Evidence-Based Medicine and Healthcare Quality in the Context of Information Failure: The Case of the UK Fertility Sector

Abstract

Economic incentives in the context of a particular type of market failure—asymmetric information (which takes place when quality information relating to treatment is not available to patients before purchasing the treatment)—are highly relevant to the understanding of the lack of clinics’ incentives to disclose reliable evidence (relating to treatment quality) in the practice of evidence-based medicine. Based on the case study of the UK in vitro fertilisation (IVF) sector, I show that inadequate quality provision (relating to treatment effectiveness and safety) can be associated with a lack of voluntary disclosure of reliable evidence in the practice of evidence-based medicine. In the absence of sufficient economic incentives on clinics to voluntarily acquire and disclose evidence, I discuss the rationale for legislation requiring mandatory evidence disclosure as a possible mechanism to facilitate the acquisition and revelation of evidence. I do so by drawing evidence from the economic literature relating to the impact of such legislation on firms’ quality improvement. Practical implications for implementation are discussed (and illustrated with examples in the context of the UK IVF sector) with the purpose to facilitate the role of regulators in setting the standards for evidence disclosure to improve interpretability of such evidence, together with the role of patients in engaging with clinics and verifying such evidence to improve its reliability and, ultimately, quality of care.