IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v173y2017icp9-17.html
   My bibliography  Save this article

Does the proportion of pay linked to performance affect the job satisfaction of general practitioners?

Author

Listed:
  • Allen, Thomas
  • Whittaker, William
  • Sutton, Matt

Abstract

There is concern that pay-for-performance (P4P) can negatively affect general practitioners (GPs) by reducing their autonomy, increasing their wage dispersion or eroding their intrinsic motivation. This is especially a concern for the Quality and Outcomes Framework (QOF), a highly powered P4P scheme for UK GPs. The QOF affected all GPs but the exposure of their income to P4P varied. GPs did not know their level of exposure before the QOF was introduced and could not choose or manage it. We examine whether changes in GPs' job satisfaction before and after the introduction of the QOF in 2004 were correlated with the proportion of their income that became exposed to P4P. We use data on 1920 GPs observed at three time points spanning the introduction of the QOF; 2004, 2005 and 2008. We estimate the effect of exposure to P4P using a continuous difference-in-differences model. We find no significant effects of P4P exposure on overall job satisfaction or 12 additional measures of working lives in either the short or longer term. The level of exposure to P4P does not harm job satisfaction or other aspects of working lives. Policies influencing the exposure of income to P4P are unlikely to alter GP job satisfaction subject to final income remaining constant.

Suggested Citation

  • Allen, Thomas & Whittaker, William & Sutton, Matt, 2017. "Does the proportion of pay linked to performance affect the job satisfaction of general practitioners?," Social Science & Medicine, Elsevier, vol. 173(C), pages 9-17.
  • Handle: RePEc:eee:socmed:v:173:y:2017:i:c:p:9-17
    DOI: 10.1016/j.socscimed.2016.11.028
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953616306463
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2016.11.028?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Hugh Gravelle & Matt Sutton & Ada Ma, 2010. "Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?," Economic Journal, Royal Economic Society, vol. 120(542), pages 129-156, February.
    2. David Card, 1992. "Using Regional Variation in Wages to Measure the Effects of the Federal Minimum Wage," Working Papers 680, Princeton University, Department of Economics, Industrial Relations Section..
    3. Eriksson, Tor & Villeval, Marie Claire, 2008. "Performance-pay, sorting and social motivation," Journal of Economic Behavior & Organization, Elsevier, vol. 68(2), pages 412-421, November.
    4. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    5. Canice Prendergast, 1999. "The Provision of Incentives in Firms," Journal of Economic Literature, American Economic Association, vol. 37(1), pages 7-63, March.
    6. Brian A. Jacob & Steven D. Levitt, 2003. "Rotten Apples: An Investigation of the Prevalence and Predictors of Teacher Cheating," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 118(3), pages 843-877.
    7. H Gravelle & AR Hole, I Hussein, 2008. "Response bias in job satisfaction surveys: English general practitioners," Discussion Papers 08/24, Department of Economics, University of York.
    8. Alina Ileana Petrescu & Rob Simmons, 2008. "Human resource management practices and workers' job satisfaction," International Journal of Manpower, Emerald Group Publishing Limited, vol. 29(7), pages 651-667, November.
    9. Gene-Badia, Joan & Escaramis-Babiano, Georgia & Sans-Corrales, Mireia & Sampietro-Colom, Laura & Aguado-Menguy, Francoise & Cabezas-Pena, Carmen & Puelles, Pedro Gallo de, 2007. "Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care," Health Policy, Elsevier, vol. 80(1), pages 2-10, January.
    10. AndrewE. Clark & Nicolai Kristensen & Niels Westergård-Nielsen, 2009. "Job Satisfaction and Co-worker Wages: Status or Signal?," Economic Journal, Royal Economic Society, vol. 119(536), pages 430-447, March.
    11. David Card, 1992. "Using Regional Variation in Wages to Measure the Effects of the Federal Minimum Wage," ILR Review, Cornell University, ILR School, vol. 46(1), pages 22-37, October.
    12. Bruno S. Frey & Reto Jegen, 2001. "Motivation Crowding Theory," Journal of Economic Surveys, Wiley Blackwell, vol. 15(5), pages 589-611, December.
    13. Dan Ariely & Uri Gneezy & George Loewenstein & Nina Mazar, 2009. "Large Stakes and Big Mistakes," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 76(2), pages 451-469.
    14. Le Grand, Julian, 2003. "Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens," OUP Catalogue, Oxford University Press, number 9780199266999.
    15. Booth, Alison L & Frank, Jeff, 1999. "Earnings, Productivity, and Performance-Related Pay," Journal of Labor Economics, University of Chicago Press, vol. 17(3), pages 447-463, July.
    16. Sicsic, Jonathan & Le Vaillant, Marc & Franc, Carine, 2012. "Intrinsic and extrinsic motivations in primary care: An explanatory study among French general practitioners," Health Policy, Elsevier, vol. 108(2), pages 140-148.
    17. Matthew Sutton & Christine Godfrey, 1995. "A grouped data regression approach to estimating economic and social influences on individual drinking behaviour," Health Economics, John Wiley & Sons, Ltd., vol. 4(3), pages 237-247, May.
    18. repec:fth:prinin:300 is not listed on IDEAS
    19. Edward P. Lazear, 2000. "Performance Pay and Productivity," American Economic Review, American Economic Association, vol. 90(5), pages 1346-1361, December.
    20. Roland Bénabou & Jean Tirole, 2003. "Intrinsic and Extrinsic Motivation," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 70(3), pages 489-520.
    21. repec:dau:papers:123456789/14768 is not listed on IDEAS
    22. Stephen Morris & Rosalind Goudie & Matt Sutton & Hugh Gravelle & Robert Elliott & Arne Risa Hole & Ada Ma & Bonnie Sibbald & Diane Skåtun, 2011. "Determinants of general practitioners' wages in England," Health Economics, John Wiley & Sons, Ltd., vol. 20(2), pages 147-160, February.
    23. Martin Emmert & Frank Eijkenaar & Heike Kemter & Adelheid Esslinger & Oliver Schöffski, 2012. "Economic evaluation of pay-for-performance in health care: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(6), pages 755-767, December.
    24. Anthony Scott & Hugh Gravelle & Steven Simoens & Chris Bojke & Bonnie Sibbald, 2006. "Job Satisfaction and Quitting Intentions: A Structural Model of British General Practitioners," British Journal of Industrial Relations, London School of Economics, vol. 44(3), pages 519-540, September.
    25. Olivier Saint-Lary & Erik Bernard & Jonathan Sicsic & Isabelle Plu & Irène François-Purssell & Carine Franc, 2013. "Why Did Most French GPs Choose Not to Join the Voluntary National Pay-for-Performance Program?," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-7, September.
    26. Siciliani, Luigi, 2009. "Paying for performance and motivation crowding out," Economics Letters, Elsevier, vol. 103(2), pages 68-71, May.
    27. Kankaanranta, Terhi & Nummi, Tapio & Vainiomaki, Jari & Halila, Hannu & Hyppola, Harri & Isokoski, Mauri & Kujala, Santero & Kumpusalo, Esko & Mattila, Kari & Virjo, Irma & Vanska, Jukka & Rissanen, P, 2007. "The role of job satisfaction, job dissatisfaction and demographic factors on physicians' intentions to switch work sector from public to private," Health Policy, Elsevier, vol. 83(1), pages 50-64, September.
    28. James, Harvey Jr., 2005. "Why did you do that? An economic examination of the effect of extrinsic compensation on intrinsic motivation and performance," Journal of Economic Psychology, Elsevier, vol. 26(4), pages 549-566, August.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Pedersen, Line Bjørnskov & Andersen, Merethe Kirstine Kousgaard & Jensen, Ulrich Thy & Waldorff, Frans Boch & Jacobsen, Christian Bøtcher, 2018. "Can external interventions crowd in intrinsic motivation? A cluster randomised field experiment on mandatory accreditation of general practice in Denmark," Social Science & Medicine, Elsevier, vol. 211(C), pages 224-233.
    2. Troels Kristensen & Kim Rose-Olsen & Christian Volmar Skovsgaard, 2020. "Effects of Point-Of-Care Testing in General Practice for Type 2 Diabetes Patients on Ambulatory Visits and Hospitalizations," IJERPH, MDPI, vol. 17(17), pages 1-16, August.
    3. Pedersen, Line Bjørnskov & Allen, Thomas & Waldorff, Frans Boch & Andersen, Merethe Kirstine Kousgaard, 2020. "Does accreditation affect the job satisfaction of general practitioners? A combined panel data survey and cluster randomised field experiment," Health Policy, Elsevier, vol. 124(8), pages 849-855.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. McCausland, David & Pouliakas, Konstantinos & Theodossiou, Ioannis, 2005. "Some are Punished and Some are Rewarded: A Study of the Impact of Performance Pay on Job Satisfaction," MPRA Paper 14243, University Library of Munich, Germany.
    2. Paul H. Jensen & Robin E. Stonecash, 2004. "The Efficiency of Public Sector Outsourcing Contracts: A Literature Review," Melbourne Institute Working Paper Series wp2004n29, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    3. Rebitzer, James B. & Taylor, Lowell J., 2011. "Extrinsic Rewards and Intrinsic Motives: Standard and Behavioral Approaches to Agency and Labor Markets," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 4, chapter 8, pages 701-772, Elsevier.
    4. Kajackaite, Agne & Werner, Peter, 2015. "The incentive effects of performance requirements – A real effort experiment," Journal of Economic Psychology, Elsevier, vol. 49(C), pages 84-94.
    5. Paul H. Jensen & Robin E. Stonecash, 2005. "Incentives and the Efficiency of Public Sector‐outsourcing Contracts," Journal of Economic Surveys, Wiley Blackwell, vol. 19(5), pages 767-787, December.
    6. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Wiesen, Daniel, 2016. "Physician performance pay: Evidence from a laboratory experiment," Ruhr Economic Papers 658, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    7. K. Pouliakas & I. Theodossiou, 2009. "Confronting Objections To Performance Pay: The Impact Of Individual And Gain‐Sharing Incentives On Job Satisfaction," Scottish Journal of Political Economy, Scottish Economic Society, vol. 56(5), pages 662-684, November.
    8. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Kokot, Johanna & Wiesen, Daniel, 2020. "Physician performance pay: Experimental evidence," HERO Online Working Paper Series 2020:3, University of Oslo, Health Economics Research Programme.
    9. Michael T. Rauh & Giulio Seccia, 2010. "Agency and Anxiety," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 19(1), pages 87-116, March.
      • Michael T. Rauh & Giulio Seccia, 2006. "Agency and Anxiety," Working Papers 2006-02, Indiana University, Kelley School of Business, Department of Business Economics and Public Policy.
    10. Pokorny, Kathrin, 2008. "Pay--but do not pay too much: An experimental study on the impact of incentives," Journal of Economic Behavior & Organization, Elsevier, vol. 66(2), pages 251-264, May.
    11. Dirk Sliwka, 2007. "Trust as a Signal of a Social Norm and the Hidden Costs of Incentive Schemes," American Economic Review, American Economic Association, vol. 97(3), pages 999-1012, June.
    12. Kenju Kamei & Thomas Markussen, 2023. "Free Riding and Workplace Democracy—Heterogeneous Task Preferences and Sorting," Management Science, INFORMS, vol. 69(7), pages 3884-3904, July.
    13. Adams, Renée B. & Ferreira, Daniel, 2008. "Do directors perform for pay?," Journal of Accounting and Economics, Elsevier, vol. 46(1), pages 154-171, September.
    14. Dohmen, Thomas J., 2008. "Do professionals choke under pressure?," Journal of Economic Behavior & Organization, Elsevier, vol. 65(3-4), pages 636-653, March.
    15. Bradler, Christiane, 2015. "How creative are you? An experimental study on self-selection in a competitive incentive scheme for creative performance," ZEW Discussion Papers 15-021, ZEW - Leibniz Centre for European Economic Research.
    16. Kirsten Bregn, 2013. "Detrimental Effects of Performance-Related Pay in the Public Sector? On the Need for a Broader Theoretical Perspective," Public Organization Review, Springer, vol. 13(1), pages 21-35, March.
    17. Moscelli, Giuseppe & Gravelle, Hugh & Siciliani, Luigi & Santos, Rita, 2018. "Heterogeneous effects of patient choice and hospital competition on mortality," Social Science & Medicine, Elsevier, vol. 216(C), pages 50-58.
    18. Jana Vyrastekova & Sander Onderstal & Pierre Koning, 2012. "Self-selection and the power of incentive schemes: an experimental study," Applied Economics, Taylor & Francis Journals, vol. 44(32), pages 4211-4219, November.
    19. Konstantinos Pouliakas, 2010. "Pay Enough, Don't Pay Too Much or Don't Pay at All? The Impact of Bonus Intensity on Job Satisfaction," Kyklos, Wiley Blackwell, vol. 63(4), pages 597-626, November.
    20. Philippe Jacquart & J. Scott Armstrong, 2013. "The Ombudsman: Are Top Executives Paid Enough? An Evidence-Based Review," Interfaces, INFORMS, vol. 43(6), pages 580-589, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:173:y:2017:i:c:p:9-17. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.