The role of providers’ intrinsic motivation for quality of care and responses to a non-financial incentive

Providers' intrinsic motivation is deemed important for quality of care and responses to incentives. Building on self-determination theory, we test the hypotheses that more intrinsically motivated providers perform better and respond less to an external incentive. We exploit the introduction of a cluster randomised accreditation scheme in Danish general practice, where practices were randomised to accreditation in different years (2016–2018) at municipality level. Combining data from administrative registers and a nationwide survey, we measure practices' quality of care and their general practitioners' intrinsic motivation. Using weighted mixed linear models with municipality random effects, we compare quality of care of accredited practices and practices in transition with non-accredited practices, while taking intrinsic motivation into account. We find a positive relationship between intrinsic motivation and performance on some quality measures. We also find that intrinsic motivation moderates practices' response to accreditation. While the least intrinsically motivated practices respond to accreditation by increasing their performances, the most intrinsically motivated practices do not respond to the incentive. These findings support the self-determination theory suggesting that intrinsically motivated providers are more autonomous and therefore less susceptible to external interventions. Policymakers should therefore consider taking providers’ intrinsic motivation into account when designing incentives.