January 14, 2013

Beware of the framing effect

Inevitably the debates over health reform are rooted in what we currently observe. And our perception is subject to be selected according to our preferences. Decision making under uncertainty has explained how individuals depart from rationality towards multiple biases and this is present everyday in health policy debates.
Currently, the demonstrations against what is called privatization of health services have achieved a difficult tipping point. Both parts, those that are in favour and those that are against are subject to framing effects. In simplest terms, a frame is a model, or lens, for understanding, interpreting, and solving a problem. Politicians have a number of frames that they use to judge people, simplify problems, and make decisions. While framing a concern represents the initial step toward a successful resolution, it is also the first place a decision can go wrong. Because most problems can be framed, or looked at, in more than one way, the lens politicians employ to define an issue can significantly influence how they respond.
And this is exactly what is happening. The frame under the current proposals is that "private management is cheaper". We are not discussing efficiency, lens are focusing on implicitly saving money. Unfortunately this frame should be confronted with the reality. Is it really cheaper? Is being cheaper enough?. Data is scarce and evidence is pending to be provided.
Therefore the recommendation would be: frame the problem from a larger number of reference points and perspectives. A variety of frames allows the decision maker to evaluate the goodness of fit with the specific context. And this is what nobody wants to talk about, about the context. Different ownership alternatives may contribute to efficiency in different ways according to context and the behaviour of the regulator.

PS. On framing bias in medicine and how to tackle it.