A study conducted by a team of researchers from the Naveen Jindal School of Management highlights the need for smarter consumer protection in expert-driven markets like healthcare—showing that while transparency and oversight are important, restricting expert judgment without considering its benefits can unintentionally put consumers at greater risk.
The study was done by Dr. Reza Roshangarzadeh, PhD’24, as part of his doctoral dissertation while a student at the Jindal School; Dr. Tongil (TI) Kim, an associate professor in the Jindal School’s Marketing Area; Dr. Shervin Shahrokhi Tehrani, an assistant professor in the Jindal School’s Marketing Area.
The paper — ”Expert’s Recommendations in Product Choices: Information Provision, Conflicts of Interest, and Consumer Protection among U.S. Kidney Disease Patients” — has been published online by Marketing Science, one of the peer-reviewed academic business journals tracked by the UTD Top 100 Business School Research Rankings™. It will appear in a forthcoming print issue.
Kim said what motivated him to explore the dynamics between physician affiliations and dialysis clinic recommendations in his research stemmed from his wife’s experience in medical school in which she conducted research with nephrologists (kidney doctors) and told him how crucial physicians are in guiding patients to choose a dialysis center — a life-or-death decision for those needing dialysis three times a week.
“I became fascinated by this high-stakes decision-making process,” he said. “After joining The University of Texas at Dallas and discussing it with my coauthors, Shervin and Reza, we recognized both the complexity of physician recommendations and concerns about conflicts of interest, given that physicians may be affiliated with dialysis centers. It was clear this warranted careful empirical study.”
The study suggests that prohibiting physicians from referring patients to affiliated clinics might inadvertently increase patient mortality.
“At first glance, banning referrals to affiliated clinics sounds like a good way to reduce conflicts of interest,” Shahrokhi said. “But physicians are not randomly affiliated with dialysis centers; it turns out, they choose to be affiliated with higher-quality dialysis centers in our data. So, prohibiting or making it difficult for physicians to recommend their affiliation can hurt patients.”
The study concludes with a recommendation to healthcare providers: carefully balance transparency about clinic affiliations with the potential benefits these relationships can bring to patient care.
“Transparency is essential, but outright bans can backfire,” Kim said. “A more balanced approach is to have physicians disclose any affiliations and explain why certain clinics are recommended, tailoring the conversation to each patient’s specific needs.”
The research also highlights the impact of public quality ratings on patient choices and outcomes in the context of dialysis care. Five-star ratings from the Centers for Medicare & Medicaid Services condense complex quality metrics into an accessible format.
“Patients often have limited medical knowledge about dialysis treatment and can use these ratings to compare dialysis centers,” Kim said. “Our results show that patients prefer higher-rated clinics, which leads to better health outcomes.”
The study notes varying responses to quality ratings among different demographic groups, such as African American patients in lower-income areas.
“We found that African American patients in lower-income neighborhoods were less responsive to quality ratings—likely due to barriers like limited access to information or digital tools,” Shahrokhi said. “To close this gap, strategies like in-person discussions, printed or video materials in clinics, and outreach through trusted community advocates can help. At the end of the day, it’s not just about making information available — it’s about making it accessible and empowering for everyone.”
Roshangarzadeh, now an assistant professor of marketing at the University of Washington’s Foster School of Business, anticipates that similar patterns regarding expert recommendations and patient outcomes will be observed in other medical specialties, such as oncology or mental health services.
“Oncologists may refer patients to infusion centers or imaging facilities they are financially tied to,” he said. “Orthopedic surgeons may refer patients to physical therapy centers or surgical centers in which they have ownership stakes. Our framework can help understand expert influence and improve patient-centered decision-making across healthcare.”
As for policymakers who may be aiming to design regulations that protect patients without inadvertently compromising care quality, the study concludes with the following recommendations:
- Avoid blanket bans: Prohibiting recommendations to affiliated facilities may lead to worse care.
- Promote transparency: Require disclosure of affiliations without restricting expert judgment.
- Support quality-informed choice: Invest in easy-to-use, credible quality metrics like star ratings.
“Effective policy should guide expert behavior without undermining expertise,” Shahrokhi said.
The key message the team hopes that healthcare professionals and patients take away from their research regarding the role of expert advice in making critical healthcare decisions is that it is not just helpful — it can be lifesaving.
“Our study shows that the way recommendations are delivered matters,” Roshangarzadeh said. “Patients benefit most when guidance is informed, transparent, and tied to high-quality care. Instead of assuming expert advice is biased, we should focus on making it both trusted and trustworthy.”
Shahrokhi said the study highlights the need for smarter consumer protection in expert-driven markets like healthcare.
“Regulations on conflicts of interest often lack evidence, yet our findings show that expert affiliations — when tied to quality — can improve outcomes,” he said. “Blanket bans may do more harm than good.”
Roshangarzadeh said transparent tools like public quality ratings help patients make safer, more informed choices, especially when paired with expert guidance.
“This isn’t just about dialysis,” he said, “it’s a broader call for evidence-based policies that build trust and improve care system-wide.”
