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Treatment Choices by Seriously III Patients

The Health Stock Risk Adjustment Model

Janet Kong, MA

Neal J. Meropol, MD

K. Robin Yabroff, MBA

Charles Weaver, MD

Kevin A. Schulman, MD

Anecdotal evidence suggests that patients who have life-threatening conditions often choose to undergo high-cost, high-risk treatments for them. This kind of risk-seeking behavior seems irrational because most patients are risk-averse. The Health Stock Risk Adjustment (HSRA) model seeks to explain this phenomenon. The model is based on the concept of relative health stock—the ratio of patients' expected quality-adjusted life years (QALYs) after a diagnosis to their expected QALYs before the diagnosis. The model predicts risk-averse patients will behave in a risk-seeking manner as their relative health stocks deteriorate. The HSRA model can help physicians better under stand why some seriously ill patients seek high-risk treatments while others elect to forgo treatment. State legislatures and insurers are attempting to appropriately design insurance benefits for patients with life-threatening conditions. The HSRA model can help predict which patients will most likely take advantage of these benefits. Key words: patients' preferences; decision making; expected utility theory; treatment choice. (Med Decis Making 1998;18:84-94)

Medical Decision Making, Vol. 18, No. 1, 84-94 (1998)
DOI: 10.1177/0272989X9801800116


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