Abstract
Non-adherence to treatments is prevalent. The aim of this paper is to model how doctors should adapt their medical treatment decisions if non-adherence is due to present-bias in the patient population, and to test the predictions of this model in a lab experiment. Under certain conditions, a rational doctor should adapt to non-adherence by choosing a treatment all patients complete (though less effective) when the probability of a patient being present-biased is
sufficiently large. This is explored in a lab experiment where we test whether students in the doctor role adapt their behaviour as they learn about the distribution of non-adherence (due to present bias) in the patient population over the rounds of the experiment. We test the model prediction when we align individual incentives with the goal of maximising overall patient welfare. The results show that, on average, participants adapt to non-adherence as they learn
about the probability of non-adherence (due to present-bias). However, a proportion of participants do not adapt to the optimal choice. The rate of adaptation was similar for the first 5 rounds under both individual incentives and salary. However, participants continued to adapt after round 5 under individual incentives whilst adaptation plateaued under salary. The adaptation to non-adherence may indicate that adherence can be improved by providing doctors
with information about the probability of non-adherence (due to present-bias) in their patients.
sufficiently large. This is explored in a lab experiment where we test whether students in the doctor role adapt their behaviour as they learn about the distribution of non-adherence (due to present bias) in the patient population over the rounds of the experiment. We test the model prediction when we align individual incentives with the goal of maximising overall patient welfare. The results show that, on average, participants adapt to non-adherence as they learn
about the probability of non-adherence (due to present-bias). However, a proportion of participants do not adapt to the optimal choice. The rate of adaptation was similar for the first 5 rounds under both individual incentives and salary. However, participants continued to adapt after round 5 under individual incentives whilst adaptation plateaued under salary. The adaptation to non-adherence may indicate that adherence can be improved by providing doctors
with information about the probability of non-adherence (due to present-bias) in their patients.
| Original language | English |
|---|---|
| Article number | 115228 |
| Number of pages | 9 |
| Journal | Social Science and Medicine |
| Volume | 308 |
| Early online date | 1 Aug 2022 |
| DOIs | |
| Publication status | Published - Sept 2022 |
Bibliographical note
AcknowledgementsThe Chief Scientist Office of the Scottish Government Health and Social Care Directorates funds HERU. Funding for the experiment was provided in part by the Scottish Economic Society. Alastair Irvine's PhD studentship was funded by the Institute of Applied Health Sciences, University of Aberdeen. The views expressed in this paper are those of the authors only and not those of the funding body.
Data Availability Statement
The authors do not have permission to share data.Keywords
- Adherence
- present bias
- physician decision making
- lab experiment