Patients "Google" and Get More Out of Visits

Here is an interesting news piece about a study of patients "googling' to get information about their conditions before they go to a general practitioner and then feeling a set of more positive feelings about the experience of the visit with the general practitioner.

At first glance, I might have thought that patients googling would not help patient/provider relationships.  My intuition may have been that the process of obtaining information from the world wide web would have been seen as a substitute for positive patient/general practitioner interaction.  Instead, it seems to be complementary to and encouraging of positive interaction.

Patients have a choice--go to the general practitioner, invest their time in conversation with the GP, and come away with an experience that will guide their future health and well-being.  Alternatively, they can spend time before the visit gathering information (a use of a scarce resource), then engage in conversation with the general practitioner.  While my intuition may have been to think that patients would use the information as a substitute for interaction with the general practitioner.  What seems to happen is that the patients are taking the information and using the information to strengthen their interaction with their general practitioner.

This suggests that at least some patients see the value of the improved interaction with the physician as being more than the value of the time that it takes to search for information on the internet.  This suggests that the value of improved interaction must be substantial.

Of course, this is not just a patient issue. It is also a physician issue.  The physicians must believe that the information that patients bring to them is useful and does not interfere with the interaction.

The information from this new study may help patients and providers to plan better for more effective and more efficient interaction in the future.  

Obesity and the Public Interest

I am teaching a course on Coursera called "Principles of Obesity Economics" which is a mini-version of the online course that I typically teach at the Johns Hopkins School of Public Health each summer that is called "Obesity Economics".  The course has only been going for a day, but the preparation for it has actually demonstrated that as far as the "production of education" is concerned, there are interesting economies of scope from needing to prepare materials that are not interchangeable but that can be used with some variation in multiple settings.  But that is not the main point I want to make today.

When I typed in "Obesity Economics" as a search in google, I saw that several things with which my teaching is concerned and a blog entry at The Economist magazine.   In this entry, the author, discusses why American politics and culture makes it unlikely (in the author's opinion) that the United States will do anything that makes a serious impact on obesity in the next several decades.

That is an interesting conclusion in light of how much this gets talked about all the time.

The author concludes that the focus on individual rights to make decisions in their own self-interest and to focus only on their self-interest leads to high levels of obesity.  That is an interesting interpretation.  I am not sure I agree that this is the exact answer, but it is worth thinking about whether, from an economic perspective, there is reason to think that this might actually be the case.

Individual self-interest means that individuals maximize their own utility.  No one that I know wants to be obese.  Some people are more willing to accept it than others.  But does that necessarily mean that obesity should increase as much as it does.  That would suppose that people make poor decisions. Or that people don't have enough information to make decisions.  Or that people are given wrong information to make decisions.    Or that people don't look forward enough when making decisions.  Each of these might involve a government intervention.  Very little would necessarily need to be changed in terms of leaving individuals witha high degree of free choice of what they want to eat and when and how they want to use their energy and when.  Perhaps we could think a little harder about regulating business.  And perhaps that is truly the issue. Perhaps we do not need to be regulating or incentivizing individual behavior (although for all of America's focus on individual rights we still tend to think that we should not have to pay all of our own medical care costs so the responsibilities that come along with those rights don't necessarily seem to be taken as strongly). Perhaps we should regulate business more.  Although that does not seem to be a large part of American culture either.  And that may be the just as important a rate limiting factor to achieving goals having to do with weight control in the United States.

We would still have to justify it with a compelling public need or an example of a market failure, but the point of whom to target and how carefully to target them would seem to remain an open question.  

Hospitals Providing Formula

There is an interesting piece in the New York Times about hospitals ending the practice of sending formula home with mothers who are breastfeeding or ending the practice of sending mothers at home with formula at all.  There are a number of interesting economic questions here.

First, what is the role of a sample of formula in determining infant feeding practices.  This is particularly relevant for mothers who have decided to breastfeed at first.  On the one hand, it makes access to formula easier.  Less time required to obtain the first amount of formula that a mother will use to feed a child.  A lower price (zero beyond the hospital costs) than if the sample was not provided.  So, there is an economic logic to the idea that this might change mothers' behavior with respect to how they choose to feed their children.  Perhaps for any mothers who were truly at the margin about their decision to breastfeed, their decision might change.  Or, at the very least, their decision to stop breastfeeding might change to an earlier time than they had otherwise planned if the cost of switching to formula feeding is made lower than it would have been otherwise.

Even if the mother continues to breastfeed, one question would be how to measure the value of having the option of formula feeding readily available.  At least some mothers may assign a value to this even if they never choose to formula feed.  

Second, there is the question about whether it is acceptable to send formula home with mothers who are already formula feeding.  This does not seem like a question of promoting behavior change in this case.  Instead, the issue here is what brand the mother will choose.  Does the mother perceive the type of formula offered as an endorsement from the hospital.  In this case, is the hospital playing a role in essentially marketing a specific type of formula to the mothers.  If they are, is this a reasonable role for the hospital to play?

The biggest question overall may be whether the hospital has a role to play in shaping mothers' behavior rather than letting the mother make a choice for herself with the information she has available.  The hospital arguably has a role in providing information and helping the mother understand tradeoffs that she might need to make but what there is beyond that is uncertain.