HOBSON’S CHOICE IN HEALTH ECONOMICS
According to Wikipedia and our companion crowd-sourced initiative the Health Dictionary Series® http://www.HealthDictionarySeries.org, a Hobson’s choice is a fee choice in which only one thing is offered. Because a person may refuse to accept what is offered, the two options are taking it or taking nothing. In other words, one may “take it or leave it”.
The phrase is said to have originated with Thomas Hobson a livery stable owner in Cambridge England, who offered customers the choice of either taking the horse in his stall nearest the door or taking none at all.
Thomas Hobson (1544-1631)
Thomas Hobson, who gives the name to this dicey doozy, was a mail carrier, who delivered mail between London and Cambridge and hence was known as the Cambridge Carrier. He also operated a livery stable (that is a kind of equestrian facility where the horse owners pay a fee to keep their horses) just outside the gates of St. Catherine’s College, Cambridge.
When he was not riding his horses to deliver the mail, Hobson would rent them out to the students and teachers of the College. He soon realized that the best and fastest of his horses were invariably being chosen in the off-work hours. To prevent them from exhaustion and overuse, he devised a clever ploy, that is known as Hobson’s Choice!
In order to prevent his horses from being overused, Hobson gave the renters the choice that they could either have the horse that stood closest to the door, or have none at all. What it actually meant was that he offered no choice in reality. This was either one or none, which meant that one had to take up whatever was on offer. The term, “Hobson’s Choice”, did not appear into literary use till almost a century after his death.
Sophie’s Choice: Based on the choice Sophie, a movie protagonist played by M. Streep, had to make when put into a concentration camp by the Nazi Germans. She was asked which one of her two children would live and which one she would choose to send to the gas chambers.
Morton’s Fork: Claims its origin from John Morton, the Archbishop of Canterbury, a public policymaker who used convoluted and contradictory logic to establish tax laws in the mid-15th century. He contended that whoever lived humbly must be saving much money and hence would be able to pay higher taxes; and those that lived lavish lives were obviously rich, so they could also pay higher taxes.
Other Expressions: Many colloquial expressions exist where one has to choose from between two undesirable variables. Expressions like catch-22, dilemma, caught between the horns of a dilemma, and at sixes and sevens may exemplify this form of choice. This is not the case in Hobson’s Choice, which as previously stated, is not even a choice.
HOBSON’S CHOICE IN MEDICINE – EXPLANATION OF 4 CATEGORIES:
1. Hobson’s Choice Decision Example for … Patients
Even in the clinical sciences, with shared decision making and user driven healthcare still in their infancy in the USA, a paternalistic physician offers naught but “this or none” choice to their patients. While one can say that the lack of general awareness of the public tends to spawn this issue, we cannot shake off our personal stake in this matter just by hiding behind the façade of moral determinism!
2. Hobson’s Choice Decision Example for … Payers and Third Parties
Most insurance plans and third parties payers use a drug formulary. A drug formulary is a list of prescription drugs, both generic and brand name, that may offer both clinical and economic value. A committee of physicians and pharmacists usually maintain the formulary. Drugs considered for the formulary are evaluated by a payer committee of experts and are chosen for their safety and effectiveness. Clinical expertise and input may also sought from other physicians who are not insurance plan committee members. The formulary, pre-service authorization parameters, and related procedures are updated as needed when new information becomes available. Yet, drug formularies are becoming increasingly restricted and limited. Of course, some brand-name drugs may be more efficacious, regardless of cost. And, some patients may be allergic or sensitive to certain generic drugs; as well.
3. Hobson’s Choice Decision Example for … Providers
One of the first examples that springs readily to mind in trying to look for examples of Hobson’s Choice for medical providers is the issue of defensive medicine. While the physician actually has the option of not “shot gunning” a patient (that is, shooting randomly large number of tests in order to cover legal liability and prevent medico-legal backlashes), the risk of missing a diagnosis and the fall outs thereof are so large, that it basically degenerates into a Hobson’s Choice. The idiosyncrasies of medicine and the way the body reacts to them always leaves us open to the risk of working within the constraints of Hobson’s Choice.
For example, antibiotics have saved more lives than we can count, yet an idio- syncratic, unpredictable reaction may just be waiting for us around the corner.
4. Hobson’s Choice Decision Example for … Public Policymakers
In the the PP-ACA, federal government, Prison Health and/or Indian Public Health scenario, patients are offered in a primarily paternalistic system, the choice Hobson offered years ago. Much like Henry Ford, who told customers lining up to buy his revolutionary Ford Model T that they could have their cars in “any color so long as it is black”, the public health policymaker system, hobbled by the lack of an empowered public, and a patient choice scheme, functions on the basis of Hobson’s choice.
[Harvesting the Power of Patients, Providers, Payers and Policymakers … for the Public Good]
THE POWER AND WISDOM OF “CROWD-SOURCING”
According to the Health Dictionary Series®, Crowd-Sourcing is an online, distributed, problem-solving, and POWERFUL production model that uses the collective intelligence of networked communities for specific purposes. Although its use has benefited many sectors of society, it has yet to be fully realized as a method for improving medical care in the USA: http://www.HealthDictionarySeries.org
Four discrete Crowd-Sourcing approaches are used in this Hobson’s Choice in Medicine Project: (1. knowledge discovery and management; 2. distributed human intelligence tasking; 3. broadcast search; and 4. peer-vetted creative production types).
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ON INTERNET CITATIONS: The “crowd-sourced” online and curated hard-cover print version of: “HOBSON’S CHOICE IN MEDICINE” [Reflections on Decision-Making, Health Economics, Rationing and Free Enterprise] directs readers to useful internet sites with additional references. However, host entities frequently reorganize and update sites, so URLs can change rapidly. Citations for are therefore accurate when published, but we cannot guarantee how long they will remain so, despite our best efforts to keep them current and “live” on this website.
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