Socioeconomic bias in physician decision-making? An experimental design

Last registered on September 06, 2019
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Pre-Trial

Trial Information

General Information

Title
Socioeconomic bias in physician decision-making? An experimental design
RCT ID
AEARCTR-0004673
Initial registration date
September 05, 2019

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
September 06, 2019, 1:50 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country
Sweden
Region

Primary Investigator

Name
Margareta Dackehag
Affiliation
Lund University
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Other Primary Investigator(s)

PI Name
Magnus Kåregård
PI Affiliation
PI Name
Erik Wengström
PI Affiliation
Lund University
PI Name
Ulf Gerdtham
PI Affiliation
Lund University
PI Name
Anders Anell
PI Affiliation
Lund University
PI Name
Anders Beckman
PI Affiliation
Lund University
PI Name
Sofia Dahlin
PI Affiliation
Region Jönköpings län
Contact Investigator

Additional Trial Information

Status
On going
Start date
2019-09-01
End date
2020-07-01
Keywords
Health
Additional Keywords
Socioeconomic status, physician decision-making, health care, bias, economic experiment
JEL code(s)
Secondary IDs
Abstract
Despite the central goal of providing medical treatment based on need there are well-known and persistent socioeconomic inequalities in all developed healthcare systems. Based on register and survey data, recent studies indicate that part of the problem relates to physician behaviour; physicians treat patients with equal care need differently depending on patients' socioeconomic status (SES). However, due to data limitations further analysis, using other methods, is required to establish a socioeconomic bias in healthcare provision and to study the underlying mechanisms. The objective of this project is to investigate whether and how patient SES influences physician decision-making, using economic experiments based on video-recordings of individuals describing their real health problems in a standardised, consultation-like setting. The “video patients” suffer from similar health problems but have different SES. The project consists of two economic experiments, where students of and graduates from medical professional programs participate. In the first experiment we investigate the alignment of SES-perceptions among a first group of experiment participants, who are asked to categorize patients according to SES after viewing individual videos. In the second experiment we investigate whether there is a socioeconomic bias in physician decision-making, by letting a second participant group assess the healthcare need of video patients.
External Link(s)

Registration Citation

Citation
Anell, Anders et al. 2019. "Socioeconomic bias in physician decision-making? An experimental design." AEA RCT Registry. September 06. https://doi.org/10.1257/rct.4673-1.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2019-09-01
Intervention End Date
2020-07-01

Primary Outcomes

Primary Outcomes (end points)
Experiment 1: assessments of patients’ socioeconomic status
Experiment 2: assessments of patients’ healthcare need
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The material (video recordings) for the experiments has been collected. All recruited “video patients” have problems with musculoskeletal pain. Administrative classification of SES and healthcare need is based on the information that the video patients registered when signing up for the study. They are classified according to SES and similar healthcare need has been established. The assessment of pain and healthcare need of the video patients is based on the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) evaluation template and the expert advice of the two GPs in the research group. There are 3-4 video patients per SES group (two SES groups: low income and low education, high income and high education), in total 6-8 video patients.

We recruit experiment participants among students of and graduates from medical professional programs. Both experiments will take place in computer laboratories. In both experiments we apply a within-subject design: every participant will watch the video recordings in random order and after each video make an assessment. In Experiment 1 the participant assigns the patient to a SES-group with respect to income and education. In addition, the participant rates the patients on bipolar attitude scales. In the second experiment the participant assesses health care need by allocating resources on a scale from 1 (watchful waiting) to 5 (intense and immediate treatment) for every patient. The main treatment in both experiments is a coordination game and rewards the participants for choosing the SES classification or medical treatment level they believe is the preferred choice of their (participant) peers, increasing the possibility to measure implicit socioeconomic bias.
Experimental Design Details
Randomization Method
Randomization done in office by a computer.
Randomization Unit
Randomization of the order in which video recordings are shown to individual participants.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
60-120 students/graduates
Sample size: planned number of observations
60-120 students/graduates
Sample size (or number of clusters) by treatment arms
Within-subject design: 60-120 students/graduates in both treatments
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Etikprövningsmyndigheten
IRB Approval Date
2019-08-19
IRB Approval Number
2019-03358
IRB Name
Regionala etikprövningsnämnden i Lund
IRB Approval Date
2017-08-16
IRB Approval Number
2017/383
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials