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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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Testing the hypothesis revealed that all doctors contribute personal wealth and time to the treatment of their patients, although the extent of doing so varies among physicians. The answers range from “Dr. 6“ and “Dr. 8” who are motivated by Christian thoughts and provide up to 50% of their work for free to “Dr. 2“ who describes himself as a purely money driven individual who only provides free treatments when he particularly sympathizes with a patient.145 Most doctors, however, explain that they are willing to accept the shortcomings of their own utility in the treatment of individual patients, as long as the overall profitability and existence of their surgery is not threatened.146 Altruism is not the doctors’ only motivation in providing free treatments. Providing Compare section 2.1.

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

Compare Interview mit Dr. 4, p. 90ff.; Interview mit Dr. 5, p. 97ff.; Interview mit Dr. 10, p. 137ff..

treatments that satisfy the patient but are unprofitable for the doctor, is also considered a marketing tool by physicians to retain existing and attract new patients.147 By means of providing free treatments, all physicians forego some of their own utility and as such violate the assumption of the homo oeconomicus. Therefore, H9 in the meaning of its first sentence needs to be rejected. Nevertheless, all doctors, except for “Dr. 6“ and “Dr. 8”, argue that ultimately in important situations they are ranking their own utility higher than those of their patients. With regard to its second sentence, H9 is consequently accepted.

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

Altruism and money have been identified as two motivations behind doctors’ work, so far. This chapter’s last hypothesis aims at understanding other reasons that potentially motivate physicians.

H10: Altruism and money are not the single most important motivations behind doctors’ work.

Altruism as a key motivation, was only explicitly mentioned by “Dr. 6 “and “Dr. 8”.148 Other doctors also refer to altruism, but only during the early stages of their career.149 Money was mentioned by all physicians, although not as their key priority “because if this were the case, most of us would rather have opted for a job in the health care industry where the salaries are higher and the working hours more regulated”.150 Only "Dr. 2“ said that money is the key driver of his motivation and even “in situations where he has the choice between money and a fatal treatment of patients, he rather goes for the money”.151 The will to help their patients is present with most physicians, although not as their single greatest motivation.152 Many doctors say that they are motivated by money and the will to help their patients at the same time, because they believe their expectations of high salaries not to be contrary to their motivation of helping patients.153 Unexpectedly, due to their establishment in a medium-sized town, providing scientific excellence was named by two physicians as their strongest motivation.154 This kind of answer was rather expected by medical practitioners who are working in the university hospitals of large cities.

Some doctors also mentioned, that due to the town’s size and its resulting tight social network, reputation among fellow citizens is also an important motivation.155 Interest in medicine and joy in performing their job are the major motivations for a majority of doctors.156 However, some doctors see their job as a simple means to an end and could imagine working in other professions, too.157 Surprisingly, the very same doctors also name an interest in “being self responsible and independent in their work” as their key motivations.158 Compare Interview mit Dr. 6, p. 105ff.; Interview mit Dr. 8, p. 121ff..

Compare Interview mit Dr. 7, p. 114ff..

Compare the interviews of all doctors, p. 68ff. and Interview mit Dr. 3, p. 82ff. in particular.

Compare Interview mit Dr. 2, p. 76ff..

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

Compare Interview mit Dr. 1, p. 68ff.; Interview mit Dr. 4, p. 90ff..

Compare Interview mit Dr. 1, p. 68ff.; Interview mit Dr. 5, p. 97ff..

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

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

Based on these findings, H10 is rejected.

Compare Interview mit Dr. 4, p. 90ff.; Interview mit Dr. 10, p. 137ff..

Compare Interview mit Dr. 4, p. 90ff.; Interview mit Dr. 10, p. 137ff..

Contrary to general public’s expectations and the impression communicated by politicians, medical treatments in Germany are not intended to be optimal. The legislature by means of Art. 12 SGB V expects doctors to only provide treatments which are “adequate and cost-effective”.

Statutory health insurances and most doctors believe that enough resources would be available to provide a treatment beyond SGB V, if fewer resources were wasted for ineffective treatments.

Among others, doctors’ lack of understanding for the economic implications of their decision making for society is one of the reasons for ineffective treatments.

University education does not prepare doctors for the economic decisions which they face on a daily basis in their surgeries.

Due to a perceived lack of economic understanding, doctors’ outsourcing of economic decision making to external advisors is the norm.

Decisions which are made by doctors themselves are in many cases reliant on intuition and past experience.

Doctors describe themselves to be easily influenced by external stakeholders, due to their lack of economic understanding.

Any doctor provides treatments free of charge. However, the willingness to do so varies among physicians.

Most doctors describe fascination in medicine as their major motivation. Although, patients benefit from this fascination, they are not doctors’ main motivation. Only a few doctors are altruistically motivated. Doctors’ above average salary is neither a major reason behind physicians’ motivation, because they believe that in other professions they could earn more.

–  –  –

This Master’s thesis aimed to provide an understanding of the economic decision making behavior of professionals with a non-economic background. The problem was applied to doctors with their own practices, because on the one hand these doctors are self-employed entrepreneurs with personal economic interests, but on the other hand they are also medical practitioners with an assumed interest in the well-being of their patients. Therefore, it was the thesis’ second objective to investigate how physicians behave in these situations, in which doctors’ economic interests and patients’ personal interests collide.

One could conclude from the findings in this thesis that patients should refrain from expecting to be optimally treated and any serious politician should not suggest that this is possible within the given framework. However, the treatment that is provided to patients in Germany follows very high standards and could be even better if the available resources were used more effectively. For achieving that purpose, doctors should be provided with a better understanding of economics, in order to understand the immense costs which are created in the case of patients’ wrong treatments, but also to manage their surgeries more cost-effectively, which would in the end benefit both themselves but also society as a whole.

In addition to being more realistic about the treatment quality that they are provided, the thesis demonstrated that patients should start understanding the doctor’s vocation, disregarding its potentially extreme influence on their lives, as a regular job, which for many physicians is only a simple and nice means to an end. Doctors, like any individuals, face concerns with regard to their personal economic existence and behave accordingly. In this context, the motivations for becoming doctors, which were discussed in the last part of this thesis, are also of minor importance because it only, if anything, influences the extent to which physicians are willing to forego their own utility to the benefit of their patients.

As said, doctors face many concerns with regard to their surgeries and their personal economic existence, but, as with many other professionals, are not prepared for these economic decisions by means of their professional education. Obtaining a medical degree at a German university does not optimally prepare doctors for the kind of decisions that they will face as soon as they start their own surgeries. Most physicians are aware of that and are consequently averse to any kind of financial risk.

It was found out that instead, and in order to overcome this limitation, many doctors try to outsource their economic decision making.

Consequently, doctors also described themselves as a target group that is relatively easy to influence and which is reliant on advisory services of external consultants.

This is where practical applications and further research should be focused.

5.2 Practical implications and opportunities for further research A better understanding of doctors’ economic decision making is of particular relevance to those stakeholders that are aiming to influence physicians for their own purpose. Especially the suppliers of medical equipment and drugs, as well as the contractors of external advisory services should be interested in the insights that describe the considerations and motivations behind doctors’ decisions because it allows them to better align their marketing efforts with their target group. Practitioners and academics interested in this field should focus their research accordingly.

Inferences on the quality of physicians’ decisions could be made if the decision making behavior of doctors were further investigated. These insights into the quality of decisions could also be useful in the development of systems that support medical practitioners in their economic decision making and hence create a benefit for both doctors and society. Therefore, research in this field might be valuable to academics and practitioners.

Finally, it could be academically interesting to further develop the moral and ethic implications of the dilemma which is faced by medical practitioners with regard to their economic decision making, because in the end, doctors are not only deciding on money, but also something very valuable and personal: Their patients’ health.

–  –  –

Abelson, R.P./Levi, A. (1985): Decision making and decision theory, New York.

Alchian, A.A./Demsetz, H. (1972): Production, Information Costs and Economic Organization, in: The American Economic Review, Vol. 62, p. 777-795.

Arrow, K.J. (1986): Agency and the Market, in: Arrow, K.J./Intriligator, M.D. (editor): Handbook of Mathematical Economics, Vol. 3, North-Holland, p. 1183-1195.

Bahner, B. (2004): Das neue Werberecht für Ärzte – Auch Ärzte dürfen werben, 2nd ed., Heidelberg.

Bamberg, G./Coenenberg, A. (1991): Betriebswirtschaftliche Entscheidungslehre, 7th ed., München.

Bamberg, G./Coenenberg, A./Krapp, M. (2008): Betriebswirtschaftliche Entscheidungslehre, 14th ed., München.

Bartscher, S./Bomke, P. (1993): Einführung in die Unternehmenspolitik, Stuttgart.

Becker, J. (2003): Die Entscheidungsanomalien des homo oeconomicus, in: Beckenbach, F. et al.

(editor): Psychologie und Umweltökonomik. Jahrbuch Ökologische Ökonomik, Vol. 3, p. 41-83.

Bekmeier – Feuerhahn, S. (2008a): Vorlesungsunterlagen - Management und Organisationstheorie Oktober 2008 - Normative Entscheidungstheorie, Lüneburg.

Bekmeier – Feuerhahn, S. (2008b): Vorlesungsunterlagen - Management und Organisationstheorie November 2008 - Prospect-Theorie, Lüneburg.

Bohsem, G. (2009): Patienten sollen Ärzte benoten, in: Süddeutsche Zeitung, Vol. 133, p. 1.

Breyer, F./Zweifel, P./Kifmann, M. (2005): Gesundheitsökonomik, Heidelberg.

Bundesagentur für Arbeit (2007): Ausbildungsbeschreibung von Arzt/Ärztin (Uni) vom 26.03.2007, Nürnberg.

Retrieved July 4, 2009 from the World Wide Web:

http://infobub.arbeitsagentur.de/berufe/docroot/r1/blobs/pdf/archiv/14581.pdf Bundesärztekammer (2008): Ärztestatistik der Bundesärztekammer zum 31.12.2008, Berlin.

Retrieved July 4, 2009 from the World Wide Web:

http://www.bundesaerztekammer.de/page.asp?his=0.3.7128 Bundesärztekammer (2009): Bundesärztekammer in brief, Berlin.

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