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«Tim Rosengart July 17, 2009 This is a Bucerius/WHU MLB thesis 12,832 words (excluding footnotes) Supervisor 1: Professor Dr. Bernhard Hirsch ...»

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Therefore, based on the aforementioned hypotheses on the expected economic decision making behavior of doctors, a formal questionnaire was developed and presented to ten physicians who possess their own medical practices. The questionnaire, which can be found in the annex of this work, was presented to ten physicians in the form of a structured interview. The order in which questions were raised during this interview differs from the order in which hypotheses were derived from the text because in the creation of the questionnaire, focus was put on the thematic coherence of questions, as well as convenience for the interviewer in guiding the doctor through the questions.99 The recorded interview outcomes are compared with the assumptions on doctors’ economic decision making behavior which were made based on the theoretical insights of chapter two and three, in order to achieve this thesis’ objective of investigating how doctors behave with regard to their economic decision making in reality.

The practical implications of the insights derived in this chapter will be discussed later in this chapter.

Compare Interviewfragen – Ärzte – Template, p. 64ff.; Compare Interview mit Dr. 1, p. 68ff..

Interview methodology as a means of conducting an empirical analysis was chosen since for many of the questionnaire’s issues no simple yes or no answer can be given. Furthermore, it was expected that by choosing this particular method, as much extra information as possible, which in such an explicit style is not available in the academic literature, could be derived and used for this thesis.

By conducting, editing and compiling the interviews in the appendix of this thesis, a theoretical foundation was laid which will be used and referred to when testing the hypotheses and achieving this thesis’ objective.

The limitations of this method are that it cannot be absolutely ensured that the developed questionnaire allows the thesis’ objective to be met to the maximum extent. Furthermore, problems need to be considered which exist in translating the theoretical insights of chapter two and three into testable hypotheses, which, again, need to be reformulated into easily understandable questions.

Even in the case of due diligence and care, distortion is likely. Additionally, it needs to be assumed that despite all efforts towards the formulation of precise questions, doctors understood questions wrongly or answered them in a context other than their economic decision making.

In addition to the limitations with regard to this thesis’ methodology, drawbacks from the chosen

sample of doctors need to be expected:

The sample is rather restricted in its size and doctors’ honesty in answering personal questions also needs to be doubted. Furthermore, the doctors’ heterogeneity with regard to their specializations and the distribution of their patients’ insurance status i.e. privately insured vs. member of a statutory health insurance need to be considered. A rather strong homogeneity of age and gender among the interviewed doctors can be observed, too. Additionally, the survey limited itself to one geographic region i.e. Dinslaken, Duisburg and Wesel in North-Rhine Westphalia. All the aforementioned limitations forbid this thesis’ outcomes to claim representativeness.

Nevertheless, it can be expected that at least dishonesty has no overriding influence on the interview outcomes. When conducting the interviews, a personal impression was developed that the doctors, due to an apparently considerable interest and emotional involvement in this thesis’ topic, together with a long-suppressed anger about their situation were first of all, willing to invest a lot of time in the interviews and second, disclosed a lot of private information about themselves, which leads to the assumption that the physicians’ answers can be assumed to be reasonably honest.100 Based on this fact, the conducted interview can be seen at least as a good survey of different doctors’ approaches to economic problems and despite the relatively small sample size, the frequency of Also compare Kuhrt (2009), p. 14ff..

similar answers allows the interested reader to make an inference on doctors’ decision making behavior.

4.2 Testing of hypotheses

All hypotheses will be tested according to the same structure: First, the hypothesis will be presented and its motivation is shortly outlined. The questions in the questionnaire which were aimed at testing the respective hypothesis will be identified, before the hypothesis is tested by discussing the answers of different medical practitioners and comparing their responses with the hypotheses derived in chapters two and three. Finally, the hypothesis will either be accepted or rejected.

H1: Doctors use mental models to simplify their economic decision making. Their decision making process is determined by a limited number of key variables.

Chapter two outlined that the concept of mental models assumes incomplete and imprecise information and a limited cognitive ability of decision makers. It was also stated that, as a consequence of these limitations, decision makers create mental models which describe their environment in a simplified way and reduce the complexity of decisions by only focusing on a limited number of key variables.101 Applied to the complex and unstable environment in which doctors with their own surgeries face their decisions and which was described in chapter three, it was assumed that doctors make use of such mental models.102 To test whether doctors use mental models and to find out whether their decision making process is determined by a limited number of key variables, was the purpose of questions 1.1 / 1.2 and questions 4.1 / 4.2 in the questionnaire.

When explaining to physicians the concept of mental models, all of the interviewed doctors claimed the concept to be applicable for their decision making behavior and admitted that in their decision making they are determined by a rather limited number of variables.103 Nevertheless, the variables which determine their decision making process differ among physicians.

Disregarding exceptional answers such as those of “Dr. 5” who describes “always buying the product with the highest quality no matter its price” and “simply having fun with the products” as the key Compare section 2.1.

Compare chapter 3.

Compare the interviews of all doctors, p. 68ff..

variables behind his economic decision making, most doctors defined “medical necessity” as the most powerful variable driver behind their economic decision making.104 “Dr. 6” is representative of the behavior of the majority of doctors who first determine a necessity, then check out and compare the available offers and decide on the product that provides them with the highest value.105 Nevertheless, the methods with which doctors determine products’ values differ. Some doctors do perform calculations whereas others base their decisions on rather soft factors such as intuition and prior experience.106

Based on these interview outcomes, H1 is accepted.

Compare Interview mit Dr. 5, p. 97ff..

Compare Interview mit Dr. 6, p. 105ff..

Compare Interview mit Dr. 1, p. 68ff.; Interview mit Dr. 2, p. 76ff.; Interview mit Dr. 6, p. 105ff. with Interview mit Dr. 3, p. 82ff.; Interview mit Dr. 7, p. 114ff.; Interview mit Dr. 10, p. 137ff..

H2: Assuming the concept of mental models to be applicable for doctors’ economic decision making. – Education is a key variable in doctors’ decision making.

H3: Assuming the concept of mental models to be applicable for doctors’ economic decision making. – Intuition and experience are key variables in doctors’ decision making.

Section 3.2 assumes that the environment or framework, in which doctors with their own surgeries perform their job, is shaped by physicians’ education and the structure of the German ambulant health care system.

107 By means of testing H1, it was found out that in order to reduce complexity, physicians create mental models and focus their attention on some key variables which are chosen by doctors based on their prevalence.108 H2 consequently aims at finding out whether the theoretical and practical experiences of students towards obtaining a medical degree, influence doctor’s economic decision making.109 Derived from the theoretical insights into the medical degrees’ standardized curriculum, it can be expected that doctors are not intensively prepared for their economic decision making tasks.110 Therefore, H3 was developed to test the degree of intuition and experience which doctors need to rely on, to compensate for their lack of economic education.

For testing the underlying assumptions of H2, questions 1.2 and 1.4, as well as 4.2 are relevant.

Question 4.3 of the questionnaire has the purpose of testing H3.

With regard to H3, a uniform answer was given by all doctors: None of the interviewed physicians describes his or her economic decision making to any extent influenced by his or her university education. Some doctors, however, emphasized this perception’s validity at their current state of career, but explain that this situation differs from the period right after their approbation. During the practical periods of their studies and the time after approbation, in which most physicians worked at hospitals, most doctors became accustomed to special equipment and particular brands. Some physicians said that their purchase behavior is affected by this effect and named it as an influence of education on their economic decision making.111 However, the overall impact of education, as a variable that is relevant to doctors’ economic decision making, appears to be negligible.

H2 is therefore rejected.

Compare section 3.2.

Compare section 2.1.

Compare section 3.2.2.

Compare section 3.2.2.

Compare for example the website of MLP Finanzdienstleistungen GmbH which offers many services to students in their clinical studies and also subsidize textbooks popular among students: http://www.mlpmedizinstudenten.de/.

Intuition is applied by all doctors. However, the extent of its use varies. Physicians such as “Dr. 6“ base their economic decision making exclusively on hard facts, whereas other practitioners rely to the largest extent on their intuition.112 In situations in which the future development of variables is not foreseeable or numbers are simply not available, all physicians have to rely on intuition.113 Doctors’ intuition in most cases is shaped by their experience.114 Experience, to a large extent, is formed by positive and negative economic decisions of the past and marketing efforts by suppliers of medical equipment and drugs.115 Nevertheless, experiences do not necessarily need to be made by doctors themselves, but can also be acquired from other physicians, who have faced similar economic problems in the past.116

Based on these findings H3 is accepted.

Compare Interview mit Dr. 6, p. 105ff. with Interview mit Dr. 5, p. 97ff.; Interview mit Dr. 7, p. 114ff..

Compare the interviews of all doctors, p. 68ff..

Compare the interviews of all doctors, p. 68ff..

Compare Interview mit Dr. 1, p. 68ff.; Interview mit Dr. 3, p. 82ff.; Interview mit Dr. 9, p. 128ff..

Compare Interview mit Dr. 1, p. 68ff..

Due to the apparently negligible influence of education on doctors’ economic decision making and their reliance on intuition and experience to compensate for their perceived lack of economic understanding, hypotheses H4 and H5 were developed. Both aim at investigating in greater detail, the role of education in physicians’ economic decision making:117 H4: University education provides prospective doctors with relevant knowledge in the field of business administration that they need to manage own medical practices.

H5: University education provides prospective physicians with an adequate understanding of the economic implications of their decision making for society.

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