IDEAS home Printed from https://ideas.repec.org/a/eee/jhecon/v27y2008i2p444-459.html
   My bibliography  Save this article

Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect

Author

Listed:
  • Leonard, Kenneth L.

Abstract

We introduce a new instrument to evaluate the impact of behavior on outcomes when the behavior may be a function of unobserved variables that also affect outcomes. The instrument is introduced through a test of patient sensitivity to increases in the quality of care provided by doctors. We utilize the Hawthorne effect, in which the very presence of a research team causes doctors to provide measurably superior quality care for any type of patient to show that patients respond to this increased quality and are more likely to be very satisfied. Using the Hawthorne effect as an instrument allows us to examine the responsiveness of satisfaction to improvements in quality despite the fact that patient satisfaction is subjective and jointly produced with quality during the course of a consultation.

Suggested Citation

  • Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.
    • Handle: RePEc:eee:jhecon:v:27:y:2008:i:2:p:444-459
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0167-6296(07)00095-1
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    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. Leonard, Kenneth L. & Masatu, Melkiory C., 2005. "The use of direct clinician observation and vignettes for health services quality evaluation in developing countries," Social Science & Medicine, Elsevier, vol. 61(9), pages 1944-1951, November.
    3. Glenn W. Harrison & John A. List, 2004. "Field Experiments," Journal of Economic Literature, American Economic Association, vol. 42(4), pages 1009-1055, December.
    4. Richard B. Smith, 2005. "An Alternative Perspective On Information Asymmetry; Implications For Consumer Authority In Physician Services Markets," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 14(3), pages 665-699, September.
    5. Glied, Sherry A. & Remler, Dahlia K., 2002. "What Every Public Finance Economist Needs to Know About Health Economics: Recent Advances and Unresolved Questions," National Tax Journal, National Tax Association;National Tax Journal, vol. 55(4), pages 771-788, December.
    6. Jung, H. P. & Van Horne, F. & Wensing, M. & Hearnshaw, H. & Grol, R., 1998. "Which aspects of general practitioners' behaviour determine patients' evaluations of care?," Social Science & Medicine, Elsevier, vol. 47(8), pages 1077-1087, October.
    7. John DiNardo & Justin L. Tobias, 2001. "Nonparametric Density and Regression Estimation," Journal of Economic Perspectives, American Economic Association, vol. 15(4), pages 11-28, Fall.
    8. Glewwe, Paul & Kremer, Michael, 2006. "Schools, Teachers, and Education Outcomes in Developing Countries," Handbook of the Economics of Education, in: Erik Hanushek & F. Welch (ed.), Handbook of the Economics of Education, edition 1, volume 2, chapter 16, pages 945-1017, Elsevier.
    9. Leonard, Kenneth L, 2007. "Learning in Health Care: Evidence of Learning about Clinician Quality in Tanzania," Economic Development and Cultural Change, University of Chicago Press, vol. 55(3), pages 531-555, April.
    10. de Ruyter, Ko & Wetzels, Martin, 1998. "On the complex nature of patient evaluations of general practice service," Journal of Economic Psychology, Elsevier, vol. 19(5), pages 565-590, October.
    11. Gaynor, Martin, 1994. "Issues in the Industrial Organization of the Market for Physician Services," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 211-255, Spring.
    12. Das, Jishnu & Sohnesen, Thomas Pave, 2006. "Patient satisfaction, doctor effort, and interview location : evidence from Paraguay," Policy Research Working Paper Series 4086, The World Bank.
    13. 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.
    14. Douglas Staiger & James H. Stock, 1997. "Instrumental Variables Regression with Weak Instruments," Econometrica, Econometric Society, vol. 65(3), pages 557-586, May.
    15. Leonard, Kenneth & Masatu, Melkiory C., 2006. "Outpatient process quality evaluation and the Hawthorne Effect," Social Science & Medicine, Elsevier, vol. 63(9), pages 2330-2340, November.
    16. Martin Chalkley & Colin Tilley, 2005. "The Existence and Nature of Physician Agency: Evidence of Stinting from the British National Health Service," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 14(3), pages 647-664, September.
    17. Chalkley, Martin & Khalil, Fahad, 2005. "Third party purchasing of health services: Patient choice and agency," Journal of Health Economics, Elsevier, vol. 24(6), pages 1132-1153, November.
    18. Kenneth L. Leonard & Gilbert R. Mliga & Damen Haile Mariam, 2002. "Bypassing Health Centres in Tanzania: Revealed Preferences for Quality," Journal of African Economies, Centre for the Study of African Economies, vol. 11(4), pages 441-471, December.
    19. Steven D. Levitt & John A. List, 2007. "What Do Laboratory Experiments Measuring Social Preferences Reveal About the Real World?," Journal of Economic Perspectives, American Economic Association, vol. 21(2), pages 153-174, Spring.
    20. Mooney, Gavin & Ryan, Mandy, 1993. "Agency in health care: Getting beyond first principles," Journal of Health Economics, Elsevier, vol. 12(2), pages 125-135, July.
    21. Ma, Ching-to Albert & McGuire, Thomas G, 1997. "Optimal Health Insurance and Provider Payment," American Economic Review, American Economic Association, vol. 87(4), pages 685-704, September.
    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. Simons, Andrew M. & Beltramo, Theresa & Blalock, Garrick & Levine, David I., 2017. "Using unobtrusive sensors to measure and minimize Hawthorne effects: Evidence from cookstoves," Journal of Environmental Economics and Management, Elsevier, vol. 86(C), pages 68-80.
    2. Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    3. David K. Evans & Anna Welander Tärneberg, 2018. "Health‐care quality and information failure: Evidence from Nigeria," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 90-93, March.
    4. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    5. Fuhai Hong & Tanjim Hossain & John A. List & Migiwa Tanaka, 2018. "Testing The Theory Of Multitasking: Evidence From A Natural Field Experiment In Chinese Factories," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 59(2), pages 511-536, May.
    6. Pérotin, Virginie & Zamora, Bernarda & Reeves, Rachel & Bartlett, Will & Allen, Pauline, 2013. "Does hospital ownership affect patient experience? An investigation into public–private sector differences in England," Journal of Health Economics, Elsevier, vol. 32(3), pages 633-646.
    7. Costa-Font, Joan & Ferrer-i-Carbonell, Ada, 2017. "Can Regional Decentralisation Shift Health Care Preferences?," IZA Discussion Papers 11180, Institute of Labor Economics (IZA).
    8. Joshua B. Gilbert & Zachary Himmelsbach & James Soland & Mridul Joshi & Benjamin W. Domingue, 2024. "Estimating Heterogeneous Treatment Effects with Item-Level Outcome Data: Insights from Item Response Theory," Papers 2405.00161, arXiv.org, revised Aug 2024.
    9. Ferreira, D.C. & Marques, R.C. & Nunes, A.M. & Figueira, J.R., 2018. "Patients’ satisfaction: The medical appointments valence in Portuguese public hospitals," Omega, Elsevier, vol. 80(C), pages 58-76.
    10. World Bank & Oxford Policy Management, 2015. "Health Worker Survey in Timor-Leste," World Bank Publications - Reports 23879, The World Bank Group.
    11. Gauthier, Bernard & Wane, Waly, 2011. "Bypassing health providers: The quest for better price and quality of health care in Chad," Social Science & Medicine, Elsevier, vol. 73(4), pages 540-549, August.
    12. Costa-Font, Joan & Ferrer-i-Carbonell, Ada, 2022. "Does devolution influence the choice and quality of public (vs private) health care?," Journal of Economic Behavior & Organization, Elsevier, vol. 202(C), pages 632-653.
    13. Ferreira, Diogo Cunha & Marques, Rui Cunha & Nunes, Alexandre Morais & Figueira, José Rui, 2021. "Customers satisfaction in pediatric inpatient services: A multiple criteria satisfaction analysis," Socio-Economic Planning Sciences, Elsevier, vol. 78(C).
    14. Tracey, Marlon R. & Polachek, Solomon W., 2018. "If looks could heal: Child health and paternal investment," Journal of Health Economics, Elsevier, vol. 57(C), pages 179-190.
    15. Dunsch, Felipe A. & Evans, David K. & Eze-Ajoku, Ezinne & Macis, Mario, 2017. "Management, Supervision, and Health Care: A Field Experiment," IZA Discussion Papers 10967, Institute of Labor Economics (IZA).
    16. Anna Popova & David K Evans & Mary E Breeding & Violeta Arancibia, 2022. "Teacher Professional Development around the World: The Gap between Evidence and Practice [Training to Teach Science: Experimental Evidence from Argentina]," The World Bank Research Observer, World Bank, vol. 37(1), pages 107-136.
    17. Joanna N. Lahey & Douglas R. Oxley, 2021. "Discrimination at the Intersection of Age, Race, and Gender: Evidence from an Eye‐Tracking Experiment," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(4), pages 1083-1119, September.
    18. Hansen, Fredrik & Anell, Anders & Gerdtham, Ulf-G & Lyttkens, Carl Hampus, 2013. "The Future of Health Economics: The Potential of Behavioral and Experimental Economics," Working Papers 2013:20, Lund University, Department of Economics.
    19. Glick, Peter, 2009. "How reliable are surveys of client satisfaction with healthcare services? Evidence from matched facility and household data in Madagascar," Social Science & Medicine, Elsevier, vol. 68(2), pages 368-379, January.
    20. Joan Costa-Font & Ada Ferrer-i-Carbonell, 2019. "Regional Decentralisation and the Demand for Public Health Care," Studies on the Spanish Economy eee2019-41, FEDEA.
    21. Duchoslav, Jan & Cecchi, Francesco, 2019. "Do incentives matter when working for god? The impact of performance-based financing on faith-based healthcare in Uganda," World Development, Elsevier, vol. 113(C), pages 309-319.
    22. Eduardo Fe & Timothy Powell‐Jackson & Winnie Yip, 2017. "Doctor Competence and the Demand for Healthcare: Evidence from Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1177-1190, October.
    23. Shimaa Elkomy & Zahra Murad & Veronica Veleanu, 2018. "Does Leadership Matter for Healthcare Service Quality? Evidence from NHS England," Working Papers in Economics & Finance 2018-08, University of Portsmouth, Portsmouth Business School, Economics and Finance Subject Group.

    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. Eduardo Fe & Timothy Powell‐Jackson & Winnie Yip, 2017. "Doctor Competence and the Demand for Healthcare: Evidence from Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1177-1190, October.
    2. Leonard, Kenneth L., 2009. "The cost of imperfect agency in health care: Evidence from rural Cameroun," Journal of Development Economics, Elsevier, vol. 88(2), pages 282-291, March.
    3. Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Moving from the lab to the field: Exploring scrutiny and duration effects in lab experiments," Economics Letters, Elsevier, vol. 100(2), pages 284-287, August.
    4. Chen, Alice & Lakdawalla, Darius N., 2019. "Healing the poor: The influence of patient socioeconomic status on physician supply responses," Journal of Health Economics, Elsevier, vol. 64(C), pages 43-54.
    5. Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    6. Barigozzi, Francesca & Levaggi, Rosella, 2008. "Emotions in physician agency," Health Policy, Elsevier, vol. 88(1), pages 1-14, October.
    7. Kevin E. Pflum, 2015. "Physician Incentives and Treatment Choice," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 24(4), pages 712-751, October.
    8. Jack, William, 2005. "Purchasing health care services from providers with unknown altruism," Journal of Health Economics, Elsevier, vol. 24(1), pages 73-93, January.
    9. Ma, Ching-to Albert & Mak, Henry Y., 2015. "Information disclosure and the equivalence of prospective payment and cost reimbursement," Journal of Economic Behavior & Organization, Elsevier, vol. 117(C), pages 439-452.
    10. Toshiaki Iizuka, 2007. "Experts' agency problems: evidence from the prescription drug market in Japan," RAND Journal of Economics, RAND Corporation, vol. 38(3), pages 844-862, September.
    11. Glick, Peter, 2009. "How reliable are surveys of client satisfaction with healthcare services? Evidence from matched facility and household data in Madagascar," Social Science & Medicine, Elsevier, vol. 68(2), pages 368-379, January.
    12. Lise Rochaix, 1997. "Asymétries d'information et incertitude en santé : les apports de la théorie des contrats," Économie et Prévision, Programme National Persée, vol. 129(3), pages 11-24.
    13. Heather Klemick & Kenneth L. Leonard & Melkiory C. Masatu, 2007. "Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 91(2), pages 347-358.
    14. Izabela Jelovac, 2001. "Physicians' payment contracts, treatment decisions and diagnosis accuracy," Health Economics, John Wiley & Sons, Ltd., vol. 10(1), pages 9-25, January.
    15. Nuscheler, Robert & Roeder, Kerstin, 2015. "Financing and funding health care: Optimal policy and political implementability," Journal of Health Economics, Elsevier, vol. 42(C), pages 197-208.
    16. John A. List, 2007. "On the Interpretation of Giving in Dictator Games," Journal of Political Economy, University of Chicago Press, vol. 115(3), pages 482-493.
    17. Steffen Huck & Wieland Müller, 2012. "Allais for all: Revisiting the paradox in a large representative sample," Journal of Risk and Uncertainty, Springer, vol. 44(3), pages 261-293, June.
    18. Leonard, David K. & Bloom, Gerald & Hanson, Kara & O’Farrell, Juan & Spicer, Neil, 2013. "Institutional Solutions to the Asymmetric Information Problem in Health and Development Services for the Poor," World Development, Elsevier, vol. 48(C), pages 71-87.
    19. Peter Zweifel & H. E. Frech, 2016. "Why ‘Optimal’ Payment for Healthcare Providers Can Never be Optimal Under Community Rating," Applied Health Economics and Health Policy, Springer, vol. 14(1), pages 9-20, February.
    20. Omar Al-Ubaydli & John A. List, 2019. "How natural field experiments have enhanced our understanding of unemployment," Nature Human Behaviour, Nature, vol. 3(1), pages 33-39, January.

    More about this item

    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:eee:jhecon:v:27:y:2008:i:2:p:444-459. 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: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505560 .

    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.