Sweetening the carrot : motivating public physicians for better performance
It is widely observed that many physicians working in public health facilities do not put in the required effort and time in their jobs. At the same time, many public physicians remain highly motivated, working long hours for little financial reward, in providing quality health services. This mix of provider-types poses fundamental challenges in the design of compensation mechanisms and monitoring regime in public facilities, where the objective of any reward-control paradigm is to improve the inoptimal performance of some physicians without compromising the effort of those already motivated. This paper presents a model to explain shirking behavior among public physicians and explores combinations of monitoring and incentive mechanisms that meet the twin objectives of inspiring the shirkers without losing the motivated. Drawing on the basic Shapiro-Stiglitz shirking model and the theory of social custom, the paper develops and presents a design of incentive structures that consists of punitive monitoring systems accompanied by non-pecuniary rewards. The analysis shows that intensive monitoring persuades the shirking physicians to improve their performance but may have a negative effect on the morale of those already motivated. The findings indicate that non-pecuniary rewards and recognition for the latter can potentially restore the incentives and counter the deleterious effect of increased supervision. The policy implications are discussed by presenting case studies in the health care context of developing countries.
|Date of creation:||01 Nov 2005|
|Date of revision:|
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- Chang, Juin-jen & Lai, Ching-chong, 1999. "Carrots or sticks? A social custom viewpoint on worker effort," European Journal of Political Economy, Elsevier, vol. 15(2), pages 297-310, June.
- Congleton, Roger D., 1991. "The economic role of a work ethic," Journal of Economic Behavior & Organization, Elsevier, vol. 15(3), pages 365-385, May.
- Bruno S. Frey & Reto Jegen, 2000. "Motivation Crowding Theory: A Survey of Empirical Evidence," CESifo Working Paper Series 245, CESifo Group Munich.
- Besley, Timothy J. & Ghatak, Maitreesh, 2004.
"Competition and Incentives with Motivated Agents,"
CEPR Discussion Papers
4641, C.E.P.R. Discussion Papers.
- Timothy Besley & Maitreesh Ghatak, 2003. "Competition and incentives with motivated agents," LSE Research Online Documents on Economics 2202, London School of Economics and Political Science, LSE Library.
- Tim Besley & Maitreesh Ghatak, 2005. "Competition and incentives with motivated agents," LSE Research Online Documents on Economics 928, London School of Economics and Political Science, LSE Library.
- Jonathan S. Leonard, 1987.
"Carrots and Sticks: Pay, Supervision and Turnover,"
NBER Working Papers
2176, National Bureau of Economic Research, Inc.
- Leonard, Jonathan S, 1987. "Carrots and Sticks: Pay, Supervision, and Turnover," Journal of Labor Economics, University of Chicago Press, vol. 5(4), pages S136-52, October.
- 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.
- Daniel S. Nagin & James B. Rebitzer & Seth Sanders & Lowell J. Taylor, 2002.
"Monitoring, Motivation, and Management: The Determinants of Opportunistic Behavior in a Field Experiment,"
American Economic Review,
American Economic Association, vol. 92(4), pages 850-873, September.
- Daniel Nagin & James Rebitzer & Seth Sanders & Lowell Taylor, 2002. "Monitoring, Motivation and Management: The Determinants of Opportunistic Behavior in a Field Experiment," NBER Working Papers 8811, National Bureau of Economic Research, Inc.
- Bruce E. Kaufman, 1989. "Models of Man in Industrial Relations Research," ILR Review, Cornell University, ILR School, vol. 43(1), pages 72-88, October.
- Roland Bénabou & Jean Tirole, 2003. "Intrinsic and Extrinsic Motivation," Review of Economic Studies, Oxford University Press, vol. 70(3), pages 489-520.
- Gordon, David M, 1990. "Who Bosses Whom? The Intensity of Supervision and the Discipline of Labor," American Economic Review, American Economic Association, vol. 80(2), pages 28-32, May.
- George A. Akerlof, 1982. "Labor Contracts as Partial Gift Exchange," The Quarterly Journal of Economics, Oxford University Press, vol. 97(4), pages 543-569.
- Franco, Lynne Miller & Bennett, Sara & Kanfer, Ruth, 2002. "Health sector reform and public sector health worker motivation: a conceptual framework," Social Science & Medicine, Elsevier, vol. 54(8), pages 1255-1266, April.
- Frey, Bruno S., 1993. "Shirking or work morale? : The impact of regulating," European Economic Review, Elsevier, vol. 37(8), pages 1523-1532, December.
- Susan Rose-Ackerman, 1996. "Altruism, Nonprofits, and Economic Theory," Journal of Economic Literature, American Economic Association, vol. 34(2), pages 701-728, June.
- Akerlof, George A, 1984. "Gift Exchange and Efficiency-Wage Theory: Four Views," American Economic Review, American Economic Association, vol. 74(2), pages 79-83, May.
- Francois, Patrick, 2000. "'Public service motivation' as an argument for government provision," Journal of Public Economics, Elsevier, vol. 78(3), pages 275-299, November.
- Bewley, Truman F, 1995. "A Depressed Labor Market as Explained by Participants," American Economic Review, American Economic Association, vol. 85(2), pages 250-54, May.
- Akerlof, George A & Yellen, Janet L, 1987. "Rational Models of Irrational Behavior," American Economic Review, American Economic Association, vol. 77(2), pages 137-42, May.
- Mukesh Chawla & Peter Berman & Dorota Kawiorska, 1998. "Financing health services in Poland: new evidence on private expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 7(4), pages 337-346.
- George A. Akerlof, 1980. "A Theory of Social Custom, of which Unemployment may be One Consequence," The Quarterly Journal of Economics, Oxford University Press, vol. 94(4), pages 749-775.
- Rebitzer, James B., 1995. "Is there a trade-off between supervision and wages? An empirical test of efficiency wage theory," Journal of Economic Behavior & Organization, Elsevier, vol. 28(1), pages 107-129, September.
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