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Do Extrinsically Motivated Mental Health Care Providers Have Better Treatment Outcomes?

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  • Rudy Douven

    (CPB Netherlands Bureau for Economic Policy Analysis)

  • Minke Remmerswaal

    (CPB Netherlands Bureau for Economic Policy Analysis)

  • Robin Zoutenbier

Abstract

This study compares different responses to financial incentives between self-employed providers in Dutch mental health care. We find that these different responses are related to differences in treatment duration and treatment outcome. In 2008, a new compensation scheme was introduced for self-employed mental health care providers in the Netherlands. The compensation that self-employed psychologists and psychiatrists received for each patient is based on the total treatment duration. The compensation increases step-wise after 800, 1800 and 3000 minutes of treatment with a large amount. It therefore provides strong financial incentives for providers to prolong their treatment till just after the threshold. Using a large administrative dataset, we exploit these different responses by providers to separate more extrinsically from non-extrinsically motivated providers. We find that the majority of the providers are, to some degree, extrinsically motivated and strategically set treatment duration to exploit the thresholds in the compensation scheme. Some providers choose to end all treatments at 800, 1800 or 3000 minutes, most providers choose to occasionally set the treatment duration strategically and some providers do not take the thresholds into account at all. Next, we study total treatment duration and treatment outcomes of all providers. Treatment outcome is measured with the increase of the GAF score of patients (the Global Assessment of Functioning is a subjective assessment by the provider regarding the mental well-being of the patient and the patient's functioning in daily life). We find that non-extrinsically motivated providers, who do not strategically set treatment duration, treat mental health patients shorter, receive less compensation and report better treatment outcomes, as measured by the improvement in GAF score. This suggests that the compensation scheme rewards inefficient or low quality providers.

Suggested Citation

  • Rudy Douven & Minke Remmerswaal & Robin Zoutenbier, 2015. "Do Extrinsically Motivated Mental Health Care Providers Have Better Treatment Outcomes?," CPB Discussion Paper 319, CPB Netherlands Bureau for Economic Policy Analysis.
  • Handle: RePEc:cpb:discus:319
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    References listed on IDEAS

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    1. Kesternich, Iris & Schumacher, Heiner & Winter, Joachim, 2015. "Professional norms and physician behavior: Homo oeconomicus or homo hippocraticus?," Journal of Public Economics, Elsevier, vol. 131(C), pages 1-11.
    2. Rebitzer, James B. & Taylor, Lowell J., 2011. "Extrinsic Rewards and Intrinsic Motives: Standard and Behavioral Approaches to Agency and Labor Markets," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 4, chapter 8, pages 701-772, Elsevier.
    3. Mark McClellan, 2011. "Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality?," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 69-92, Spring.
    4. Ellis, Randall P. & McGuire, Thomas G., 1990. "Optimal payment systems for health services," Journal of Health Economics, Elsevier, vol. 9(4), pages 375-396, December.
    5. Janet Currie & W. Bentley MacLeod & Jessica Van Parys, 2015. "Physician Practice Style and Patient Health Outcomes: The Case of Heart Attacks," NBER Working Papers 21218, National Bureau of Economic Research, Inc.
    6. Machiel Westerdijk & Joost Zuurbier & Martijn Ludwig & Sarah Prins, 2012. "Defining care products to finance health care in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(2), pages 203-221, April.
    7. 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.
    8. Janet Currie & W. Bentley MacLeod, 2017. "Diagnosing Expertise: Human Capital, Decision Making, and Performance among Physicians," Journal of Labor Economics, University of Chicago Press, vol. 35(1), pages 1-43.
    9. Frank, Richard G. & McGuire, Thomas G., 2000. "Economics and mental health," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 16, pages 893-954, Elsevier.
    10. Jason Abaluck & Leila Agha & Christopher Kabrhel & Ali Raja & Arjun Venkatesh, 2014. "Negative Tests and the Efficiency of Medical Care: What Determines Heterogeneity in Imaging Behavior?," NBER Working Papers 19956, National Bureau of Economic Research, Inc.
    11. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
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    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply
    • M52 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Personnel Economics - - - Compensation and Compensation Methods and Their Effects

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