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1 – 2 of 2Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for…
Abstract
Purpose
Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for this variance, policies such as the Affordable Care Act (ACA) call for health care providers to engage in shared decision making (SDM) with patients to ensure they are informed of treatment options and asked their preferences. Yet, gender may influence the decision-making process. Thus, this project examines the decision process and how gender impacts patients’ participation in decisions to undergo certain surgeries compared to uncertain surgeries.
Methodology/approach
This research project analyzed data from the National Survey of Medical Decisions 2006–2007 which surveyed the medical decisions of US residents 40 and older.
Findings
First, the data reveals that women felt more informed having uncertain surgeries compared to men. Second, patients were less likely asked their preference for surgery when undergoing certain surgeries compared to uncertain surgeries. Third, compared to men, women having uncertain surgeries were less likely to make the final decision to have surgery, compared to sharing the final decision with health care providers.
Limitations
Due to the sample size, this project could not perform three-way interactions between gender, race, and surgery type.
Originality/value
Gender influences the level patients feel informed having uncertain surgeries. Though policy calls for SDM, health care providers are less likely to ask patients their preference for surgery regarding certain surgeries, relative to uncertain surgeries. Gender impacts the final decision-making process regarding whether patients should have uncertain surgeries.
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Keywords
David H. Howard and Yu-Chu Shen
Purpose – Policymakers hope that comparative effectiveness research will identify examples of widely used therapies that are no better than less expensive alternatives and…
Abstract
Purpose – Policymakers hope that comparative effectiveness research will identify examples of widely used therapies that are no better than less expensive alternatives and, consequently, reduce health care spending. Comparative effectiveness research is unlikely to reduce spending if physicians are quick to adopt effective treatments but slow to abandon ineffective ones.
Methodology/approach – We present a theoretical model that shows how physicians will adopt new treatments in response to positive evidence more readily than they abandon existing treatments in response to negative evidence if the marginal costs of production decline post-adoption. We report trends in the use of two common procedures, percutaneous coronary intervention (PCI) for patients with stable angina and routine episiotomy in vaginal childbirth, where comparative effectiveness research studies have failed to find evidence of a benefit.
Findings – Use of PCI and episiotomy have declined over time but are still excessive based on the standards implied by comparative effectiveness research.
Practical implications (if applicable) – The findings suggest that comparative effectiveness research has the potential to reduce costs but additional efforts are necessary to fully realize savings from abandonment.
Originality/value of chapter – There is a large literature on technological adoption in health care, but few studies address technological abandonment. Understanding abandonment is important for efforts to decrease health care costs by reducing use of ineffective but costly treatments.
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