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Healer or Gatekeeper? Physicians' Role Conflict When Symptoms Are Non-Verifiable

Author

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  • Carlsen, Benedicte

    (Uni Research Rokkan Centre)

  • Nyborg, Karine

    (University of Oslo)

Abstract

Although physicians are often expected to be gatekeepers to health insurance benefits such as paid sick leave, research indicates a substantial reluctance to reject patient requests for sickness certificates. We show that private information on the patient's part creates a conflict between the healer and gatekeeper roles: if a patient reports subjective symptoms indicating a need for sick leave, the physician is unable to tell if the patient is truly sick or a shirker. We show that even if most physicians prefer to be good gatekeepers, all of them may trust their patients in Nash equilibrium. These ideas are illustrated using results from focus group interviews with Norwegian primary care physicians.

Suggested Citation

  • Carlsen, Benedicte & Nyborg, Karine, 2017. "Healer or Gatekeeper? Physicians' Role Conflict When Symptoms Are Non-Verifiable," IZA Discussion Papers 10735, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp10735
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    References listed on IDEAS

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    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. Timothy Besley & Maitreesh Ghatak, 2005. "Competition and Incentives with Motivated Agents," American Economic Review, American Economic Association, vol. 95(3), pages 616-636, June.
    3. Ayres, Philip J., 1996. "Rationing health care: Views from general practice," Social Science & Medicine, Elsevier, vol. 42(7), pages 1021-1025, April.
    4. Jean Tirole & Roland Bénabou, 2006. "Incentives and Prosocial Behavior," American Economic Review, American Economic Association, vol. 96(5), pages 1652-1678, December.
    5. Geir Godager & Tor Iversen & Ching-To Ma, 2009. "Service motives and profit incentives among physicians," International Journal of Health Economics and Management, Springer, vol. 9(1), pages 39-57, March.
    6. Brekke, Kjell Arne & Nyborg, Karine, 2010. "Selfish bakers, caring nurses? A model of work motivation," Journal of Economic Behavior & Organization, Elsevier, vol. 75(3), pages 377-394, September.
    7. Bergstrom, Theodore & Blume, Lawrence & Varian, Hal, 1986. "On the private provision of public goods," Journal of Public Economics, Elsevier, vol. 29(1), pages 25-49, February.
    8. Simen Markussen, 2012. "The individual cost of sick leave," Journal of Population Economics, Springer;European Society for Population Economics, vol. 25(4), pages 1287-1306, October.
    9. George A. Akerlof & Rachel E. Kranton, 2005. "Identity and the Economics of Organizations," Journal of Economic Perspectives, American Economic Association, vol. 19(1), pages 9-32, Winter.
    10. Andreoni, James, 1990. "Impure Altruism and Donations to Public Goods: A Theory of Warm-Glow Giving?," Economic Journal, Royal Economic Society, vol. 100(401), pages 464-477, June.
    11. Alger, Ingela & Albert Ma, Ching-to, 2003. "Moral hazard, insurance, and some collusion," Journal of Economic Behavior & Organization, Elsevier, vol. 50(2), pages 225-247, February.
    12. Brekke, Kjell Arne & Nyborg, Karine, 2008. "Attracting responsible employees: Green production as labor market screening," Resource and Energy Economics, Elsevier, vol. 30(4), pages 509-526, December.
    13. Josse Delfgaauw & Robert Dur, 2008. "Incentives and Workers’ Motivation in the Public Sector," Economic Journal, Royal Economic Society, vol. 118(525), pages 171-191, January.
    14. Dur, Robert & Glazer, Amihai, 2008. "The desire for impact," Journal of Economic Psychology, Elsevier, vol. 29(3), pages 285-300, June.
    15. Roland Bénabou & Jean Tirole, 2002. "Self-Confidence and Personal Motivation," The Quarterly Journal of Economics, Oxford University Press, vol. 117(3), pages 871-915.
    16. Nyborg, Karine & Rege, Mari, 2003. "Does Public Policy Crowd Out Private Contributions to Public Goods," Public Choice, Springer, vol. 115(3-4), pages 397-418, June.
    17. Farley, Pamela J., 1986. "Theories of the price and quantity of physician services : A synthesis and critique," Journal of Health Economics, Elsevier, vol. 5(4), pages 315-333, December.
    18. 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.
    19. Roland Bénabou & Jean Tirole, 2003. "Intrinsic and Extrinsic Motivation," Review of Economic Studies, Oxford University Press, vol. 70(3), pages 489-520.
    20. De Jaegher, Kris & Jegers, Marc, 2000. "A model of physician behaviour with demand inducement," Journal of Health Economics, Elsevier, vol. 19(2), pages 231-258, March.
    21. Gneezy, Uri & Rockenbach, Bettina & Serra-Garcia, Marta, 2013. "Measuring lying aversion," Journal of Economic Behavior & Organization, Elsevier, vol. 93(C), pages 293-300.
    22. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, vol. 26(2), pages 281-298, April.
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    Cited by:

    1. René Böheim & Thomas Leoni, 2020. "Absenteeism on bridging days," Applied Economics Letters, Taylor & Francis Journals, vol. 27(20), pages 1667-1671, November.
    2. Thomas Leoni & René Böheim, 2018. "Fehlzeitenreport 2018. Krankheits- und unfallbedingte Fehlzeiten in Österreich Präsentismus und Absentismus," WIFO Studies, WIFO, number 61487, June.

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    More about this item

    Keywords

    sicklisting; subjective diagnoses; asymmetric information; focus group interviews;
    All these keywords.

    JEL classification:

    • D11 - Microeconomics - - Household Behavior - - - Consumer Economics: Theory
    • D21 - Microeconomics - - Production and Organizations - - - Firm Behavior: Theory
    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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