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The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment


  • Roland Cheo

    (Center for Economic Research, Shandong University)

  • Ge Ge

    (Department of Health Management and Health Economics, University of Oslo)

  • Geir Godager

    (Department of Health Management and Health Economics, University of Oslo
    Health Services Research Unit, Akershus University Hospital)

  • Rugang Liu

    (School of Health Policy & Management, Nanjing Medical University
    Center for Global Health, Nanjing Medical University)

  • Jian Wang

    (Dong Fureng Institute of Economic and Social Development, Wuhan University
    Center for Health Economics and Management in School of Economics and Management, Wuhan University)

  • Qiqi Wang

    (School of Economics, Xi’an University of Finance and Economics)


Background Health care systems in many countries are characterized by limited availability of provider performance data that can be used to design and implement welfare improving reforms in the health sector. We question whether a simple mystery shopper scheme can be an effective measure to improve primary care quality in such settings. Methods Using a randomized treatment-control design, we conducted a field experiment in primary care clinics in a Chinese city. We investigate whether informing physicians of a forthcoming mystery shopper audit influences their prescribing behavior. The intervention effects are estimated using conditional fixed-effects logistic regression. The estimated coefficients are interpreted as marginal utilities in a choice model. Results Our findings suggest that the mystery shopper intervention reduced the probability of prescribing overall. Moreover, the intervention had heterogeneous effects on different types of drugs. Conclusions This study provides new evidence suggesting that announced performance auditing of primary care providers could directly affect physician behavior even when it is not combined with pay-for-performance, or measures such as reminders, feedback or educational interventions.

Suggested Citation

  • Roland Cheo & Ge Ge & Geir Godager & Rugang Liu & Jian Wang & Qiqi Wang, 2020. "The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment," Health Economics Review, Springer, vol. 10(1), pages 1-19, December.
  • Handle: RePEc:spr:hecrev:v:10:y:2020:i:1:d:10.1186_s13561-020-00290-z
    DOI: 10.1186/s13561-020-00290-z

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    Blog mentions

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    1. Chris Sampson’s journal round-up for 26th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-26 12:00:03


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