. The Internet information enters both stages of the encounter: diagnosis and treatment. In the diagnosis stage, Internet information affects the patients’ prior beliefs and may affect the number of tests ordered by the physician depending on the quality of the information and the physician’s acceptance. In the treatment stage Internet information may affect the physician’s choice of risky treatments. The potential impacts of Internet information are parameterized in the model to examine how Internet information affects health care costs, patient’s health loss (gain) and both patients’ and physicians’ satisfaction with the encounter.
Results: Preliminary results of the model indicate that although quality Internet information tends to increase medical costs via unnecessary tests and procedures, it can increase patient’s welfare by inducing a better signaling and facilitating adequate treatments when the illness is serious and difficult to diagnose. The information gap between physician and patient is not significantly shortened by Internet information due to the complicated nature of medicine. The quality of Internet information and patient’s health literacy level are crucial in leading to more desirable outcomes.
Conclusions: Our paper provides a much-needed guidance in quantifying the impact of Internet information seeking on health care. Results suggest a need for effective and accessible public health programs that help improve the public access to general health information and public ability to digest the abundant information from multiple sources.
Several practical questions have been addressed, such as the time and reasons for the information seeking, physician’s reactions towards the seeking, quality of information, etc. However, the more essential questions of the impact of Internet information on clinical outcomes have rarely been addressed. The literature has called for studies that directly investigate the uncertainty about the effect of the Internet on patient-physician relationship, the impact of Internet information on individual medical decision-making and effects on public health outcomes (Gerber 2001).
Objective: We take up the challenge of developing a theoretical model to capture the mechanism behind the issues. Specifically, we investigate if and how Internet information potentially affects clinical outcomes and the associated costs and benefits. Conditions will be generated and tested with empirical data and simulations such as under which health care costs are increased and when clinical outcomes can be improved.
Methods: Information asymmetry and unaligned objectives between physicians and patients fits the classic principal agent model. Following Jelovac (2001), our model starts with discrete case assuming that the patient’s illness is either curable or incurable. The patient does not fully understand the severity while the doctor’s diagnosis helps convey the severity of the illness. The Internet information enters both stages of the encounter: diagnosis and treatment. In the diagnosis stage, Internet information affects the patients’ prior beliefs and may affect the number of tests ordered by the physician depending on the quality of the information and the physician’s acceptance. In the treatment stage Internet information may affect the physician’s choice of risky treatments. The potential impacts of Internet information are parameterized in the model to examine how Internet information affects health care costs, patient’s health loss (gain) and both patients’ and physicians’ satisfaction with the encounter.
Results: Preliminary results of the model indicate that although quality Internet information tends to increase medical costs via unnecessary tests and procedures, it can increase patient’s welfare by inducing a better signaling and facilitating adequate treatments when the illness is serious and difficult to diagnose. The information gap between physician and patient is not significantly shortened by Internet information due to the complicated nature of medicine. The quality of Internet information and patient’s health literacy level are crucial in leading to more desirable outcomes.
Conclusions: Our paper provides a much-needed guidance in quantifying the impact of Internet information seeking on health care. Results suggest a need for effective and accessible public health programs that help improve the public access to general health information and public ability to digest the abundant information from multiple sources.
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