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2017 | OriginalPaper | Buchkapitel

11. Imperfect Agency and Non-Expected Utility Models

verfasst von : Stefan Felder, Thomas Mayrhofer

Erschienen in: Medical Decision Making

Verlag: Springer Berlin Heidelberg

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Abstract

The final chapter takes a more realistic stance to medical decision making by assuming that physicians are only imperfect agents of their patients. Specifically, we assume that physicians internalize only some share of the patient’s utility and follow a profit motive in their test and treatment decisions. We then analyze the effects of imperfect agency on the thresholds and discuss the role of liability rules and medical guidelines in regulating imperfect agency. Finally, we present non-expected utility models under risk and uncertainty (i.e., ambiguity). While these models can explain observed test and treatment decisions, they are not suitable for normative analyses aimed at providing guidance on medical decision making.

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Fußnoten
1
In a letter to Milton Friedman, dated August 25, 1950, Paul Samuelson, an originally severe critic, wrote that he accepted the expected utility theory after Leonard Savage persuaded him of the normative force of the Independence Axiom (quoted after Moscati 2016).
 
2
Note that the parameter β can also capture potential moral hazard in the case of the patient whose medical costs are covered by health insurance coverage. Instead of paying the full price, this patient only pays a fraction \( 1-\beta \) of the treatment cost.
 
3
Note that these conditions were also required in Chap. 5 for the effect of an increase in the willingness to pay for a QALY on the test-treatment threshold being positive.
 
4
This explains the classification as rank-dependent choice model.
 
5
Note the similarity between the threshold analysis under the dual theory and the analysis of the certainty equivalent under EUT.
 
6
In the framework of non-EUT models, the value of information relates to differences in outcomes rather than differences in EUT.
 
7
Another interpretation is that these are weighting factors for the size of a trial in a meta-analysis of prevalence estimates.
 
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Metadaten
Titel
Imperfect Agency and Non-Expected Utility Models
verfasst von
Stefan Felder
Thomas Mayrhofer
Copyright-Jahr
2017
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-53432-8_11