Study On Patients' Health Seeking Behavioral Decision-making Based On Prospect Theory

[Purpose]In accordance with the research paradigm of behavioral economics,based on the prospect theory and the hypothesis of "limited rationality",this special population of rural hypertensive patients in Qianjiang District,Chongqing City was selected as the object of study.We analysed the whole process of decision-making systematically instead of the results,described the formation of patients' beliefs in the process from the cognition and value judgment of health seeking behavior and the systematic deviations that may exist during this process,discovered the risk preference for the prospective behaviors under uncertain conditions so as to detect the mechanism between the scenario factors and patients' individual factors,and the reference points that have crucial impact on patients'decision-making.Then we tried to quantify the patients' sensitivity to the key influencing factors.Based on the results,we digged the in-depth causes that may lead to illogical and disorderly health seeking behaviors in the western rural area of China,and try to explore the right and efficacious measure to make a effectinve policy to help guide the patients'health seeking behavior.[Methods]According to prospect theory and the study purpose,psychological experiments were developed to test the systematic deviations and patients' risk preference structure during the course of patients'beliefs formation and health seeking behavioral decision-making.Questionnaire survey was used to collect the information of situational factors and patients' individual factors including social demographic factors,policy environmental factors,patients' health literacy,self-management efficacy,health-related quality of life and hypertension cognition status etc.A structural equation model was constructed based on the information to detect the reference points and mechanism of interaction of the situational factors and patients'individual factors,and to interpret patients' decision logic and their sensitivity to the reference points under uncertain situation.[Results]1.Status of health seeking behavioral decision-making of patientsIn the choice of timing for medical treatment,medical treatment delay is widespread in rural area of western China.When disease symptoms occur,73.2%of patients choose to have a rest or a self-care way to alleviate the symptoms first.Only when resting or self-care treatment can not relieve their symptoms will they seek medical treatment.In the choice of way of medical treatment,most patients choose outpatient medical treatment,which decided by the patients themselves or their families,while hospitalization decisions are generally made by patients' attending doctors.There are a number of patients who are accepted their doctoers suggestion to hospitalize during the outpatient.In the choice of medical institutions,the first visit is determined by the accessibility of the service most of time.Less attention is paid to the level and service capabilities of medical institutions.Patients with multiple visits usually choose according to their experiences on their own.2.The patients' health seeking behavioral decision-making logic and mechanismPatients' beliefs and risk preference structures on decision timing directly determine their health seeking behavioral decision-making.The composition of the beliefs is the result of the interaction between the situational factors in the external environment and the patients' individual factors such as value,cognition ability and experiences.And the judgment of the health seeking behavior value is directly affected by the reference points.Under the guidance of their health care service demand,recognition and value judgments of the prospective behavior are carried on according to the reference points based on their belief characteristics,and 'satisfaction" rather than "optima" is the very principle to follow.Most patients get "satisfaction" when feeling the remission of disease symptoms and are often reluctant to increase economic spending in order to obtain"optimal" disease control effect to improve the long-term health status in the future.Patients' risk reference at the very timing of decision-making has a direct impact on their final decision.3.The sensitive factors and mechanism of patient's decision-making.(1)Patients'cognition and value judgment of prospective health seeking behavior will be influenced by deviations caused by representative intuition,availability intuition and anchoring&adjustment.In the evaluation stage,the risk preference will be affected by certainty effect,reflection effect and isolation effect.(2)The reference points are affected by sensitive elements,which influence patient decision-making by changing their beliefs and external situations.Decision-making situational factors include the severity of the disease,type of family structure,economic burden of the disease,availability of health insurance and availability of health services.And individual factors that influence the characteristics of patients'beliefs include age,level of education,health literacy,the quality of life,self-management efficacy,disease mental account,disease cognition status,representative intuition,availability intuition,anchoring&adjustment,certainty effect,reflection effect and isolation effect.(3)The reference point starts from the perception and evaluation of patients' own health status and health service demand rather than scientific diagnosis made by doctors.And it will change following the change of patients' cognition caused by the interaction between the external scene factor and patients' risk preference.In the process of patient decision-making,there are multiple reference points existing at the same time.Patients have different sensitivity to reference points in different decision-making situations.(4)The risk preference structure of patients is affected by their disease mental account,family structure type,disease severity,medical insurance status and the economic burden of the disease.Under uncertain conditions,certainty effect,reflection effect and isolation effect have a great influence on patients' risk preference,which at the time point can directly determine their final decision.[Conclusions]Patients' health seeking behavioral decision under uncertain conditions depends on their own beliefs and risk preferences.Patients' belief formation process is the process by which patients use their own ability to deal with the disease-related information.During this process,the way of comprehension and subjective systemic deviations should not be ignored.These deviations directly affect the correctness and validity of patients' perception of the external situation information,thus affecting the scientific nature of their health seeking behavioral decision-making.There should be a variety of ways and measures to reduce the influence of various types of systemic deviations,and help patients deal with health related information effectively in order to make a scientific decision.With the policy intervention,to make the policy elements to be the characteristics of patients' beliefs can really help implemente the policy control effect.At the same time,adjustment to the policy environment is necessary to help patients make a reasonable reference points which should also be the focus of policy control.The risk preference at the decision-making time point plays an important role during the decision making process,and the relevant effective measures should be carried on to help strengthen the communication and interaction between the doctors and the patients.And reducing the influence of frame effect under the uncertain condition is an important guarantee for the scientific decision-making.