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How Payment Systems Affect Physicians´ Provision Behaviour – An Experimental Investigation

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  • Heike Hennig-Schmidt
  • Reinhard Selten
  • Daniel Wiesen

    ()

Abstract

A central concern in health economics is to understand the influence of commonly used physician payment systems. We introduce a controlled laboratory experiment to analyze the influence of fee-for-service (FFS) and capitation (CAP) payments on physicians' behaviour. Medical students decide as experimental physicians on the quantity of medical services. Real patients gain a monetary benefit from their choices. Our main findings are that patients are overserved in FFS and underserved in CAP. Financial incentives are not the only motivation for physicians' quantity decisions, though. The patient benefit is of considerable importance as well. Patients are affected differently by the two payment systems. Those patients in need of a low level of medical services are better off under CAP, whereas patients with a high need of medical services gain more health benefit when physicians are paid by FFS.

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Bibliographic Info

Paper provided by University of Bonn, Germany in its series Bonn Econ Discussion Papers with number bgse29_2009.

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Length: 34
Date of creation: Jul 2009
Date of revision:
Handle: RePEc:bon:bonedp:bgse29_2009

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Postal: Bonn Graduate School of Economics, University of Bonn, Adenauerallee 24 - 26, 53113 Bonn, Germany
Fax: +49 228 73 6884
Web page: http://www.bgse.uni-bonn.de

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Keywords: Physician payment system; laboratory experiment; incentives; fee-for-service; capitation;

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Cited by:
  1. Troels Kristensen & Kim Olsen & Henrik Schroll & Janus Thomsen & Anders Halling, 2014. "Association between fee-for-service expenditures and morbidity burden in primary care," The European Journal of Health Economics, Springer, vol. 15(6), pages 599-610, July.
  2. Miriam Krieger & Thomas Mayrhofer, 2012. "Patient Preferences and Treatment Thresholds under Diagnostic Risk – An Economic Laboratory Experiment," Ruhr Economic Papers 0321, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
  3. Buckley, Neil J. & Cuff, Katherine & Hurley, Jeremiah & McLeod, Logan & Mestelman, Stuart & Cameron, David, 2012. "An experimental investigation of mixed systems of public and private health care finance," Journal of Economic Behavior & Organization, Elsevier, vol. 84(3), pages 713-729.
  4. 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.
  5. Ellen P. Green, 2013. "Payment Systems in the Healthcare Industry: An Experimental Study Of Physician Incentives," Working Papers 13-05, University of Delaware, Department of Economics.
  6. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2012. "Quality competition with profit constraints," Journal of Economic Behavior & Organization, Elsevier, vol. 84(2), pages 642-659.
  7. Sung-Hee Jeon & Jeremiah Hurley, 2010. "Physician Resource Planning in Canada: The Need for a Stronger Behavioural Foundation," Canadian Public Policy, University of Toronto Press, vol. 36(3), pages 359-375, September.
  8. Claudia Keser & Claude Montmarquette & Martin Schmidt & Cornelius Schnitzler, 2013. "Custom-made healthcare – An experimental investigation," CIRANO Working Papers 2013s-15, CIRANO.
  9. Schmitz, Hendrik, 2013. "Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation," Journal of Health Economics, Elsevier, vol. 32(6), pages 1240-1249.
  10. Jeannette Brosig-Koch & Heike Hennig-Schmidt & Nadja Kairies & Daniel Wiesen, 2013. "How to Improve Patient Care? – An Analysis of Capitation, Fee-for-Service, and Mixed Payment Schemes for Physicians," Ruhr Economic Papers 0412, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
  11. Kesternich, Iris & Schumacher, Heiner & Winter, Joachim, 2014. "Professional norms and physician behavior: homo oeconomicus or homo hippocraticus?," Discussion Paper Series of SFB/TR 15 Governance and the Efficiency of Economic Systems 456, Free University of Berlin, Humboldt University of Berlin, University of Bonn, University of Mannheim, University of Munich.

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