IDEAS home Printed from https://ideas.repec.org/p/hhs/oslohe/2023_006.html
   My bibliography  Save this paper

Physician beneficence and profit-taking among private for profit clinics in China: A field study using a mystery shopper audit

Author

Listed:
  • Ge, Ge

    (Department of Health Management and Health Economics)

  • Cheo, Roland

    (Centre for Behavioural and Implementation Science Interventions,)

  • Liu, Rugang

    (School of Public Health and Policy, Nanjing Medical University)

  • Wang, Jian

    (Dong Fureng Institute of Economic and Social Development and Center for Health Economics and Management, Wuhan University)

  • Wang, Qiqi

    (School of Economics, Xian School of Economics and Finance)

Abstract

This study employs a mystery shopper audit on a random sample of 96 for-profit private clinics in Jinan, China. We investigate two instruments which reflect beneficence among for-profit clinicians in private practice. The first is whether physicians returned a lost wallet “accidentally” left next to the physician’s table; and the second, whether physicians prescribed antibiotics to pseudopatients who displayed no symptoms of any illness but had complained of fever the night before. These measures quantify beneficence under two different valence framing: returning a wallet represents clinicians who “do good” at personal cost to themselves, while not prescribing antibiotics represents a choice “not to do harm” to patients. We look at the correlation between these beneficence measures and the physicians’ prescription behaviours, and their revenues from the consultation. We find that whether doctors return a lost wallet or not, and prescribe antibiotics or not, such physicians are still as likely to prescribe medications which increase their incomes.

Suggested Citation

  • Ge, Ge & Cheo, Roland & Liu, Rugang & Wang, Jian & Wang, Qiqi, 2023. "Physician beneficence and profit-taking among private for profit clinics in China: A field study using a mystery shopper audit," HERO Online Working Paper Series 2023:6, University of Oslo, Health Economics Research Programme.
  • Handle: RePEc:hhs:oslohe:2023_006
    as

    Download full text from publisher

    File URL: https://www.med.uio.no/helsam/forskning/nettverk/hero/publikasjoner/skriftserie/2023/2023-6.pdf
    File Function: Full text
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Jan Stoop, 2014. "From the lab to the field: envelopes, dictators and manners," Experimental Economics, Springer;Economic Science Association, vol. 17(2), pages 304-313, June.
    2. Currie, Janet & Lin, Wanchuan & Zhang, Wei, 2011. "Patient knowledge and antibiotic abuse: Evidence from an audit study in China," Journal of Health Economics, Elsevier, vol. 30(5), pages 933-949.
    3. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Wiesen, Daniel, 2016. "Using artefactual field and lab experiments to investigate how fee-for-service and capitation affect medical service provision," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 17-23.
    4. 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).
    5. Dufwenberg, Martin & Gneezy, Uri, 2000. "Measuring Beliefs in an Experimental Lost Wallet Game," Games and Economic Behavior, Elsevier, vol. 30(2), pages 163-182, February.
    6. Cappelen, Alexander W. & Nielsen, Ulrik H. & Sørensen, Erik Ø. & Tungodden, Bertil & Tyran, Jean-Robert, 2013. "Give and take in dictator games," Economics Letters, Elsevier, vol. 118(2), pages 280-283.
    7. 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.
    8. Donal Crilly & Na Ni & Yuwei Jiang, 2016. "Do-no-harm versus do-good social responsibility: Attributional thinking and the liability of foreignness," Strategic Management Journal, Wiley Blackwell, vol. 37(7), pages 1316-1329, July.
    9. 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.
    10. Balafoutas, Loukas & Kerschbamer, Rudolf, 2020. "Credence goods in the literature: What the past fifteen years have taught us about fraud, incentives, and the role of institutions," Journal of Behavioral and Experimental Finance, Elsevier, vol. 26(C).
    11. Peter Martinsson & Emil Persson, 2019. "Physician behavior and conditional altruism: the effects of payment system and uncertain health benefit," Theory and Decision, Springer, vol. 87(3), pages 365-387, October.
    12. John A. List, 2007. "On the Interpretation of Giving in Dictator Games," Journal of Political Economy, University of Chicago Press, vol. 115, pages 482-493.
    13. Stephen Knack & Philip Keefer, 1997. "Does Social Capital Have an Economic Payoff? A Cross-Country Investigation," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 112(4), pages 1251-1288.
    14. Loukas Balafoutas & Adrian Beck & Rudolf Kerschbamer & Matthias Sutter, 2013. "What Drives Taxi Drivers? A Field Experiment on Fraud in a Market for Credence Goods," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 80(3), pages 876-891.
    15. 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.
    16. Grossman, Philip J. & Eckel, Catherine C., 2015. "Giving versus taking for a cause," Economics Letters, Elsevier, vol. 132(C), pages 28-30.
    17. Ge, Ge & Godager, Geir, 2021. "Predicting strategic medical choices: An application of a quantal response equilibrium choice model," Journal of choice modelling, Elsevier, vol. 39(C).
    18. Iversen, Tor, 2004. "The effects of a patient shortage on general practitioners' future income and list of patients," Journal of Health Economics, Elsevier, vol. 23(4), pages 673-694, July.
    19. Thomas G. McGuire & Mark V. Pauly, 1991. "Physician Response to Fee Changes with Multiple Payers," Papers 0015, Boston University - Industry Studies Programme.
    20. Böhm, Robert & Theelen, Maik M.P., 2016. "Outcome valence and externality valence framing in public good dilemmas," Journal of Economic Psychology, Elsevier, vol. 54(C), pages 151-163.
    21. 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.
    22. Christel E. van Dijk & Bernard van den Berg & Robert A. Verheij & Peter Spreeuwenberg & Peter P. Groenewegen & Dinny H. de Bakker, 2013. "Moral Hazard And Supplier‐Induced Demand: Empirical Evidence In General Practice," Health Economics, John Wiley & Sons, Ltd., vol. 22(3), pages 340-352, March.
    23. James Andreoni & Nikos Nikiforakis & Jan Stoop, 2021. "Higher socioeconomic status does not predict decreased prosocial behavior in a field experiment," Nature Communications, Nature, vol. 12(1), pages 1-8, December.
    24. Sara Reardon, 2014. "Antibiotic resistance sweeping developing world," Nature, Nature, vol. 509(7499), pages 141-142, May.
    25. Charness, Gary & Haruvy, Ernan & Sonsino, Doron, 2007. "Social distance and reciprocity: An Internet experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 63(1), pages 88-103, May.
    26. Oleg Korenok & Edward Millner & Laura Razzolini, 2014. "Taking, giving, and impure altruism in dictator games," Experimental Economics, Springer;Economic Science Association, vol. 17(3), pages 488-500, September.
    27. Lu, Fangwen, 2014. "Insurance coverage and agency problems in doctor prescriptions: Evidence from a field experiment in China," Journal of Development Economics, Elsevier, vol. 106(C), pages 156-167.
    28. Troy Quast & David E. M. Sappington & Elizabeth Shenkman, 2008. "Does the quality of care in Medicaid MCOs vary with the form of physician compensation?," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 545-550, April.
    29. Michael Robert Plotzke & Charles Courtemanche, 2011. "Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?," Health Economics, John Wiley & Sons, Ltd., vol. 20(7), pages 817-830, July.
    30. Felix Gottschalk & Wanda Mimra & Christian Waibe, 2020. "Health Services as Credence Goods: a Field Experiment," The Economic Journal, Royal Economic Society, vol. 130(629), pages 1346-1383.
    31. Alem, Yonas & Eggert, Håkan & Kocher, Martin G. & Ruhinduka, Remidius D., 2018. "Why (field) experiments on unethical behavior are important: Comparing stated and revealed behavior," Journal of Economic Behavior & Organization, Elsevier, vol. 156(C), pages 71-85.
    32. James Cox & Maroš Servátka & Radovan Vadovič, 2010. "Saliency of outside options in the lost wallet game," Experimental Economics, Springer;Economic Science Association, vol. 13(1), pages 66-74, March.
    33. John A. Rizzo & Richard J. Zeckhauser, 2003. "Reference Incomes, Loss Aversion, and Physician Behavior," The Review of Economics and Statistics, MIT Press, vol. 85(4), pages 909-922, November.
    34. Menusch Khadjavi & Andreas Lange, 2015. "Doing good or doing harm: experimental evidence on giving and taking in public good games," Experimental Economics, Springer;Economic Science Association, vol. 18(3), pages 432-441, September.
    35. Uwe Dulleck & Rudolf Kerschbamer & Matthias Sutter, 2011. "The Economics of Credence Goods: An Experiment on the Role of Liability, Verifiability, Reputation, and Competition," American Economic Review, American Economic Association, vol. 101(2), pages 526-555, April.
    36. Nicholas Bardsley, 2008. "Dictator game giving: altruism or artefact?," Experimental Economics, Springer;Economic Science Association, vol. 11(2), pages 122-133, June.
    37. Eric Delattre & Brigitte Dormont, 2003. "Fixed fees and physician‐induced demand: A panel data study on French physicians," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 741-754, September.
    38. Reynolds, Lucy & McKee, Martin, 2009. "Factors influencing antibiotic prescribing in China: An exploratory analysis," Health Policy, Elsevier, vol. 90(1), pages 32-36, April.
    39. Jason Dana & Roberto Weber & Jason Kuang, 2007. "Exploiting moral wiggle room: experiments demonstrating an illusory preference for fairness," Economic Theory, Springer;Society for the Advancement of Economic Theory (SAET), vol. 33(1), pages 67-80, October.
    40. J. Michelle Brock & Andreas Lange & Kenneth L. Leonard, 2016. "Generosity and Prosocial Behavior in Healthcare Provision: Evidence from the Laboratory and Field," Journal of Human Resources, University of Wisconsin Press, vol. 51(1), pages 133-162.
    41. 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.
    42. Ge Ge & Geir Godager & Jian Wang, 2022. "Exploring physician agency under demand‐side cost sharing—An experimental approach," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1202-1227, June.
    43. Judith K. Hellerstein, 1998. "The Importance of the Physician in the Generic Versus Trade-Name Prescription Decision," RAND Journal of Economics, The RAND Corporation, vol. 29(1), pages 108-136, Spring.
    44. Jinhu Li & Jeremiah Hurley & Philip DeCicca & Gioia Buckley, 2014. "Physician Response To Pay‐For‐Performance: Evidence From A Natural Experiment," Health Economics, John Wiley & Sons, Ltd., vol. 23(8), pages 962-978, August.
    45. Quinn, Amity E. & Trachtenberg, Aaron J. & McBrien, Kerry A. & Ogundeji, Yewande & Souri, Sepideh & Manns, Liam & Rennert-May, Elissa & Ronksley, Paul & Au, Flora & Arora, Nikita & Hemmelgarn, Brenda , 2020. "Impact of payment model on the behaviour of specialist physicians: A systematic review," Health Policy, Elsevier, vol. 124(4), pages 345-358.
    46. Rizzo, John A. & Zeckhauser, Richard J., 2007. "Pushing incomes to reference points: Why do male doctors earn more?," Journal of Economic Behavior & Organization, Elsevier, vol. 63(3), pages 514-536, July.
    47. McGuire, Thomas G. & Pauly, Mark V., 1991. "Physician response to fee changes with multiple payers," Journal of Health Economics, Elsevier, vol. 10(4), pages 385-410.
    48. Currie, Janet & Lin, Wanchuan & Meng, Juanjuan, 2014. "Addressing antibiotic abuse in China: An experimental audit study," Journal of Development Economics, Elsevier, vol. 110(C), pages 39-51.
    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. Balafoutas, Loukas & Kerschbamer, Rudolf, 2020. "Credence goods in the literature: What the past fifteen years have taught us about fraud, incentives, and the role of institutions," Journal of Behavioral and Experimental Finance, Elsevier, vol. 26(C).
    2. Jeannette Brosig‐Koch & Burkhard Hehenkamp & Johanna Kokot, 2023. "Who benefits from quality competition in health care? A theory and a laboratory experiment on the relevance of patient characteristics," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1785-1817, August.
    3. 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).
    4. Korenok, Oleg & Millner, Edward L. & Razzolini, Laura, 2018. "Taking aversion," Journal of Economic Behavior & Organization, Elsevier, vol. 150(C), pages 397-403.
      • Korenok Oleg & Edward L. Millner & Laura Razzolini, 2017. "Taking Aversion," Working Papers 1702, VCU School of Business, Department of Economics.
    5. Oxholm, Anne Sophie & Di Guida, Sibilla & Gyrd-Hansen, Dorte, 2021. "Allocation of health care under pay for performance: Winners and losers," Social Science & Medicine, Elsevier, vol. 278(C).
    6. Ge Ge & Geir Godager & Jian Wang, 2022. "Exploring physician agency under demand‐side cost sharing—An experimental approach," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1202-1227, June.
    7. 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).
    8. Silvia Angerer & Daniela Glätzle-Rützler & ChristianWaibel, 2020. "Monitoring institutions in health care markets: Experimental evidence," Working Papers 2020-32, Faculty of Economics and Statistics, Universität Innsbruck.
    9. Waibel, Christian & Wiesen, Daniel, 2021. "An experiment on referrals in health care," European Economic Review, Elsevier, vol. 131(C).
    10. Cadena, Brian C. & Smith, Austin C., 2022. "Performance pay, productivity, and strategic opt-out: Evidence from a community health center," Journal of Public Economics, Elsevier, vol. 206(C).
    11. Ben Greiner & Le Zhang & Chengxiang Tang, 2017. "Separation of prescription and treatment in health care markets: A laboratory experiment," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 21-35, December.
    12. Loukas Balafoutas & Helena Fornwagner & Rudolf Kerschbamer & Matthias Sutter & Maryna Tverdostup, 2020. "Diagnostic Uncertainty and Insurance Coverage in Credence Goods Markets," Working Papers 2020-21, Faculty of Economics and Statistics, Universität Innsbruck.
    13. Katharina Momsen & Markus Ohndorf, 2022. "Seller Opportunism in Credence Good Markets – The Role of Market Conditions," Working Papers 2022-10, Faculty of Economics and Statistics, Universität Innsbruck.
    14. Peter Martinsson & Emil Persson, 2019. "Physician behavior and conditional altruism: the effects of payment system and uncertain health benefit," Theory and Decision, Springer, vol. 87(3), pages 365-387, October.
    15. Kandul, Serhiy & Lanz, Bruno & Reins, Evert, 2023. "Reciprocity and gift exchange in markets for credence goods," Games and Economic Behavior, Elsevier, vol. 141(C), pages 52-69.
    16. Anthony Scott & Peter Sivey, 2022. "Motivation and competition in health care," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1695-1712, August.
    17. Thunström, Linda, 2019. "Preferences for fairness over losses," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 83(C).
    18. Finocchiaro Castro Massimo & Lisi Domenico & Romeo Domenica, 2024. "An Experimental Analysis of Patient Dumping Under Different Payment Systems," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 24(1), pages 205-258, January.
    19. Dylan Martin-Lapoirie, 2022. "Teamwork in health care and medical malpractice liability: an experimental investigation," European Journal of Law and Economics, Springer, vol. 54(2), pages 251-282, October.
    20. Silvia Angerer & Daniela Glätzle‐Rützler & Christian Waibel, 2021. "Monitoring institutions in healthcare markets: Experimental evidence," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 951-971, May.

    More about this item

    Keywords

    mystery shopper audit; antibiotic prescription; lost wallet; beneficence; for-profit clinics; physicians;
    All these keywords.

    JEL classification:

    • C93 - Mathematical and Quantitative Methods - - Design of Experiments - - - Field Experiments
    • D64 - Microeconomics - - Welfare Economics - - - Altruism; Philanthropy; Intergenerational Transfers
    • D91 - Microeconomics - - Micro-Based Behavioral Economics - - - Role and Effects of Psychological, Emotional, Social, and Cognitive Factors on Decision Making
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:hhs:oslohe:2023_006. 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: Kristi Brinkmann Lenander (email available below). General contact details of provider: https://edirc.repec.org/data/heuiono.html .

    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.