An experimental analysis of patient dumping under different payment systems

Physicians behave differently depending on the payment systems, giving rise to several problems such as patient dumping, when patients are refused because of economic or liability reasons. While different studies have focused on the impact of remuneration scheme on the quantity of medical services provided, little research has been dedicated to patient dumping. This paper aims to test whether and to which extent the adoption of fee-for-service (FFS) or salary system can induce physicians to practice patient dumping. For, we will use an artefactual field experiment where physicians facing the possibility of being sued for medical malpractice, decide whether or not to provide medical services for patients with different state of health. Also, we check whether the introduction of the risk of being sued for a physician for having practiced dumping can have effect on his behaviour. Results show that dumping is more often observed under Salary than under FFS. However, physicians seem to be insensitive to the introduction of dumping liability under the same incentive mechanism, though it seems to trigger a higher amount of services provided. Policy strategies concerning the incentive scheme may vary on the hospital purposes..