Providers preferences towards greater patient health benefit is associated with higher quality of care

Abstract

OBJECTIVES: Standard theories of health provider behavior suggest that providers are motivated by both profit and patient health benefit. Detailed empirical data are seldom available to measure marginal rates of substitution (MRS) between profit and patient health outcomes. Furthermore, it is difficult to empirically assess how these relative preferences affect quality of care.METHODS: This study uses a unique dataset from rural Myanmar to assess heterogeneous preferences toward treatment efficacy relative to provider profit and the impact of these preferences on the quality of provider diagnosis and treatment. Using conjoint survey data from 187 providers, we estimated the marginal utilities of higher treatment efficacy and of higher profit, and the MRS between these outcomes. We also measured the quality of diagnosis and treatment for malaria among these providers using a previously validated observed patient simulation. RESULTS: There is substantial heterogeneity in provider willingness to substitute greater treatment efficacy for higher profits. Higher preferences for treatment efficacy are positively associated with the quality of treatment among providers, and higher preferences for profit are negatively associated with quality of diagnosis. We found no consistent effect of provider MRS on quality of care. CONCLUSIONS: Our findings suggest that providers vary in their preferences towards profit and treatment efficacy, with those providers that place greater weight on treatment efficacy providing higher quality of care. This suggests that incentive schemes that are not purely financial may have a role in increasing quality of care.