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Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards

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  • Jonathan T. Kolstad

Abstract

If profit maximization is the objective of a firm, new information about quality should affect firm behavior only through its effects on market demand. I consider an alternate model in which suppliers are motivated by a desire to perform well in addition to profit. The introduction of quality "report cards" for cardiac surgery in Pennsylvania provides an empirical setting to isolate the relative role of extrinsic and intrinsic incentives in determining surgeon response. Information on performance that was new to surgeons and unrelated to patient demand led to an intrinsic response four times larger than surgeon response to profit incentives.

Suggested Citation

  • Jonathan T. Kolstad, 2013. "Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards," NBER Working Papers 18804, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:18804
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    Cited by:

    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. Simona Grassi & Ching-To Albert Ma, 2015. "Information Acquisition, Referral, and Organization," Boston University - Department of Economics - Working Papers Series wp2015-007, Boston University - Department of Economics.
    3. Jeffrey E. Harris & Beatriz G. López-Valcárcel & Patricia Barber & Vicente Ortún, 2014. "Efficiency versus Equity in the Allocation of Medical Specialty Training Positions in Spain: A Health Policy Simulation Based on a Discrete Choice Model," NBER Working Papers 19896, National Bureau of Economic Research, Inc.
    4. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    5. repec:zbw:rwirep:0414 is not listed on IDEAS
    6. Taylor J. Christensen, 2016. "A framework for guiding efforts to reward value instead of volume," International Journal of Health Economics and Management, Springer, vol. 16(2), pages 175-187, June.
    7. Anthony Scott & Peter Sivey, 2017. "Motivation and Competition in Health Care," Melbourne Institute Working Paper Series wp2017n05, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    8. repec:eee:socmed:v:181:y:2017:i:c:p:54-65 is not listed on IDEAS
    9. Lagarde, Mylène & Blaauw, Duane, 2017. "Physicians’ responses to financial and social incentives: A medically framed real effort experiment," Social Science & Medicine, Elsevier, vol. 179(C), pages 147-159.
    10. Kairies-Schwarz, Nadja & Krieger, Miriam, 2014. "How do Non-Monetary Performance Incentives for Physicians Affect the Quality of Medical Care? A Laboratory Experiment," Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100583, Verein für Socialpolitik / German Economic Association.
    11. Kairies, Nadja & Krieger, Miriam, 2013. "How do Non-Monetary Performance Incentives for Physicians Affect the Quality of Medical Care? – A Laboratory Experiment," Ruhr Economic Papers 414, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    12. Kongstad, L.P. & Mellace, G. & Olsen, K.R., 2016. "Can the use of Electronic Health Records in General Practice reduce hospitalizations for diabetes patients? Evidence from a natural experiment," Health, Econometrics and Data Group (HEDG) Working Papers 16/25, HEDG, c/o Department of Economics, University of York.
    13. Alexander, Diane, 2017. "How do Doctors Respond to Incentives? Unintended Consequences of Paying Doctors to Reduce Costs," Working Paper Series WP-2017-9, Federal Reserve Bank of Chicago.
    14. Behrendt, Katja & Groene, Oliver, 2016. "Mechanisms and effects of public reporting of surgeon outcomes: A systematic review of the literature," Health Policy, Elsevier, vol. 120(10), pages 1151-1161.
    15. Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2016. "Effects of Increased Competition on Quality of Primary Care in Sweden," Working Papers 2016:36, Lund University, Department of Economics.
    16. Nadja Kairies & Miriam Krieger, 2013. "How do Non-Monetary Performance Incentives for Physicians Affect the Quality of Medical Care? – A Laboratory Experiment," Ruhr Economic Papers 0414, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    17. Rechel, Bernd & McKee, Martin & Haas, Marion & Marchildon, Gregory P. & Bousquet, Frederic & Blümel, Miriam & Geissler, Alexander & van Ginneken, Ewout & Ashton, Toni & Saunes, Ingrid Sperre & Anell, , 2016. "Public reporting on quality, waiting times and patient experience in 11 high-income countries," Health Policy, Elsevier, vol. 120(4), pages 377-383.
    18. Andrew E. Clark & Carine Milcent, 2018. "Ownership and Hospital Behaviour: Employment and Local Unemployment," PSE Working Papers halshs-01649493, HAL.
    19. Brock, J. Michelle & Lange, Andreas & Leonard, Kenneth L., 2015. "Esteem and social information: On determinants of prosocial behavior of clinicians in Tanzania," Journal of Economic Behavior & Organization, Elsevier, vol. 118(C), pages 85-94.
    20. repec:eee:jhecon:v:55:y:2017:i:c:p:1-13 is not listed on IDEAS
    21. Bingxiao Wu, 2014. "Mismeasurement in Pay-for-Performance: Evidence from an Intervention to Reduce Health Care Spending in China," Departmental Working Papers 201409, Rutgers University, Department of Economics.
    22. Van Gestel, R.; Müller, T.; Bosmans, J.;, 2017. "Learning from failure in healthcare: dynamic panel evidence of a physician shock effect," Health, Econometrics and Data Group (HEDG) Working Papers 17/24, HEDG, c/o Department of Economics, University of York.
    23. Gerdes, Christer, 2015. "Does Performance Information Affect Job Seekers in Selecting Private Providers in Voucher-Based ALMP Programs?," IZA Discussion Papers 8992, Institute for the Study of Labor (IZA).

    More about this item

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L15 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Information and Product Quality

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