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Profit or patients’ health benefit? Exploring the heterogeneity in physician altruism

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  • Godager, Geir
  • Wiesen, Daniel

Abstract

This paper investigates physician altruism toward patients’ health benefit using behavioral data from Hennig-Schmidt et al.'s (2011) laboratory experiment. In the experiment, medical students in the role of physicians decide on the provision of medical services. The experimental setup allows us to identify the influence of profits and patients’ health benefit on the choice of medical treatment. We estimate physician altruism, the weight individuals attach to patients’ health benefit, by fitting mixed logit and multinomial logit regression models to the experimental data. Estimation results provide evidence for physician altruism. We find, however, substantial variation in the degree of physician altruism. We also discuss some implications of our results for the design of physician payment schemes in the light of the theoretical literature.

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  • Godager, Geir & Wiesen, Daniel, 2013. "Profit or patients’ health benefit? Exploring the heterogeneity in physician altruism," Journal of Health Economics, Elsevier, vol. 32(6), pages 1105-1116.
  • Handle: RePEc:eee:jhecon:v:32:y:2013:i:6:p:1105-1116
    DOI: 10.1016/j.jhealeco.2013.08.008
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    1. Liu, Ting & Ma, Ching-to Albert, 2013. "Health insurance, treatment plan, and delegation to altruistic physician," Journal of Economic Behavior & Organization, Elsevier, vol. 85(C), pages 79-96.
    2. Chalkley, Martin & Malcomson, James M., 1998. "Contracting for health services when patient demand does not reflect quality," Journal of Health Economics, Elsevier, vol. 17(1), pages 1-19, January.
    3. Julie Riise Kolstad, 2011. "How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 20(2), pages 196-211, February.
    4. Hennig-Schmidt, Heike & Selten, Reinhard & Wiesen, Daniel, 2011. "How payment systems affect physicians' provision behaviour--An experimental investigation," Journal of Health Economics, Elsevier, vol. 30(4), pages 637-646, July.
    5. repec:zbw:rwirep:0413 is not listed on IDEAS
    6. Armin Falk & James J. Heckman, 2009. "Lab Experiments are a Major Source of Knowledge in the Social Sciences," Working Papers 200935, Geary Institute, University College Dublin.
    7. Whynes, David K. & Ennew, Christine T. & Feighan, Teresa, 1999. "Entrepreneurial attitudes of primary health care physicians in the United Kingdom," Journal of Economic Behavior & Organization, Elsevier, vol. 38(3), pages 331-347, March.
    8. Ma, Ching-to Albert, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 93-112, Spring.
    9. Arne Risa Hole, 2007. "A comparison of approaches to estimating confidence intervals for willingness to pay measures," Health Economics, John Wiley & Sons, Ltd., vol. 16(8), pages 827-840, August.
    10. Ellis, Randall P. & McGuire, Thomas G., 1990. "Optimal payment systems for health services," Journal of Health Economics, Elsevier, vol. 9(4), pages 375-396, December.
    11. Schram, Arthur & Sonnemans, Joep, 2011. "How individuals choose health insurance: An experimental analysis," European Economic Review, Elsevier, vol. 55(6), pages 799-819, August.
    12. Josse Delfgaauw, 2007. "Dedicated Doctors: Public and Private Provision of Health Care with Altruistic Physicians," Tinbergen Institute Discussion Papers 07-010/1, Tinbergen Institute, revised 17 Sep 2007.
    13. Allard, Marie & Jelovac, Izabela & Léger, Pierre Thomas, 2011. "Treatment and referral decisions under different physician payment mechanisms," Journal of Health Economics, Elsevier, vol. 30(5), pages 880-893.
    14. John A. Rizzo & Richard J. Zeckhauser, 2003. "Reference Incomes, Loss Aversion, and Physician Behavior," The Review of Economics and Statistics, MIT Press, vol. 85(4), pages 909-922, November.
    15. Hole, Arne Risa, 2008. "Modelling heterogeneity in patients' preferences for the attributes of a general practitioner appointment," Journal of Health Economics, Elsevier, vol. 27(4), pages 1078-1094, July.
    16. Arne Hole & Julie Kolstad, 2012. "Mixed logit estimation of willingness to pay distributions: a comparison of models in preference and WTP space using data from a health-related choice experiment," Empirical Economics, Springer, vol. 42(2), pages 445-469, April.
    17. Scott, Anthony, 2001. "Eliciting GPs' preferences for pecuniary and non-pecuniary job characteristics," Journal of Health Economics, Elsevier, vol. 20(3), pages 329-347, May.
    18. Cameron,A. Colin & Trivedi,Pravin K., 2005. "Microeconometrics," Cambridge Books, Cambridge University Press, number 9780521848053.
    19. Jack, William, 2005. "Purchasing health care services from providers with unknown altruism," Journal of Health Economics, Elsevier, vol. 24(1), pages 73-93, January.
    20. repec:zbw:rwirep:0412 is not listed on IDEAS
    21. Ching‐To Albert Ma & Michael H. Riordan, 2002. "Health Insurance, Moral Hazard, and Managed Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 11(1), pages 81-107, March.
    22. Cubitt, Robin P. & Drouvelis, Michalis & Gächter, Simon & Kabalin, Ruslan, 2011. "Moral judgments in social dilemmas: How bad is free riding?," Journal of Public Economics, Elsevier, vol. 95(3), pages 253-264.
    23. Philippe Choné & Ching-To Albert Ma, 2011. "Optimal Health Care Contract under Physician Agency," Annals of Economics and Statistics, GENES, issue 101-102, pages 229-256.
    24. Ma, Ching-to Albert & McGuire, Thomas G, 1997. "Optimal Health Insurance and Provider Payment," American Economic Review, American Economic Association, vol. 87(4), pages 685-704, September.
    25. Rizzo, John A. & Zeckhauser, Richard J., 2007. "Pushing incomes to reference points: Why do male doctors earn more?," Journal of Economic Behavior & Organization, Elsevier, vol. 63(3), pages 514-536, July.
    26. Newhouse, Joseph P, 1970. "Toward a Theory of Nonprofit Institutions: An Economic Model of a Hospital," American Economic Review, American Economic Association, vol. 60(1), pages 64-74, March.
    27. Train,Kenneth E., 2009. "Discrete Choice Methods with Simulation," Cambridge Books, Cambridge University Press, number 9780521766555.
    28. Siciliani, Luigi, 2009. "Paying for performance and motivation crowding out," Economics Letters, Elsevier, vol. 103(2), pages 68-71, May.
    29. Godager, Geir & Iversen, Tor & Hennig-Schmidt, Heike, 2013. "Does performance disclosure influence physicians’ medical decisions? An experimental analysis," HERO Online Working Paper Series 2013:1, University of Oslo, Health Economics Research Programme.
    30. Joseph P. Newhouse, 2004. "Pricing the Priceless: A Health Care Conundrum," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262640589, April.
    31. Train,Kenneth E., 2009. "Discrete Choice Methods with Simulation," Cambridge Books, Cambridge University Press, number 9780521747387.
    32. McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536, Elsevier.
    33. David Revelt & Kenneth Train, 1998. "Mixed Logit With Repeated Choices: Households' Choices Of Appliance Efficiency Level," The Review of Economics and Statistics, MIT Press, vol. 80(4), pages 647-657, November.
    34. Arne Risa Hole, 2007. "Fitting mixed logit models by using maximum simulated likelihood," Stata Journal, StataCorp LP, vol. 7(3), pages 388-401, September.
    35. Gary Chamberlain, 1980. "Analysis of Covariance with Qualitative Data," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 47(1), pages 225-238.
    36. Farley, Pamela J., 1986. "Theories of the price and quantity of physician services : A synthesis and critique," Journal of Health Economics, Elsevier, vol. 5(4), pages 315-333, December.
    37. Greiner, Ben, 2004. "An Online Recruitment System for Economic Experiments," MPRA Paper 13513, University Library of Munich, Germany.
    38. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies, Nadja & Wiesen, Daniel, 2013. "How to Improve Patient Care? – An Analysis of Capitation, Fee-for-Service, and Mixed Payment Schemes for Physicians," Ruhr Economic Papers 412, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    39. repec:adr:anecst:y:2011:i:101-102:p:11 is not listed on IDEAS
    40. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
    41. Armin Falk & Stephan Meier & Christian Zehnder, 2013. "Do Lab Experiments Misrepresent Social Preferences? The Case Of Self-Selected Student Samples," Journal of the European Economic Association, European Economic Association, vol. 11(4), pages 839-852, August.
    42. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, vol. 26(2), pages 281-298, April.
    43. Train,Kenneth E., 2009. "Discrete Choice Methods with Simulation," Cambridge Books, Cambridge University Press, number 9780521747387.
    44. A. J. Culyer & J. P. Newhouse (ed.), 2000. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, edition 1, volume 1, number 1.
    45. repec:bla:jemstr:v:3:y:1994:i:1:p:93-112:a is not listed on IDEAS
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    More about this item

    Keywords

    Payment incentives; Physician behavior; Physician altruism; Health care quantity; Mixed logit regression;
    All these keywords.

    JEL classification:

    • C91 - Mathematical and Quantitative Methods - - Design of Experiments - - - Laboratory, Individual Behavior
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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