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A Pilot Inquiry on Incentives and Intrinsic Motivation in Health Care: the Motivational Capital Explained by Doctors

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  • Mikel Berdud

    ()
    (Departamento de Economía-UPNA)

  • Juan M. Cabasés Hita

    ()
    (Departamento de Economía-UPNA)

  • Jorge Nieto

    ()
    (Departamento de Economía-UPNA)

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    Abstract

    Where the contracts are incomplete, the resulting co-ordination problems may be attenuated if workers are intrinsically motivated to do the work. It is established by theoretical and empirical literature that workers within public organizations are intrinsically motivated to exert effort doing the job and have a strong sense of social agents with the mission of providing collective goods to citizens and tax payers. This paper is an empirical pilot study in the health care sector using methods of Qualitative Analysis research. We run semistructured interviews á-la- Bewley to sixteen physicians of Navarre’s health Care Servicio Navarro de Salud-Osasunbidea (SNS-O). The objective of the work is twofold: first, to find empirical evidence about doctors’ non-monetary motives and second, to find evidence about how these non-monetary motives shape doctors’behavior. We formulate several testable hypotheses: (1) Doctors are intrinsically motivated agents, (2) Economic incentives and control policies may crowd- out intrinsic motivation and (3) Well designed incentives may crowd-in agents intrinsic motivation. Results confirm the hypotheses formulated above and coming from our theoretical findings [11], [12]. Finally, we also found empirical evidence of conflict between political advisors or health managers (principals) and physicians (agents). Results are a step forward in the optimal design of incentive schemes and policies which crowd in doctors’ intrinsic motivation.

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    File URL: ftp://ftp.econ.unavarra.es/pub/DocumentosTrab/DT1401.PDF
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    Bibliographic Info

    Paper provided by Departamento de Economía - Universidad Pública de Navarra in its series Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra with number 1401.

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    Date of creation: 2014
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    Publication status: Published in
    Handle: RePEc:nav:ecupna:1401

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    Keywords: qualitative research; interviews; intrinsic motivation; crowding effects;

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    References

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    1. Bowles, Samuel & Hwang, Sung-Ha, 2008. "Social preferences and public economics: Mechanism design when social preferences depend on incentives," Journal of Public Economics, Elsevier, vol. 92(8-9), pages 1811-1820, August.
    2. Roland Bénabou & Jean Tirole, 2003. "Intrinsic and Extrinsic Motivation," Review of Economic Studies, Oxford University Press, vol. 70(3), pages 489-520.
    3. Maitreesh Ghatak & Hannes Mueller, 2009. "Thanks for Nothing? Not-for-Profits and Motivated Agents," STICERD - Economic Organisation and Public Policy Discussion Papers Series 014, Suntory and Toyota International Centres for Economics and Related Disciplines, LSE.
    4. Rafael Rob & Peter Zemsky, . "Social Capital, Corporate Culture and Incentive Intensity," Penn CARESS Working Papers 7380c2f90d0b2f362ad71f139, Penn Economics Department.
    5. Dewatripont, Mathias & Jewitt, Ian & Tirole, Jean, 1999. "The Economics of Career Concerns, Part II: Application to Missions and Accountability of Government Agencies," Review of Economic Studies, Wiley Blackwell, vol. 66(1), pages 199-217, January.
    6. Tirole, Jean, 1996. "A Theory of Collective Reputations (with Applications to the Persistence of Corruption and to Firm Quality)," Review of Economic Studies, Wiley Blackwell, vol. 63(1), pages 1-22, January.
    7. Frey, Bruno S & Jegen, Reto, 2001. " Motivation Crowding Theory," Journal of Economic Surveys, Wiley Blackwell, vol. 15(5), pages 589-611, December.
    8. Denis Gromb, 2007. "Cultural Inertia and Uniformity in Organizations," Journal of Law, Economics and Organization, Oxford University Press, vol. 23(3), pages 743-771, October.
    9. Kevin Murdock, 2002. "Intrinsic Motivation and Optimal Incentive Contracts," RAND Journal of Economics, The RAND Corporation, vol. 33(4), pages 650-671, Winter.
    10. Dewatripont, Mathias & Jewitt, Ian & Tirole, Jean, 1999. "The Economics of Career Concerns, Part I: Comparing Information Structures," Review of Economic Studies, Wiley Blackwell, vol. 66(1), pages 183-98, January.
    11. Carrillo, Juan D. & Gromb, Denis, 1999. "On the strength of corporate cultures," European Economic Review, Elsevier, vol. 43(4-6), pages 1021-1037, April.
    12. Samuel Bowles & Sandra Polania-Reyes, 2012. "Economic Incentives and Social Preferences: Substitutes or Complements?," Journal of Economic Literature, American Economic Association, vol. 50(2), pages 368-425, June.
    13. 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.
    14. Roland Bénabou & Jean Tirole, 2002. "Self-Confidence And Personal Motivation," The Quarterly Journal of Economics, MIT Press, vol. 117(3), pages 871-915, August.
    15. Sen, Amartya, 1985. "Goals, Commitment, and Identity," Journal of Law, Economics and Organization, Oxford University Press, vol. 1(2), pages 341-55, Fall.
    16. Avinash Dixit, 2002. "# Incentives and Organizations in the Public Sector: An Interpretative Review," Journal of Human Resources, University of Wisconsin Press, vol. 37(4), pages 696-727.
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