Edited by Alistair McGuire and Joan Costa-Font
Chapter 18: Physician-patient Relationship: A Review of the Theory and Policy Implications
18 The doctor–patient relationship: a review of the theory and policy implications Charitini Stavropoulou 1. INTRODUCTION The doctor–patient relationship remains the cornerstone of medical practice. At the same time it is one of the most complex interactions in health care, which goes beyond consultation and clinical practice and involves aspects that are developed outside the encounter. On the one side of this relationship stands the doctor, whose diagnosing skills, prescribing patterns and referral decisions determine not only health outcomes but also, and to a great extent, health care costs. On the other side stands the patient, who is increasingly empowered to make decisions that concern his health. In many cases he chooses among a number of physicians, he collects information from sources other than the doctor and finally decides whether to adhere to the medical recommendations. These are all decisions that affect his health but also health care utilisation and expenditure. Health economists and policy makers realise the importance of this relationship on health systems and put great effort into exploring its underlying mechanisms. A number of models have been proposed to understand the elements of the physician’s utility function (McGuire, 2000; Scott, 2000), and different payment schemes have been designed in an effort to change physicians’ behaviour. The patient’s side has received less attention. In health economics the agency relationship that is often used to describe the doctor– patient interaction implies that the doctor acts on the patient’s behalf and therefore the majority of the decisions are...
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