IDEAS home Printed from https://ideas.repec.org/p/iza/izadps/dp10735.html
   My bibliography  Save this paper

Healer or Gatekeeper? Physicians' Role Conflict When Symptoms Are Non-Verifiable

Author

Listed:
  • Carlsen, Benedicte

    (Uni Research Rokkan Centre)

  • Nyborg, Karine

    (University of Oslo)

Abstract

Although physicians are often expected to be gatekeepers to health insurance benefits such as paid sick leave, research indicates a substantial reluctance to reject patient requests for sickness certificates. We show that private information on the patient's part creates a conflict between the healer and gatekeeper roles: if a patient reports subjective symptoms indicating a need for sick leave, the physician is unable to tell if the patient is truly sick or a shirker. We show that even if most physicians prefer to be good gatekeepers, all of them may trust their patients in Nash equilibrium. These ideas are illustrated using results from focus group interviews with Norwegian primary care physicians.

Suggested Citation

  • Carlsen, Benedicte & Nyborg, Karine, 2017. "Healer or Gatekeeper? Physicians' Role Conflict When Symptoms Are Non-Verifiable," IZA Discussion Papers 10735, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp10735
    as

    Download full text from publisher

    File URL: https://docs.iza.org/dp10735.pdf
    Download Restriction: no
    ---><---

    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. Jean Tirole & Roland Bénabou, 2006. "Incentives and Prosocial Behavior," American Economic Review, American Economic Association, vol. 96(5), pages 1652-1678, December.
    3. Geir Godager & Tor Iversen & Ching-To Ma, 2009. "Service motives and profit incentives among physicians," International Journal of Health Economics and Management, Springer, vol. 9(1), pages 39-57, March.
    4. Simen Markussen, 2012. "The individual cost of sick leave," Journal of Population Economics, Springer;European Society for Population Economics, vol. 25(4), pages 1287-1306, October.
    5. George A. Akerlof & Rachel E. Kranton, 2005. "Identity and the Economics of Organizations," Journal of Economic Perspectives, American Economic Association, vol. 19(1), pages 9-32, Winter.
    6. Alger, Ingela & Albert Ma, Ching-to, 2003. "Moral hazard, insurance, and some collusion," Journal of Economic Behavior & Organization, Elsevier, vol. 50(2), pages 225-247, February.
    7. Timothy Besley & Maitreesh Ghatak, 2005. "Competition and Incentives with Motivated Agents," American Economic Review, American Economic Association, vol. 95(3), pages 616-636, June.
    8. Brekke, Kjell Arne & Nyborg, Karine, 2008. "Attracting responsible employees: Green production as labor market screening," Resource and Energy Economics, Elsevier, vol. 30(4), pages 509-526, December.
    9. Josse Delfgaauw & Robert Dur, 2008. "Incentives and Workers’ Motivation in the Public Sector," Economic Journal, Royal Economic Society, vol. 118(525), pages 171-191, January.
    10. Dur, Robert & Glazer, Amihai, 2008. "The desire for impact," Journal of Economic Psychology, Elsevier, vol. 29(3), pages 285-300, June.
    11. Roland Bénabou & Jean Tirole, 2005. "Self-Confidence and Personal Motivation," International Economic Association Series, in: Bina Agarwal & Alessandro Vercelli (ed.), Psychology, Rationality and Economic Behaviour, chapter 2, pages 19-57, Palgrave Macmillan.
    12. Nyborg, Karine & Rege, Mari, 2003. "Does Public Policy Crowd Out Private Contributions to Public Goods," Public Choice, Springer, vol. 115(3-4), pages 397-418, June.
    13. Farley, Pamela J., 1986. "Theories of the price and quantity of physician services : A synthesis and critique," Journal of Health Economics, Elsevier, vol. 5(4), pages 315-333, December.
    14. Roland Bénabou & Jean Tirole, 2003. "Intrinsic and Extrinsic Motivation," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 70(3), pages 489-520.
    15. De Jaegher, Kris & Jegers, Marc, 2000. "A model of physician behaviour with demand inducement," Journal of Health Economics, Elsevier, vol. 19(2), pages 231-258, March.
    16. Ayres, Philip J., 1996. "Rationing health care: Views from general practice," Social Science & Medicine, Elsevier, vol. 42(7), pages 1021-1025, April.
    17. Brekke, Kjell Arne & Nyborg, Karine, 2010. "Selfish bakers, caring nurses? A model of work motivation," Journal of Economic Behavior & Organization, Elsevier, vol. 75(3), pages 377-394, September.
    18. Bergstrom, Theodore & Blume, Lawrence & Varian, Hal, 1986. "On the private provision of public goods," Journal of Public Economics, Elsevier, vol. 29(1), pages 25-49, February.
    19. Andreoni, James, 1990. "Impure Altruism and Donations to Public Goods: A Theory of Warm-Glow Giving?," Economic Journal, Royal Economic Society, vol. 100(401), pages 464-477, June.
    20. Rochaix, Lise, 1989. "Information asymmetry and search in the market for physicians' services," Journal of Health Economics, Elsevier, vol. 8(1), pages 53-84, March.
    21. Gneezy, Uri & Rockenbach, Bettina & Serra-Garcia, Marta, 2013. "Measuring lying aversion," Journal of Economic Behavior & Organization, Elsevier, vol. 93(C), pages 293-300.
    22. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, vol. 26(2), pages 281-298, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. René Böheim & Thomas Leoni, 2020. "Absenteeism on bridging days," Applied Economics Letters, Taylor & Francis Journals, vol. 27(20), pages 1667-1671, November.
    2. Thomas Leoni & René Böheim, 2018. "Fehlzeitenreport 2018. Krankheits- und unfallbedingte Fehlzeiten in Österreich – Präsentismus und Absentismus," WIFO Studies, WIFO, number 61487, April.

    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. Benedicte Carlsen & Jo Thori Lind & Karine Nyborg, 2020. "Why physicians are lousy gatekeepers: Sicklisting decisions when patients have private information on symptoms," Health Economics, John Wiley & Sons, Ltd., vol. 29(7), pages 778-789, July.
    2. Brekke, Kjell Arne & Nyborg, Karine, 2010. "Selfish bakers, caring nurses? A model of work motivation," Journal of Economic Behavior & Organization, Elsevier, vol. 75(3), pages 377-394, September.
    3. Nyborg, Karine, 2011. "I don't want to hear about it: Rational ignorance among duty-oriented consumers," Journal of Economic Behavior & Organization, Elsevier, vol. 79(3), pages 263-274, August.
    4. Rebitzer, James B. & Taylor, Lowell J., 2011. "Extrinsic Rewards and Intrinsic Motives: Standard and Behavioral Approaches to Agency and Labor Markets," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 4, chapter 8, pages 701-772, Elsevier.
    5. Stijn VAN PUYVELDE & Marc JEGERS, 2016. "Heterogeneity and self-selection into nonprofit management," CIRIEC Working Papers 1603, CIRIEC - Université de Liège.
    6. Markus Kitzmueller, 2008. "Economics and Corporate Social Responsibility," Economics Working Papers ECO2008/37, European University Institute.
    7. 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.
    8. Ester Manna, 2017. "Customer‐oriented employees: Blessing or curse for firms?," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 26(4), pages 842-875, December.
    9. Robert Dur & Ola Kvaløy & Anja Schöttner, 2022. "Leadership Styles and Labor Market Conditions," Management Science, INFORMS, vol. 68(4), pages 3150-3168, April.
    10. Hiller, Victor & Raffin, Natacha, 2020. "Firms’ social responsibility and workers’ motivation at the industry equilibrium," Journal of Economic Behavior & Organization, Elsevier, vol. 174(C), pages 131-149.
    11. Dur, Robert & Non, Arjan & Roelfsema, Hein, 2010. "Reciprocity and incentive pay in the workplace," Journal of Economic Psychology, Elsevier, vol. 31(4), pages 676-686, August.
    12. Lea Cassar, 2014. "Optimal contracting with endogenous project mission," ECON - Working Papers 150, Department of Economics - University of Zurich, revised Oct 2014.
    13. Banuri’s, Sheheryar & de Oliveira, Angela C.M. & Eckel, Catherine C., 2019. "Care provision: An experimental investigation," Journal of Economic Behavior & Organization, Elsevier, vol. 157(C), pages 615-630.
    14. Jacobsen, Karin J. & Eika, Kari H. & Helland, Leif & Lind, Jo Thori & Nyborg, Karine, 2011. "Are nurses more altruistic than real estate brokers?," Journal of Economic Psychology, Elsevier, vol. 32(5), pages 818-831.
    15. Carlsen, Benedicte & Nyborg, Karine, 2009. "The Gate is Open: Primary Care Physicians as Social Security Gatekeepers," Memorandum 07/2009, Oslo University, Department of Economics.
    16. Elliott Ash & W. Bentley MacLeod, 2015. "Intrinsic Motivation in Public Service: Theory and Evidence from State Supreme Courts," Journal of Law and Economics, University of Chicago Press, vol. 58(4).
    17. Cassar, Lea & Armouti-Hansen, Jesper & Dereky, Anna & Engl, Florian, 2021. "Efficiency Wages with Motivated Agents," CEPR Discussion Papers 15723, C.E.P.R. Discussion Papers.
    18. Sanjit Dhami, 2017. "Human Ethics and Virtues: Rethinking the Homo-Economicus Model," CESifo Working Paper Series 6836, CESifo.
    19. Jesper Armouti-Hansen & Lea Cassar & Anna Deréky & Florian Engl, 2020. "Efficiency Wages with Motivated Agents," CESifo Working Paper Series 8474, CESifo.
    20. Ester Manna, 2013. "Intinsically Motivated Agents: Blessing or Curse for Firms ?," Working Papers ECARES ECARES 2013-37, ULB -- Universite Libre de Bruxelles.

    More about this item

    Keywords

    sicklisting; subjective diagnoses; asymmetric information; focus group interviews;
    All these keywords.

    JEL classification:

    • D11 - Microeconomics - - Household Behavior - - - Consumer Economics: Theory
    • D21 - Microeconomics - - Production and Organizations - - - Firm Behavior: Theory
    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • 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:iza:izadps:dp10735. 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: Holger Hinte (email available below). General contact details of provider: https://edirc.repec.org/data/izaaade.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.