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Do institutional logics predict interpretation of contract rules at the dental chair-side?

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  • Harris, Rebecca
  • Brown, Stephen
  • Holt, Robin
  • Perkins, Elizabeth

Abstract

In quasi-markets, contracts find purchasers influencing health care providers, although problems exist where providers use personal bias and heuristics to respond to written agreements, tending towards the moral hazard of opportunism. Previous research on quasi-market contracts typically understands opportunism as fully rational, individual responses selecting maximally efficient outcomes from a set of possibilities. We take a more emotive and collective view of contracting, exploring the influence of institutional logics in relation to the opportunistic behaviour of dentists. Following earlier qualitative work where we identified four institutional logics in English general dental practice, and six dental contract areas where there was scope for opportunism; in 2013 we surveyed 924 dentists to investigate these logics and whether they had predictive purchase over dentists' chair-side behaviour. Factor analysis involving 300 responses identified four logics entwined in (often technical) behaviour: entrepreneurial commercialism, duty to staff and patients, managerialism, public good.

Suggested Citation

  • Harris, Rebecca & Brown, Stephen & Holt, Robin & Perkins, Elizabeth, 2014. "Do institutional logics predict interpretation of contract rules at the dental chair-side?," Social Science & Medicine, Elsevier, vol. 122(C), pages 81-89.
    • Handle: RePEc:eee:socmed:v:122:y:2014:i:c:p:81-89
    DOI: 10.1016/j.socscimed.2014.10.020
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    References listed on IDEAS

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    1. Hughes, David & Griffiths, Lesley & McHale, Jean V, 1997. "Do Quasi-markets Evolve? Institutional Analysis and the NHS," Cambridge Journal of Economics, Cambridge Political Economy Society, vol. 21(2), pages 259-276, March.
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    4. Harris, Rebecca & Mosedale, Sarah & Garner, Jayne & Perkins, Elizabeth, 2014. "What factors influence the use of contracts in the context of NHS dental practice? A systematic review of theory and logic model," Social Science & Medicine, Elsevier, vol. 108(C), pages 54-59.
    5. Allen, Pauline, 2002. "A socio-legal and economic analysis of contracting in the NHS internal market using a case study of contracting for district nursing," Social Science & Medicine, Elsevier, vol. 54(2), pages 255-266, January.
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