IDEAS home Printed from https://ideas.repec.org/a/eee/pubeco/v131y2015icp1-11.html
   My bibliography  Save this article

Professional norms and physician behavior: Homo oeconomicus or homo hippocraticus?

Author

Listed:
  • Kesternich, Iris
  • Schumacher, Heiner
  • Winter, Joachim

Abstract

Physicians' treatment decisions determine the level of health care spending to a large extent. The analysis of physician agency describes how doctors trade off their own and their patients' benefits, with a third party (such as the collective of insured individuals or the taxpayers) bearing the costs. Professional norms are viewed as restraining physicians' self-interest and as introducing altruism towards the patient. We present a controlled experiment that analyzes the impact of professional norms on prospective physicians' trade-offs between their own profits, the patients' benefits, and the payers' expenses for medical care. Our data support the notion that professional norms derived from the Hippocratic tradition shift weight to the patient in physicians' decisions while decreasing their self-interest and efficiency concerns.

Suggested Citation

  • Kesternich, Iris & Schumacher, Heiner & Winter, Joachim, 2015. "Professional norms and physician behavior: Homo oeconomicus or homo hippocraticus?," Journal of Public Economics, Elsevier, vol. 131(C), pages 1-11.
    • Handle: RePEc:eee:pubeco:v:131:y:2015:i:c:p:1-11
    DOI: 10.1016/j.jpubeco.2015.08.009
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0047272715001449
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.jpubeco.2015.08.009?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 look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. 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.
    2. Heiner Schumacher & Iris Kesternich & Michael Kosfeld & Joachim Winter, 2014. "Us and Them: Distributional Preferences in Small and Large Groups," CESifo Working Paper Series 4657, CESifo.
    3. James Andreoni & Lise Vesterlund, 2001. "Which is the Fair Sex? Gender Differences in Altruism," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 116(1), pages 293-312.
    4. Raymond Fisman & Shachar Kariv & Daniel Markovits, 2007. "Individual Preferences for Giving," American Economic Review, American Economic Association, vol. 97(5), pages 1858-1876, December.
    5. David J. Cooper & James B. Rebitzer, "undated". "Physician Incentives In Managed Care Organizations: Medical Practice Norms and the Quality of Care," Economics Public Policy Brief Archive ppb_70, Levy Economics Institute.
    6. Jonathan T. Kolstad, 2013. "Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards," NBER Working Papers 18804, National Bureau of Economic Research, Inc.
    7. 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.
    8. Dirk Engelmann & Martin Strobel, 2004. "Inequality Aversion, Efficiency, and Maximin Preferences in Simple Distribution Experiments," American Economic Review, American Economic Association, vol. 94(4), pages 857-869, September.
    9. Christoph Engel, 2011. "Dictator games: a meta study," Experimental Economics, Springer;Economic Science Association, vol. 14(4), pages 583-610, November.
    10. Daniel J. Benjamin & James J. Choi & A. Joshua Strickland, 2010. "Social Identity and Preferences," American Economic Review, American Economic Association, vol. 100(4), pages 1913-1928, September.
    11. Gary Charness & Matthew Rabin, 2002. "Understanding Social Preferences with Simple Tests," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 117(3), pages 817-869.
    12. 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.
    13. Sohl, P. & Bassford, H. A., 1986. "Codes of medical ethics: Traditional foundations and contemporary practice," Social Science & Medicine, Elsevier, vol. 22(11), pages 1175-1179, January.
    14. 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.
    15. 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.
    16. 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.
    17. Kerschbamer, Rudolf, 2015. "The geometry of distributional preferences and a non-parametric identification approach: The Equality Equivalence Test," European Economic Review, Elsevier, vol. 76(C), pages 85-103.
    18. Rachel Croson & Uri Gneezy, 2009. "Gender Differences in Preferences," Journal of Economic Literature, American Economic Association, vol. 47(2), pages 448-474, June.
    19. Jordi Brandts & Gary Charness, 2011. "The strategy versus the direct-response method: a first survey of experimental comparisons," Experimental Economics, Springer;Economic Science Association, vol. 14(3), pages 375-398, September.
    20. Amitabh Chandra & Jonathan Skinner, 2012. "Technology Growth and Expenditure Growth in Health Care," Journal of Economic Literature, American Economic Association, vol. 50(3), pages 645-680, September.
    21. Jeannette Brosig‐Koch & Heike Hennig‐Schmidt & Nadja Kairies‐Schwarz & Daniel Wiesen, 2017. "The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence," Health Economics, John Wiley & Sons, Ltd., vol. 26(2), pages 243-262, February.
    22. Dirk Engelmann & Martin Strobel, 2007. "Preferences over Income Distributions," Public Finance Review, , vol. 35(2), pages 285-310, March.
    23. Schildberg-Hörisch, Hannah, 2010. "Is the veil of ignorance only a concept about risk? An experiment," Journal of Public Economics, Elsevier, vol. 94(11-12), pages 1062-1066, December.
    24. David J. Cooper & James B. Rebitzer, 2002. "Managed Care, Physician Incentives, and Norms of Medical," Microeconomics 0209001, University Library of Munich, Germany.
    25. Messer, Kent D. & Poe, Gregory L. & Rondeau, Daniel & Schulze, William D. & Vossler, Christian A., 2010. "Social preferences and voting: An exploration using a novel preference revealing mechanism," Journal of Public Economics, Elsevier, vol. 94(3-4), pages 308-317, April.
    26. 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.
    27. Jonathan T. Kolstad, 2013. "Information and Quality When Motivation Is Intrinsic: Evidence from Surgeon Report Cards," American Economic Review, American Economic Association, vol. 103(7), pages 2875-2910, December.
    28. repec:zbw:rwirep:0412 is not listed on IDEAS
    29. Janet Currie & W. Bentley MacLeod, 2008. "First Do No Harm? Tort Reform and Birth Outcomes," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 123(2), pages 795-830.
    30. Raymond Fisman & Pamela Jakiela & Shachar Kariv, 2014. "The Distributional Preferences of Americans," NBER Working Papers 20145, National Bureau of Economic Research, Inc.
    31. Alain Cohn & Ernst Fehr & Michel André Maréchal, 2014. "Business culture and dishonesty in the banking industry," Nature, Nature, vol. 516(7529), pages 86-89, December.
    32. repec:adr:anecst:y:2011:i:101-102:p:11 is not listed on IDEAS
    33. 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.
    34. James Andreoni & John Miller, 2002. "Giving According to GARP: An Experimental Test of the Consistency of Preferences for Altruism," Econometrica, Econometric Society, vol. 70(2), pages 737-753, March.
    Full references (including those not matched with items on IDEAS)

    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. Attema, Arthur E. & Galizzi, Matteo M. & Groß, Mona & Hennig-Schmidt, Heike & Karay, Yassin & L’Haridon, Olivier & Wiesen, Daniel, 2023. "The formation of physician altruism," Journal of Health Economics, Elsevier, vol. 87(C).
    2. Simon Reif & Lucas Hafner & Michael Seebauer, 2020. "Physician Behavior under Prospective Payment Schemes—Evidence from Artefactual Field and Lab Experiments," IJERPH, MDPI, vol. 17(15), pages 1-37, July.
    3. Waibel, Christian & Wiesen, Daniel, 2016. "Kickbacks, referrals and efficiency in health care markets: Experimental evidence," HERO Online Working Paper Series 2016:8, University of Oslo, Health Economics Research Programme.
    4. Waibel, Christian & Wiesen, Daniel, 2021. "An experiment on referrals in health care," European Economic Review, Elsevier, vol. 131(C).
    5. Lagarde, Mylène & Blaauw, Duane, 2017. "Physicians’ responses to financial and social incentives: A medically framed real effort experiment," Social Science & Medicine, Elsevier, vol. 179(C), pages 147-159.
    6. Adrian Bruhin & Ernst Fehr & Daniel Schunk, 2019. "The many Faces of Human Sociality: Uncovering the Distribution and Stability of Social Preferences," Journal of the European Economic Association, European Economic Association, vol. 17(4), pages 1025-1069.
    7. Kerschbamer, Rudolf & Müller, Daniel, 2020. "Social preferences and political attitudes: An online experiment on a large heterogeneous sample," Journal of Public Economics, Elsevier, vol. 182(C).
    8. Jeannette Brosig‐Koch & Burkhard Hehenkamp & Johanna Kokot, 2017. "The effects of competition on medical service provision," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 6-20, December.
    9. Li, Jing, 2018. "Plastic surgery or primary care? Altruistic preferences and expected specialty choice of U.S. medical students," Journal of Health Economics, Elsevier, vol. 62(C), pages 45-59.
    10. Godager, Geir & Hennig-Schmidt, Heike & Iversen, Tor, 2016. "Does performance disclosure influence physicians’ medical decisions? An experimental study," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 36-46.
    11. Daniel Müller & Sander Renes, 2017. "Fairness views and political preferences - Evidence from a large online experiment," Working Papers 2017-10, Faculty of Economics and Statistics, Universität Innsbruck.
    12. Wang, Jian & Iversen, Tor & Hennig-Schmidt, Heike & Godager, Geir, 2020. "Are patient-regarding preferences stable? Evidence from a laboratory experiment with physicians and medical students from different countries," European Economic Review, Elsevier, vol. 125(C).
    13. 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.
    14. Linda Kamas & Anne Preston, 2012. "Gender and Social Preferences in the US: An Experimental Study," Feminist Economics, Taylor & Francis Journals, vol. 18(1), pages 135-160, January.
    15. Deborah Kerley Keisner & Kent D. Messer & William D. Schulze & Homa Zarghamee, 2013. "Testing Social Preferences for an Economic “Bad”: An Artefactual Field Experiment," Scandinavian Journal of Economics, Wiley Blackwell, vol. 115(1), pages 27-61, January.
    16. Gauriot, Romain & Heger, Stephanie A. & Slonim, Robert, 2020. "Altruism or diminishing marginal utility?," Journal of Economic Behavior & Organization, Elsevier, vol. 180(C), pages 24-48.
    17. Krawczyk, Michal & Le Lec, Fabrice, 2021. "How to elicit distributional preferences: A stress-test of the equality equivalence test," Journal of Economic Behavior & Organization, Elsevier, vol. 182(C), pages 13-28.
    18. Hennig-Schmidt, Heike & Wiesen, Daniel, 2014. "Other-regarding behavior and motivation in health care provision: An experiment with medical and non-medical students," Social Science & Medicine, Elsevier, vol. 108(C), pages 156-165.
    19. Godager , Geir & Scott, Anthony, 2023. "Physician Behavior and Health Outcomes," HERO Online Working Paper Series 2023:3, University of Oslo, Health Economics Research Programme.
    20. Laurent Denant-Boemont & Matthieu Leprince & Matthieu Pourieux, 2019. "Distributive Preferences of Public Representatives: A Field-in-the-Lab Experiment," Economics Working Paper from Condorcet Center for political Economy at CREM-CNRS 2019-05-ccr, Condorcet Center for political Economy.

    More about this item

    Keywords

    Social preferences; Allocation of medical resources; Professional norms;
    All these keywords.

    JEL classification:

    • A13 - General Economics and Teaching - - General Economics - - - Relation of Economics to Social Values
    • I19 - Health, Education, and Welfare - - Health - - - Other
    • C72 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - Noncooperative Games
    • C91 - Mathematical and Quantitative Methods - - Design of Experiments - - - Laboratory, Individual Behavior

    Statistics

    Access and download statistics

    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:pubeco:v:131:y:2015:i:c:p:1-11. 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/locate/inca/505578 .

    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.