TY  - JOUR
AU  - Fang,Hai
AU  - Miller,Nolan H.
AU  - Rizzo,John A.
AU  - Zeckhauser,Richard J.
TI  - Demanding Customers: Consumerist Patients and Quality of Care
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 14350
PY  - 2008
Y2  - September 2008
UR  - http://www.nber.org/papers/w14350
L1  - http://www.nber.org/papers/w14350.pdf
N1  - Author contact info:
Hai Fang
5665 Ponce de Leon Blvd.
Flipse Bldg., Rm 120
Health Economics Research Group
University of Miami
Coral Gables, FL 33124
E-Mail: hfang@miami.edu

Nolan H. Miller
College of Business
University of Illinois at Urbana Champaign
4033 BIF
515 East Gregory Drive
Champaign, IL 61820
Tel: 217/244-2847
E-Mail: nmiller@illinois.edu

John Rizzo
Stony Brook University
N-637 Social and Behavioral Sciences Bldg.
Stony Brook, NY 11794
E-Mail: John.Rizzo@stonybrook.edu

Richard J. Zeckhauser
John F. Kennedy School of Government
Harvard University
79 John F. Kennedy Street
Cambridge, MA  02138
Tel: 617/495-1174
Fax: 617/384-9340
E-Mail: richard_zeckhauser@harvard.edu
AB  - Consumerism arises when patients acquire and use medical information from sources apart from their physicians, such as the Internet and direct-to-patient advertising.  Consumerism has been hailed as a means of improving quality.   This need not be the result.  Consumerist patients place additional demands on their doctors' time, thus imposing a negative externality on other patients.  Our theoretical model has the physician treat both consumerist and ordinary patient under a binding time budget.  Relative to a world in which consumerism does not exist, consumerism is never Pareto improving, and in some cases harms both consumerist and ordinary patients.  Data from a large national survey of physicians shows that high levels of consumerism are associated with lower perceived quality.  Three different measures of quality were employed.  The analysis uses instrumental variables to control for the endogeneity of consumerism.  A control function approach is employed, since our dependent variable is ordered and categorical, not continuous.
ER  -