David Cutler: observation

Transcript context

…How do we explain the cross-sectional variation there? Because I agree with what you said, but if I look, say, today, at the vaccines, there are really quite a few Americans who obsess over Moderna versus Pfizer, this versus that. Maybe some of what they think is wrong, but they spend enormous amounts of time on social media consuming information about vaccines. They don’t seem to be put off by nervousness. Yet, when it comes to the brain surgeon, there’s nothing, right? Very hard to find out anything, and that’s endogenous because, in part, the demand isn’t there. What accounts for that difference? You can sometimes get people to do shopping. Where people have time and settings, and it’s a very clear choice, you can get them to do someshopping, particularly if there are not people involved. It helps if it’s a pill and not a person who you’re deciding between yes or no, and where you don’t feel like your doctor has a stake in it, something like that. Ironically, on the vaccines, people mostly decided on their own, without a doctor’s recommendation, as to which one they wanted. Therefore, they would go online and decide which of the different vaccines do they want. Sometimes you can do that. The other famous example of where you can do that is, for example, in vitro fertilization, where the records of the different centers do seem to matter. That is, people will go more to the centers that have a good record because families are thinking about which centers should I go to and stuff like that. For other things, particularly when it’s a surgeon who you feel you might be offending, or it’s a conversation with your doctor that you don’t feel comfortable with, then people are extremely loath to do that. I would say that in some settings, you can make it happen, but oftentimes, you can’t. Why don’t we have more paying for healthcare outcomes? I give my doctor a bonus if I stay healthy, for instance. More complex ways of doing it, using intermediaries, collective contracts, but there’s very little. Why?…

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