Satisficing as a driver of low-value care and healthcare costs

Abstract

This thesis explores 'satisficing' in clinical decision-making, where clinicians choose "good enough" solutions to problems rather than optimal ones. The research employed a diverse range of methodologies to examine different aspects of satisficing in clinical decision-making. A systematic review was conducted to synthesise evidence from studies on heuristics in medical decision-making. A randomised vignette-based study investigated the efficacy of two nudges (default and partition display) in guiding clinical decisions. To explore satisficing in the context of resource constraints, regression modelling of Medicare Benefits Schedule (MBS) data on CT and MRI utilisation was performed. Finally, the research analysed aggregate-level retrospective cohort data from a breast-screening clinic to estimate screening and further-investigation costs for the Australian population breast-screening program.

The studies indicate that both cognitive factors and systemic constraints lead to clinician satisficing which influences clinical decision-making and resource utilisation. Potential improvements in healthcare quality and efficiency include enhanced medical education on cognitive biases, careful design of clinical decision support systems, and more equitable distribution of healthcare resources. Further research is needed to link satisficing behaviours to health outcomes, explore long-term intervention effects, and develop standardised healthcare cost analysis methodologies.