The Medium Matters: Medical Decision-Making in Telemedicine versus In-person Care
with Paul Gertler, Ada Kwan, Eric Remera, Piero Irakiza, Jeanine Condo, and James Humuza
Abstract: The use of telemedicine has been on the rise. Although telemedicine has increased access to health care, little is known about how the medium changes providers’ medical decision-making. To evaluate how telemedicine differs from in-person care, we compare the quality and cost of in-person clinic visits and virtual visits over the phone for common conditions in Rwanda. To control for patient selection, we conduct an audit study with 2,532 standardized patient visits, where individuals portraying real patients presented standardized cases for malaria and upper respiratory infection (URI). We find that the quality of virtual care is higher than that of in-person care for URI and equally as good for malaria. Telemedicine providers also asked more questions about symptoms and medical history and prescribed more optional medicines for symptom management than in-person providers. We further find that telemedicine is more efficient than in-person care: virtual consultations were faster, had shorter wait times, resulted in fewer unnecessary medications and tests, and cost less for patients. Controlling for a rich set of provider characteristics, we show that provider selection does not appear to drive the results. Instead, better provider-patient communication over the phone emerges as a key mechanism. Providers report that it is easier to treat, get information from, and relate to patients over the phone. Providers also report feeling less social pressure during phone consultations. Consistent with survey evidence, we find that providers prescribe unnecessary antibiotics when asked by patients face-to-face, but not over the phone.
Simple Actions, Complex Habits: Lessons from Hospital Hand Hygiene
Abstract: Routine tasks are often critical to performance but not consistently done. In the case of hospital hand hygiene, vital for infection prevention, guidelines are followed only half the time. Using data on whether 13,606 healthcare workers wash their hands 123M times that they are expected to, I document substantial heterogeneity consistent with a model of automatic cue-based habits. High performers fatigue 43% less than low performers but respond similarly when routines are disrupted. Behavior is also location-specific; healthcare workers wash more in rooms they have visited more in the past. These features of habit have implications for motivating routine behaviors.
Goals, Expectations, and Performance
with Avner Strulov-Shlain
Revise & Resubmit to Management Science
Abstract: People and organizations often set goals to self-motivate and achieve better outcomes in challenging tasks. But goals, and their effectiveness, might depend on what people expect to happen. Do goals reflect expectations or do goals set expectations? How do goals and expectations affect performance? These distinctions are important for motivation and intervention design. We run an online real-effort task to answer these two questions by introducing exogenous variation in goals and expectations. First, we find that goals mostly reflect existing expectations rather than set expectations. Second, practicing an easier version of a task leads to higher expectations and higher performance. Eliciting a goal leads to higher performance as well. However, controlling for expectations, changing the difficulty of the goal has no discernible effect. These results suggest that people benefit from being optimistic and setting a goal, but they cannot fool themselves into expecting and doing more simply by choosing a higher goal.
Integrating Neuro-Psychological Habit Research into Consumer Choice Models
with Ryan Webb, Jessica Fong, Asaf Mazar, Julia Levine, Olivia Natan, Clarice Zhao, Phillippa Lally, Sanne de Wit, John O’Doherty, Andrew Ching, Raphael Thomadsen, Matthew Osborne, Peter Landry, Mark Bouton, Wendy Wood, and Colin Camerer
Abstract: We discuss how habit is defined across disciplines that study human choices. In particular, we examine the role of learning in forming habits, the roles of automaticity, context and cues, and attention, and whether habits reflect a change in preferences or a choice system which is partly decoupled from preferences. These constructs are used to create a framework for economics, psychology, and marketing research, suitable for analysis of consumer choice experiments and datasets.
