Health
Opinion Article
INVITED EDITOR
Editorial from
Daniel Lopes
Nova SBE PhD Alumnus, and a former member of Nova SBE Health Economics & Management Knowledge Center. Today, Daniel is a Researcher at Rede Transparência & Sustentabilidade, in Brazil.
July 16, 2024
3. Good health and well-being

3. Good health and well-being

Ensuring access to quality health and promoting well-being for all, at all ages
LEARN MORE

16. Peace, justice and strong institutions

Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.
LEARN MORE

Conjectures About Sharing Resources: what can we learn from physicians’ marketplace?

Physicians show how is possible to learn and improve reputation records when resources are shared, but we need to care about some hidden perverse incentives.

Can you imagine Bill Gates as the new Apple CEO while holding his position at Microsoft? Or a manager working for BurgerKing and responsible for a McDonald’s restaurant? Or Cristiano Ronaldo playing for Juve, Milan, and Internazionale at the same time?

These cases may sound awkward, but you would not feel surprised if you were seen by a doctor who works in the three largest private hospitals in Lisbon. Physicians who work at only one hospital are more of an exception than a rule.

The reason why the market has shaped itself in this way is non-trivial. Moreover, we know little about how this impacts healthcare performance. We may guess it involves at least three aspects: the diffusion of knowledge and practices; the role of social relations and reputation; and the presence of some perverse incentives that may be hidden within this arrangement.

Each dot represents a healthcare facility in the Brazilian city of Porto Velho. Lines are doctors shared by facilities. Line’s thickness indicates the number of doctors shared.

1- The diffusion of knowledge and practices

The academic training of a doctor never ceases with the conclusion of their university degree. The medical residency itself indicates that it is in the work place that the physician absorbs much of the medical practice. Also, at that time they have contact with topics that end up not being covered by academic training such as soft skills[i].

Most of physician’s improvement occurs in the professional environment as a patient care outcome rather than motivated by competence improvement personal goals[ii]. Furthermore, it is through discussions with colleagues about patients that much of the learning takes place.

Adam Key tells an anecdote in his book “This Is Going to Hurt: Secret Diaries of a Junior Doctor” that illustrates this point.

At lunch, in the doctors’ room, sharing stories of nonsense “symptoms”: sudden improvement in hearing, arm pain during urination, and someone sweating from only half of their face. After this last symptom there is a silence in the room. After a while, one asks: So, it was Horner’s Syndrome? The doctor rushed to call his patient…

It seems reasonable to conjecture that physician’s interaction among multiple healthcare facilities can be beneficial to practice-based learning.

2- The role of social relations and reputation

Websites such as Portal da Queixa, in Portugal, and Reclame Aqui, in Brazil, have created a mechanism for publicizing the reputation of medical services. Surely, this is a huge advantage for good professionals who can now differentiate themselves from those who provide a poor service.

However, these mechanisms are not always able to truly reflect patient dissatisfaction[iii].

Then, mouth-to-mouth dissemination of the physicians’ behavior becomes relevant as an informal mechanism to deal with poor care. Physicians working in several hospitals create a dense network and make the dissemination of reputation testimonials exponential.

3- Hidden perverse incentives

Some perverse incentives may be hidden in each highlighted topic.

Firstly, there is the risk of disclosure of sensitive and strategic information to competitors. After all, a doctor working daily in two companies, sometimes even in management positions, may face moral dilemmas about sharing information.

Secondly, social relations may also be the first step to corporativism. Then, a credibility mechanism becomes a strategy to smooth things over, hiding peers’ bad behavior.

Conclusion

It makes no sense to have Ronaldo playing in both Juve and Inter. However, Medicine may have good reasons not to follow this rule. We also should ask ourselves whether this open-to-share arrangement can be replicated in other segments. Software Engineers, Data Scientists, and Designers may have much more to offer if they are not limited to work at one place. For the record, a sharing economy may not be only about consumers sharing goods and services but also organizations sharing resources.

References:

[i] Arthur Lazarus, M. D. (2013). Soften up: the importance of soft skills for job success. Physician executive, 39(5), 40.

[ii] Van de Wiel, M. W., Van den Bossche, P., Janssen, S., & Jossberger, H. (2011). Exploring deliberate practice in medicine: how do physicians learn in the workplace?. Advances in health sciences education, 16(1), 81–95.

[iii] Widmer, R. J., Maurer, M. J., Nayar, V. R., Aase, L. A., Wald, J. T., Kotsenas, A. L., … & Pruthi, S. (2018, April). Online physician reviews do not reflect patient satisfaction survey responses. In Mayo Clinic Proceedings (Vol. 93, №4, pp. 453–457). Elsevier.

Daniel Lopes
Nova SBE PhD Alumnus, and a former member of Nova SBE Health Economics & Management Knowledge Center. Today, Daniel is a Researcher at Rede Transparência & Sustentabilidade, in Brazil.
LEARN MORE
SHARE

Keep reading

Industrial Organization & Antitrust in the Digital Age

Industrial organization and antitrust paradigms face new challenges as the digital world matures. Tech giants rely on business models which effectively grant them monopoly power over a cross-section of markets, with the adverse effects of monopolies being amplified by the negligible regulatory action taken against them. This research insight takes Lina Khan’s “Amazon’s Antitrust Paradox” and expands on the rationale for a new antitrust policy while listing some of the potential concerns digital health applications produced by these giants or their partner firms entail.

Over one century of Pharmaceutical Innovation - Incremental Innovation and Strategic repositioning of acetylsalicylic acid (ASA).

Not just only for your common headache! This century old product has an exciting story to tell about reinvention and staying relevant in today’s pharma market.

Brown sugar, how come you taste so good?

More than 40 countries around the world have introduced or are considering introducing soda taxes. These instruments aim to reduce the consumption of products whose prices do not reflect their true social costs by making them comparatively more expensive. In Portugal, the soda tax is particularly interesting to study because there is a clear incentive for manufacturers of drinks with sugar content at or above the threshold to reformulate recipes and avoid paying the higher tax.

Rethinking public health spending sustainability

Keeping a growing healthcare system sustainable in developed economies might mean a raise in taxes or cost reducing actions in other sectors. How should a society and its governmental bodies reflect on its expenditure balance and priorities?

THE CHOICES OF

Nova SBE awarded at the 1st edition of the EFFAS Gasperini Awards

Professors Miguel Ferreira and José Tavares and Nova SBE PhD student Sharmin Sazedj were awarded the first edition of the EFFAS Gasperini Awards, where they represented Nova SBE

Subscribe our weekly newsletter

By subscribing to the Nova SBE Role to Play newsletter, you can stay up-to-date on the latest articles posted on the website.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

We all have a role to play

We are on a mission to be a community dedicated to the development of talent and knowledge that impacts the world.

With just ten years to go, an ambitious global effort is underway to deliver the 2030 promise. We want to take a stand and we are calling on our community to showcase how they are contributing to the 17 Sustainable Development Goals, whilst influencing more and more people to unravel their role to play.

Here, you will find four different ways your ideas can flourish, dialogue can be enhanced, and action can take place. You can choose one or all four, and Nova SBE will be there to support you all the way and guarantee tangible change.

We all have a role to play, and this is your way in.