Page 1145 Mark A. University of California, Los Angeles In 1963 Kenneth Arrow offered a simple empirical observation that suggested a core impediment to the effective functioning of market arrangements in health care. âBecause medical knowledge is so complicated,â he noted, âthe information possessed by the physician as to the consequences and possibilities of treatment is very much greater than that of the patient, or at least it is so believed by both partiesâ (951). According to Arrow, however, society found a way to manage this information asymmetry that would otherwise leave people vulnerable to suboptimal decision making and exploitation by the suppliers of medical services. âDelegation and trust are the social institutions designed to obviate the problem of informational inequalityâ (966). According to this reasoning, we make efï¬cacious choices by permitting our physicians to both deï¬ne the choice set of the various treatment options and weight their expected values. We feel comfortable delegating a signiï¬cant chunk of our decision-making sovereignty regarding medical care because of the trust we have in our physicians. But in Arrowâs framework, why does this dyadic trust emerge in which we place such faith, given the lack of a formal instrument for insuring
Journal of Health Politics, Policy and Law – Duke University Press
Published: Oct 1, 2001
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