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

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Author Info

  • Dumont, Etienne

    () (Université Laval)

  • Fortin, Bernard

    () (Université Laval)

  • Jacquemet, Nicolas

    () (University of Paris 1 Panthéon-Sorbonne)

  • Shearer, Bruce S.

    () (Université Laval)

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 fixed per diem with a discounted (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 differentiated 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 Institute for the Study of Labor (IZA) in its series IZA Discussion Papers with number 3229.

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Length: 33 pages
Date of creation: Dec 2007
Date of revision:
Handle: RePEc:iza:izadps:dp3229

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Related research

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

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References

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Citations

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Cited by:
  1. Samson, Anne-Laure, 2009. "Faut-il remettre en cause le paiement à l’acte des médecins ?," Open Access publications from Université Paris-Dauphine urn:hdl:123456789/4872, Université Paris-Dauphine.
  2. 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.
  3. Kantarevic, Jasmin & Kralj, Boris, 2011. "Quality and Quantity in Primary Care Mixed Payment Models: Evidence from Family Health Organizations in Ontario," IZA Discussion Papers 5762, Institute for the Study of Labor (IZA).
  4. Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00305308, HAL.
  5. Heike Hennig-Schmidt & Reinhard Selten & Daniel Wiesen, 2009. "How Payment Systems Affect Physicians´ Provision Behaviour – An Experimental Investigation," Bonn Econ Discussion Papers bgse29_2009, University of Bonn, Germany.
  6. Damien Échevin & Bernard Fortin, 2011. "Physician Payment Mechanisms, Hospital Length of Stay and Risk of Readmission: a Natural Experiment," CIRANO Working Papers 2011s-44, CIRANO.
  7. Bernard Fortin & Nicolas Jacquemet & Bruce S. Shearer, 2010. "Labour Supply, Work Effort and Contract Choice: Theory and Evidence on Physicians," CIRANO Working Papers 2010s-40, CIRANO.
  8. 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.
  9. repec:eee:socmed:v:82:y:2013:i:c:p:10-20 is not listed on IDEAS
  10. 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.
  11. G. Fiorentini & M. Lippi Bruni & C. Ugolini, 2012. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Working Papers wp829, Dipartimento Scienze Economiche, Universita' di Bologna.
  12. 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.

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