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

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Author Info
Etienne Dumont (CIRPEE - Université Laval)
Bernard Fortin (CIRPEE - Université Laval)
Nicolas Jacquemet () (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
Bruce Shearer (CIRPEE - Université Laval)

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Abstract

We analyse how physicians respond to contractual changes and incentives within a multitaskingenvironment. In 1999 the Quebec government (Canada) introduced an optional mixed compensationsystem, 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 physiciansto evaluate the impact of this change in incentives on their practice choices. We highlight thedierentiated impact of incentives on various dimensions of physician behaviour by considering awide 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 perclinical service. Our results show that, on average, the reform induced physicians who changedfrom FFS to MC to reduce their volume of (billable) services by 6.15% and to reduce their hours ofwork 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 toincrease their time spent on teaching and administrative duties (tasks not remunerated under thefee-for-service system) by 7.9%.

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Paper provided by HAL in its series Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) with number halshs-00305308_v1.

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Date of creation: Dec 2008
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Publication status: Published, Journal of Health Economics, 2008, 27, 6, 1436-1450
Handle: RePEc:hal:cesptp:halshs-00305308_v1

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Related research
Keywords: physician payment mechanisms; multitasking; mixed-payment systems; incentive con-tracts; labour supply; self-selection; panel estimation.;

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
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    Other versions:
  3. Ching-to Albert Ma, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Papers 0047, Boston University - Industry Studies Programme.
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  4. Jason Barro & Nancy Beaulieu, 2003. "Selection and Improvement: Physician Responses to Financial Incentives," NBER Working Papers 10017, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  7. Richard Blundell & Thomas MaCurdy, 1998. "Labour supply: A review of alternative approaches," IFS Working Papers W98/18, Institute for Fiscal Studies.
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  9. Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Policy Analysis in the Health-Services Market: Accounting for Quality and Quantity," Cahiers de recherche 0807, CIRPEE. [Downloadable!]
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  11. Croxson, B. & Propper, C. & Perkins, A., 2001. "Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme," Journal of Public Economics, Elsevier, vol. 79(2), pages 375-398, February. [Downloadable!] (restricted)
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  17. Heckman, James J & Heinrich, Carolyn & Smith, Jeffrey, 1997. "Assessing the Performance of Performance Standards in Public Bureaucracies," American Economic Review, American Economic Association, vol. 87(2), pages 389-95, May. [Downloadable!] (restricted)
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  20. Jonathan Gruber & Maria Owings, 1996. "Physician Financial Incentives and Cesarean Section Delivery," RAND Journal of Economics, The RAND Corporation, vol. 27(1), pages 99-123, Spring. [Downloadable!] (restricted)
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  21. 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. [Downloadable!]
  22. 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. [Downloadable!] (restricted)
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  25. Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2007. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," Cahiers de recherche 0745, CIRPEE. [Downloadable!]
    Other versions:
  26. Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September. [Downloadable!] (restricted)
Full references

Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce S. Shearer, 2008. "Physicians’ Multitasking and Incentives: Empirical Evidence from a Natural Experiment," CIRANO Working Papers 2008s-20, CIRANO. [Downloadable!]
    Other versions:
  2. 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. [Downloadable!]
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