Error message

The page you requested does not exist. For your convenience, a search was performed using the query cbssm med umich edu people.

Page not found

You are here

Does order matter when distributing resources? (Jun-03)

Should people with more severe health problems receive state funding for treatment before people with less severe health problems? See how your opinion compares with the opinions of others.

Imagine that you are a government official responsible for deciding how state money is spent on different medical treatments. Your budget is limited so you cannot afford to offer treatment to everyone who might benefit. Right now, you must choose to spend money on one of two treatments.

  • Treatment A treats a life threatening illness. It saves patients' lives and returns them to perfect health after treatment
  • Treatment B treats a different life threatening illness. It saves patients' lives but is not entirely effective and leaves them with paraplegia after treatment. These patients are entirely normal before their illness but after treatment will have paraplegia.

Suppose the state has enough money to offer Treatment A to 100 patients. How many patients would have to offered Treatment B so that you would have difficulty choosing which treatment to offer?

How do your answers compare?

The average person said that it would become difficult to decide which treatment to offer when 1000 people were offered Treatment B.

What if you had made another comparison before the one you just made?

In the study, some people were asked to make a comparison between saving the lives of otherwise-healthy people and saving the lives of people who already had paraplegia. After they made that comparison, they made the comparison you just completed. The average person in that group said it would take 126 people offered Treatment B to make the decision difficult. The differences are shown in the graph below

Why is this important?

The comparison you made is an example of a person tradeoff (PTO). The PTO is one method used to find out the utilities of different health conditions. These utilities are basically measures of the severities of the conditions. More severe conditions have a lower utility, and less severe conditions have a higher utility, on a scale of 0 to 1. Insurance companies, the government, and other organizations use these utilities as a way to decide which group to funnel money into for treatments.

On the surface, it seems like basing the money division on the severity of a condition is a good and fair method, since theoretically the people who are in the greatest need will be treated first. However, the PTO raises issues of fairness and equity that aren't accounted for in other utility elicitation methods like the time tradeoff (TTO) and rating scale (RS).

For example, when asked to decide how many people with paraplegia would have to be saved to equal saving 100 healthy people, many people say 100; that is, they think it is equally important to save the life of someone with paraplegia and a healthy person. Going by values obtained using the TTO or RS, an insurance company may conclude that 160 people with paraplegia (using a utility of .6) would have to be saved to make it equal to saving 100 healthy people. This would mean that less benefit would be gotten by saving someone with paraplegia, and thus they might not cover expenses for lifesaving treatments for people with paraplegia as much as they would for a healthy person. The PTO shows that many people would not agree with doing this, even though their own responses to other utility questions generated the policy in the first place.

For more information see:

Ubel PA, Richardson J, Baron J. Exploring the role of order effects in person trade-off elicitations. Health Policy, 61(2):189-199, 2002.

The 2012 CBSSM Research Colloquium took place on Thursday, May 10, and was attended by over 130 people.  This year's colloquium focused on research around medical decision making, and featured presentations by numerous faculty, fellows, and students.  In addition, the CBSSM Research Colloquium featured the annual Bishop Lecture in Bioethics as its keynote address.  Drs. Jerome Groopman and Pamela Hartzband of Harvard Medical School jointly presented the Bishop Lecture with a talk entitled, "When Experts Disagree: The Art of Medical Decision Making."  For more information about the event and to view photos and a video of the Bishop Lecture, click here.

CBSSM researcher Brian J. Zikmund-Fisher, PhD, and collaborator Mick Couper, PhD, from the UM Institute for Social Research spoke to the Medical Editors Meeting of the Foundation for Informed Medical Decision Making in Jackson Hole, Wyoming. Drs. Couper and Zikmund-Fisher reported on "Methods and Early Results from the National Survey of Medical Decisions." This pioneering survey reveals surprising information about the epidemiology of ten common medical decisions that are made by older Americans. Discussion of the presentation was lively!

The Foundation for Informed Medical Decision Making, which funded this CBSSM research, is a nonprofit organization dedicated to assuring that people understand their choices and have the information they need to make sound decisions affecting their health and well being.
Learn more at http://www.fimdm.org

CBSSM Seminar: Jacob Solomon, PhD

Thu, November 19, 2015, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room 266C

Jacob Solomon, PhD


CBSSM Postodoctoral Fellow

Title:

Designing the information cockpit: The impact of customizable algorithms on computer-supported decision making

Abstract:

Intelligent systems that provide decision support necessitate interaction between a human decision maker and powerful yet complex and often opaque algorithms. I will discuss my research on end-user control of these algorithms and show that designing highly customizable decision aids can make it difficult for decision makers to identify when the system is giving poor advice.

CBSSM Seminar: Kayte Spector-Bagdady, JD

Wed, December 09, 2015, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room B004E

Kayte Spector-Bagdady, JD


CBSSM Postdoctoral Fellow

From the Guatemala STD Experiments to the NPRM for Revisions to the Common Rule: Why We Still Don’t Have Human Subjects Research Ethics Right

While much has been made of scandals, and academics zealously deliberate nuances, we still find ourselves revisiting the most basic of human subjects research ethics questions: What is a research subject? What is informed consent? This talk will address this ongoing debate but also the less often asked question of why—what are the structural pressures that bring us time and again to step one and is human subjects research ethics a zero sum game?

CBSSM Seminar: Chithra Perumalswami, MD, MSc

Wed, May 23, 2018, 3:00pm
Location: 
NCRC, Building 10, Room G065

Chithra Perumalswami, MD, MSc
CBSSM Postdoctoral Fellow

 

Title:
Defining High Quality Health Care at the End of Life: Obesity in Hospice

Brief abstract:
Little is known about the challenges of providing high quality health care at the end of life for patients with obesity.  We conducted 22 semi-structured telephone interviews with hospice medical directors from each major geographic region of the US to understand physicians’ clinical and administrative perspectives regarding the effects of obesity on quality of hospice care for patients, caregivers, nurses, and other members of the hospice team.

 

CBSSM Seminar: Michael D. Fetters, MD, MPH, MA

Thu, April 14, 2016, 3:00pm to 4:00pm
Location: 
NCRC Building 16, Conference Rm 266C

Michael D. Fetters, M.D., M.P.H., M.A.
Professor, University of Michigan
Co-Director, Michigan Mixed Methods Research and Scholarship Program
Director, Japanese Family Health Program
Co-Editor, Journal of Mixed Methods Research

"Mixed methods research approaches for empirical medical ethics”

Abstract: Mixed methods research involves the integration of qualitative and quantitative methodology. The purpose of this presentation is to illustrate potential applications of mixed methods methodology for conducting empirical medical ethics research.

CBSSM Seminar: Reshma Jagsi, MD, PhD

Wed, May 18, 2016, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room 266C

Reshma Jagsi, MD, PhD
Associate Professor, Radiation Oncology

"Stewardship and Value:  Are we choosing wisely in managing breast cancer?"

Abstract: This lecture will begin with a brief discussion of the moral foundations of physicians' obligations to serve society, in addition to the patients they directly serve.  It will then consider analogies between financial stewardship and antibiotic stewardship, and it will conclude by focusing on several examples of opportunities for better physician stewardship in breast cancer, including slow uptake of short courses of breast radiation and rapid increases in the use of bilateral mastectomy for unilateral disease.

CBSSM Seminar: Susan Goold & Zachary Rowe (DECIDERS Project)

Thu, December 15, 2016, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Susan Goold, MD, MHSA, MA
Professor of Internal Medicine, Medical School
Professor of Health Management and Policy, School of Public Health

Zachary Rowe
Executive Director of Friends of Parkside (FOP)

Title:  Evaluation of CHAT as a tool for engaging communities in priority setting

Abstract:  Engaging minority and underserved communities in setting research priorities could make the scientific research agenda more equitable and more responsive to their needs.  This presentation evaluates CHAT, a serious game, to prioritize health research based on feedback from 47 focus groups (N=519) across Michigan.

CBSSM Seminar: Jan Van den Bulck, PhD

Tue, November 28, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Jan Van den Bulck, PhD
Professor, Communication Studies

Topic:
"Are the media (re-)defining how we interact with each other and with the world?

We know everything there is to know about people we have never even met. Through social media, we follow their every move. We even know their pets. Our media use interferes with healthy sleep, family meals, or even our work. Our children need levels of self-control to manage distractions that threaten their schoolwork. Or do they?"

Pages