Motivation and competition in health care

Abstract

The effect of competition and other economic incentives in health care will depend, in part, upon the objectives of health care providers. The aim of this paper is to examine whether the degree of monetary motivation modifies the impact of economic incentives on physicians. This has not yet been examined empirically in health care. This paper examines whether physicians with a low monetary motivation, measured by their marginal utility of income (MUY), are less likely to respond to a change in competition relative to physicians with a relatively high monetary motivation. We contribute to the literature by linking preference parameters from a discrete choice experiment (DCE) to real world data on market structure and prices charged.In health care, evidence that physicians respond to financial incentives is interpreted as physicians being motivated by income. However, theoretical models have always acknowledged that physicians may also be altruistic (

Evolving Referral Patterns and Management Following Implementation of a Multidisciplinary Fibroid Center: A Retrospective Cohort Study

“…Competition for patient volume can improve healthcare quality but may incentivize physicians to engage in opportunistic behaviors [22]. These behaviors may depend on the weight the physician places on profit, but they can be affected by altruistic motivations to help their patients or social motivations in collaborative settings [23]. Potential for care bias based on specialty-specific knowledge, personal values, or financial reimbursement may result in suboptimal management and affect patient outcomes [22][23][24].…”

“…These behaviors may depend on the weight the physician places on profit, but they can be affected by altruistic motivations to help their patients or social motivations in collaborative settings [23]. Potential for care bias based on specialty-specific knowledge, personal values, or financial reimbursement may result in suboptimal management and affect patient outcomes [22][23][24]. When multiple specialties are involved in treating the same condition, such as gynecologists and interventional radiologists with regard to symptomatic fibroids, this is especially apparent [13].…”

Do physicians' attitudes toward prioritization predict poor‐health patients' access to care?

“…First, the literature shows both theoretically (Ellis & McGuire, 1986) and empirically (Godager & Wiesen, 2013;Yordanov et al, 2023) that physicians may be motivated by both financial and nonfinancial factors. These factors may impact patients' access to care (see e.g., Hennig-Schmidt et al, 2011;Kolstad, 2013;Scott and Sivey, 2022;Oxholm et al, 2023) and could potentially also be related to GPs' preferences for prioritization. This study uncovers the association between GPs' preferred prioritization principle and patients' access to care.…”

“…There may be several ways to combat such inequities. As previously mentioned, studies show variation in what motivates healthcare providers delivery of care (Oxholm et al, 2023;Scott & Sivey, 2022;Yordanov et al, 2023). Some providers may be motivated by altruistic concerns toward society or the individual patients, whereas others may be motivated by financial gains.…”

The link between physician motivation and care

“…Two recent studies support this conclusion. The first study shows that physicians who have a higher marginal utility of income, uncovered by a stated-choice experiment, are more likely to exploit a lack of competition by setting higher prices [ 11 ]. The second study uses experimental data and observes that primary care physicians who are more responsive to financial incentives also generate higher profits in reality [ 12 ].…”