Which Patient do I treat?
Economists and Physicians in the Lab
Marlies Ahlert
Stefan Felder
Bodo Vogt
University Halle-Wittenberg
Universities of Duisburg-Essen and Basel
University of Magdeburg
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)?
2
Overview
1.
2.
3.
4.
5.
The allocation problem and possible solutions
Classification of distributors
Framing and professional effects
Who is being served and how much do they
receive?
Conclusion
3
1. Allocation problem
•
•
•
•
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
4
The allocator decides about the ration of the
resources each of the recipients i receives: ri
Payoff of recipient i
0,
i  
ri  pi
if ri  mi
if ri  mi
r  R
i
i
5
„Induced“ preferences
Payoff of the allocator:
 0  t   i 
i
i
c


i 0
t:
participation rate of the recipients‘ payoffs
(20%)
c:
Fine for every recipient with zero payoff
(50 ECU)
6
Examples for allocation problems (3 out of 10)
Ressource Endowments R{1000, 1600}
Person
1
2
3
4
5
6
7
 mi
i
mi
300
50
150
50
100
300
100
pi
4
3
3
2
3
5
4
mi
200
100
10
50
50
10
100
pi
4
2
1
2
3
2
3
mi
300
200
500
100
100
200
300
pi
4
2
1
2
3
4
1
7
1050
520
1700
2. Classification of allocators
(ideal types)
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
8
Utilitarian: Typ U (UA)
WU  0 , 1 ,  2 ,...,  n    0    i
i
Modified dominance criterion for serving k:
t  1  mk  pk  t  1  mk  p1  c
Hurdle is higher
9
Number maximizer: Typ N (NMA)
maximizes
WN  0 , 1 ,  2 ,...,  n    Ni
i
0, if  i  0
with Ni  
1, if  i  0
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.
10
Rawlsian: Typ R (RA)
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
11
Experimental design /1
• 10 treatments
• 1 distributor
• 7 potential recipients
• 10 x 7 choices for each distributor
R 1000,1600
12
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
13
2. Classification of allocators
Framing
S
Max payoff
N
Max number
R
Rawls
not classified
Economists
neutral
med.

Physicians
neutral med.

6
2
8
1
1
2
1
2
3
1
1
2
10
6
16
2
4
6
0
2
2
2
3
5
2
1
3
3
4
7
2
2
4
0
1
1
14
General observations tested for
• 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
15
3. Framing and professional effects
Type
Faculty
Economists
Physicians
OPMA
NMA
RA
Framing effect (medical vs. neutral setting)
1.45***
(1/1.29)**
1.26*
(1/1.20)
1.10
(1/1.08)
Faculty effect (physicians vs. economists)
1.28**
1.12
16
(1/1.19)**
5. Who is being served and by how
much?
Hypothesis set 1
• All allocators prioritize persons with low minimal
need
• Typ S has a strong positive interest to serve
persons with high productivity
17
5. Who is being served and by how
much?
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
18
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
19
Size of allocation, given the payoff is
positive
Variables
Coefficient
Constant
OPMA
NMA
RA
Endowment
Minimum need
Productivity
OPMA . productivity
NMA . productivity
RA . productivity . minimum need
-49.81
-161.24
-52.12
-6.12
14.99
-0.02
60.12
53.85
2.84
***
***
**
***
***
-0.08 ***
Number of observations = 2,973 Number of Groups = 58
R²: within = 0.169
R²: between = 0.279 R²: overall = 0.175
20
Std. err.
15.68
27.03
20.53
17.07
10.60
0.02
4.61
8.73
6.47
0.01
Conclusion
• 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
21