Which Patient do I treat?Economists and Physicians in the Lab

Marlies Ahlert University Halle-WittenbergStefan Felder Universities of Duisburg-Essen and BaselBodo Vogt University of Magdeburg

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Research questions

• Elicitation of social preferences of indi-viduals deciding in allocation problems

• Choices more in line with utilitarian prin-ciples or more with some egalitarian rules?

• Framing effects (med vs. neutral)?• Professional effects (physicians vs. economists)?

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Overview

1. The allocation problem and possible solutions

2. Classification of distributors

3. Framing and professional effects

4. Who is being served and how much do they receive?

5. Conclusion

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• Economist / physician i = 0

• Endowment: ECU / time R

• 7 recipients / patients i = 1,...,7

• Recipients are differentiated acc. to- minimal needs mi

- productivity / effectivity pi

1. Allocation problem

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Payoff of recipient i

The allocator decides about the ration of the resources each of the recipients i receives: ri

0, if

if i i

ii i i i

r m

r p r m

ii

r R

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t: participation rate of the recipients‘ payoffs (20%)

c: Fine for every recipient with zero payoff (50 ECU)

„Induced“ preferences

Payoff of the allocator:

00i

ii i

t c

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Examples for allocation problems (3 out of 10)Ressource Endowments R{1000, 1600}

Person1 2 3 4 5 6 7

300 50 150 50 100 300 100 1050

4 3 3 2 3 5 4

200 100 10 50 50 10 100 520

4 2 1 2 3 2 3

300 200 500 100 100 200 300 1700

4 2 1 2 3 4 1

ii

m

im

ip

im

ip

im

ip

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Own payoff maximizer: Typ S (OPMA)Maximizes his own payoff, acts according to the induced

preferences

WS (0 , 1 ,...,n) = 0

Be i the most productive person, person k is being served if

t mk pk > t mk pi - c .

Residual endowment goes to the most productive individual

2. Classification of allocators(ideal types)

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Modified dominance criterion for serving k:

0 1 2 0, , ,..., U n ii

W

11 1k k kt m p t m p c

Hurdle is higher

Utilitarian: Typ U (UA)

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maximizes

Priorization acc. to minimal need serves to overcome

i=0

If the residual endowment is not sufficient to serve a

further person, the allocator is indifferent as to which

person is being served and who receives the residual.

Number maximizer: Typ N (NMA)

0 1 2

0, if 0, , ,..., with

1, if 0i

N n i ii i

W N N

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Priorization according ot minimal need (like NMA)

Allocates the residual resources according to the leximin-criterion

He serves persons with low mi pi within the set of recipients

Rawlsian: Typ R (RA)

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Experimental design /1

• 10 treatments• 1 distributor• 7 potential recipients

• 10 x 7 choices for each distributor

1000,1600R

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Experimental design /2

17 Sessions with 136 students in total 2 different „framings“: neutral, medical

22 advanced medical students(8 in the neutral, 14 in the medical frame )

36 students in economics(21 in the neutral, 15 in the medical frame )

MaXLab Magdeburg, elfe Essen

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2. Classification of allocators

FramingEconomists

neutral med. Physicians

neutral med.

S Max payoff 6 2 8 1 1 2

1 2 3 1 1 2

NMax number 10 6 16 2 4 6

0 2 2 2 3 5

RRawls 2 1 3 3 4 7

not classified 2 2 4 0 1 1

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• Type of allocators are more clearly revealed unter familiar conditions:

- Economist in the neutral frame, Types S and N

- Physicians in the medical frame, types N uad R

• in both frames, physician more clearly deviate from the induced direction (toward altruistic behavior)

• Economist deviate more from the induced direction in the neutral frame

General observations tested for

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3. Framing and professional effects

Type OPMA NMA RA

Faculty Framing effect (medical vs. neutral setting)

Economists 1.45*** 1.26* 1.10 Physicians (1/1.29)** (1/1.20) (1/1.08)

Faculty effect (physicians vs. economists)

1.28** 1.12 (1/1.19)**

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Hypothesis set 1• All allocators prioritize persons with low minimal

need• Typ S has a strong positive interest to serve

persons with high productivity

5. Who is being served and by how much?

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logit-model for positive payoffs of the recipients

• The endowment has a positive effect on the likelihood of being served

• All allocator serve those persons more likely who have a low minimial need (holds for types N and R)

• All allocator serve those persons more likely who have a high productivity (holds for types S and N

5. Who is being served and by how much?

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5. Who is being served and by how much?

Hypotheses set 2

• Typ S und Typ N will serve those recipient

extra, who show a high productivity

• Rawlsian will increase the extra ration for those,

who have a long initial payoff

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Size of allocation, given the payoff is positive

Variables Coefficient Std. err.

Constant -49.81 *** 15.68

OPMA -161.24 *** 27.03

NMA -52.12 ** 20.53

RA -6.12 17.07

Endowment 14.99 10.60

Minimum need -0.02 0.02

Productivity 60.12 *** 4.61

OPMA . productivity 53.85 *** 8.73

NMA . productivity 2.84 6.47

RA . productivity . minimum need -0.08 *** 0.01

Number of observations = 2,973 Number of Groups = 58

R²: within = 0.169 R²: between = 0.279 R²: overall = 0.175

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• We are able to identify types, who systematically differ

from each other

• Distributive norms show up more clearly under

conditions familiar to the allocators (oec,oec; med,med)

• Productivity (+) und minimal need (-) influence the

probability of being served

Conclusion