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Conflict in the doctor-patient relation and non-adherence: a game theory approach

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Abstract Non-adherence to medication leads to reduced health outcomes and increased health care costs. More evidence and analysis is needed to understand the determinants of non-adherence, particularly the impact of the doctor-patient interaction. This relationship is often characterised by conflict during consultations. The aim of this paper is to investigate whether a game theoretic approach can explain the conflict during consultations that lead patients to non-adhere to medical recommendations. The game theoretic models constructed employ the Psychological Expected Utility theory. There is a distinction between information-loving and information-averse patients. Doctors do not always know the type of patient they have and on the basis of limited knowledge, they need to decide how much information to pass on. We relax the assumption of perfect agency and introduce the concept of the doctor’s effort. Uncertainty is resolved under various hypotheses of bounded rationality. A complete resolution of the games is offered, and comparative statics results and economic interpretations are given. When a doctor knows with certainty the type of patient she has, she will transfer adequate information and the patient will adhere. If the doctor cannot recognize the patient’s need the outcome may be non-adherence to recommendations. Doctors who understand patients’ needs improve adherence rates. To enhance adherence, a number of policy recommendations are made. Financial incentives to the doctor do not benefit all types of patients.

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