Expert's Recommendations in Product Choices: Information Provision, Conflicts of Interest, and Consumer Protection among U.S. Kidney Disease Patients.

This article investigates how physician recommendations influence patients’ choices of dialysis treatment facilities, focusing on the effects of conflicts of interest and quality information on patient outcomes. Using detailed data from over 16,900 U.S. end-stage kidney disease (ESKD) patients and 750 physicians between 2015 and 2017, the study develops a two-stage empirical framework that first models physicians’ recommendation sets—affected by factors such as physician affiliation with facilities and facility proximity—and then patients’ choices from those recommendations. The findings reveal that physicians tend to recommend affiliated and nearby facilities, and patients prefer facilities with higher Centers for Medicare & Medicaid Services (CMS) five-star ratings and closer locations, though responsiveness varies by patient demographics. Policy simulations indicate that providing quality information via CMS star ratings reduces patient mortality, while banning the use of physician affiliation in recommendations—a potential conflict of interest—may inadvertently increase mortality, as affiliated physicians are more likely connected to higher-quality facilities. The study underscores the complexity of expert-mediated consumer choices in healthcare and offers insights relevant to ongoing policy debates on information provision and conflict of interest regulation in the dialysis market.