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Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment

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Author Info

  • Etienne Dumont

    (CIRPEE - Universite Laval (Quebec) - Canada)

  • Bernard Fortin

    (CIRPEE - Universite Laval (Quebec) - Canada)

  • Nicolas Jacquemet

    ()
    (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)

  • Bruce Shearer

    (CIRPEE - Universite Laval (Quebec) - Canada)

Abstract

We analyse how physicians respond to contractual changes and incentives within a multitasking environment. In 1999 the Quebec government (Canada) introduced an optional mixed compensation system, combining a xed per diem with a partial (relative to the traditional fee-for-service system) fee for services provided. We combine panel survey and administrative data on Quebec physicians to evaluate the impact of this change in incentives on their practice choices. We highlight the dierentiated impact of incentives on various dimensions of physician behaviour by considering a wide range of labour supply variables: time spent on seeing patients, time devoted to teaching, administrative tasks or research, as well as the volume of clinical services and average time per clinical service. Our results show that, on average, the reform induced physicians who changed from FFS to MC to reduce their volume of (billable) services by 6.15% and to reduce their hours of work spent on seeing patients by 2.57%. Their average time spent per service increased by 3.58%, suggesting a potential quality-quantity substitution. Also the reform induced these physicians to increase their time spent on teaching and administrative duties (tasks not remunerated under the fee-for-service system) by 7.9%.

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Bibliographic Info

Paper provided by HAL in its series Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) with number halshs-00305308.

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Date of creation: Dec 2008
Date of revision:
Publication status: Published, Journal of Health Economics, 2008, 27, 6, 1436-1450
Handle: RePEc:hal:cesptp:halshs-00305308

Note: View the original document on HAL open archive server: http://halshs.archives-ouvertes.fr/halshs-00305308
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Web page: http://hal.archives-ouvertes.fr/

Related research

Keywords: physician payment mechanisms; multitasking; mixed-payment systems; incentive contracts; labour supply; self-selection; panel estimation;

References

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  1. Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Policy Analysis in the Health-Services Market: Accounting for Quality and Quantity," Cahiers de recherche 0807, CIRPEE.
  2. Anirban Basu & James J. Heckman & Salvador Navarro-Lozano & Sergio Urzua, 2007. "Use of instrumental variables in the presence of heterogeneity and self-selection: an application to treatments of breast cancer patients," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1133-1157.
  3. Dumont, Etienne & Fortin, Bernard & Jacquemet, Nicolas & Shearer, Bruce S., 2007. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," IZA Discussion Papers 3229, Institute for the Study of Labor (IZA).
  4. Ching-to Albert Ma & Thomas G. McGuire, 1995. "Optimal Health Insurance and Provider Payment," Papers 0059, Boston University - Industry Studies Programme.
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  12. Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Policy Analysis in the health-services market: accounting for quality and quantity," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00305309, HAL.
  13. Baker, George P, 1992. "Incentive Contracts and Performance Measurement," Journal of Political Economy, University of Chicago Press, vol. 100(3), pages 598-614, June.
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  17. Bolduc, Denis & Fortin, Bernard & Fournier, Marc-Andre, 1996. "The Effect of Incentive Policies on the Practice Location of Doctors: A Multinomial Probit Analysis," Journal of Labor Economics, University of Chicago Press, vol. 14(4), pages 703-32, October.
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  20. Devlin, Rose Anne & Sarma, Sisira, 2008. "Do physician remuneration schemes matter? The case of Canadian family physicians," Journal of Health Economics, Elsevier, vol. 27(5), pages 1168-1181, September.
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Citations

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Cited by:
  1. Boris Kralj & Jasmin Kantarevic, 2013. "Quality and quantity in primary care mixed-payment models: evidence from family health organizations in Ontario," Canadian Journal of Economics, Canadian Economics Association, vol. 46(1), pages 208-238, February.
  2. Fuhai Hong & Tanjim Hossain & John A. List & Migiwa Tanaka, 2013. "Testing the Theory of Multitasking: Evidence from a Natural Field Experiment in Chinese Factories," CESifo Working Paper Series 4522, CESifo Group Munich.
  3. 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.
  4. E. Iezzi & M. Lippi Bruni & C. Ugolini, 2011. "The role of GP’s compensation schemes in diabetes care: evidence from panel data," Working Papers wp766, Dipartimento Scienze Economiche, Universita' di Bologna.
  5. Damien Échevin & Bernard Fortin, 2011. "Physician Payment Mechanisms, Hospital Length of Stay and Risk of Readmission: a Natural Experiment," Cahiers de recherche 1112, CIRPEE.
  6. Heike Hennig-Schmidt & Reinhard Selten & Daniel Wiesen, 2011. "How Payment Systems Affect Physicians' Provision Behaviour – An Experimental Investigation," Bonn Econ Discussion Papers bgse03_2011, University of Bonn, Germany.
  7. Claudia Keser & Claude Montmarquette & Martin Schmidt & Cornelius Schnitzler, 2013. "Custom-made healthcare – An experimental investigation," CIRANO Working Papers 2013s-15, CIRANO.
  8. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010. "Physicians self selection of a payment mechanism: Capitation versus fee-for-service," Post-Print halshs-00523370, HAL.
  9. Anthony Scott & Stefanie Schurer & Paul H. Jensen & Peter Sivey, 2009. "The effects of an incentive program on quality of care in diabetes management," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 1091-1108.
  10. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2014. "Payment mechanism and GP self-selection: capitation versus fee for service," International Journal of Health Care Finance and Economics, Springer, vol. 14(2), pages 143-160, June.
  11. Échevin, Damien & Fortin, Bernard, 2013. "Physician Payment Mechanisms, Hospital Length of Stay and Risk of Readmission: Evidence from a Natural Experiment," IZA Discussion Papers 7835, Institute for the Study of Labor (IZA).
  12. Ann Bartel & Brianna Cardiff-Hicks & Kathryn Shaw, 2013. "Compensation Matters: Incentives for Multitasking in a Law Firm," NBER Working Papers 19412, National Bureau of Economic Research, Inc.
  13. Yuda, Michio, 2013. "Medical Fee Reforms, Changes In Medical Supply Densities, And Supplier-Induced Demand: Empirical Evidence From Japan," Hitotsubashi Journal of Economics, Hitotsubashi University, vol. 54(1), pages 79-93, June.

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