In the study "A new look at physicians' responses to financial incentives: Quality of care, practice characteristics, and motivations", published in the "Journal of Health Economics", WiSo Professor Daniel Wiesen, together with colleagues from various German universities, investigated the effect of quality-based incentives on doctors. The focus was on primary healthcare, i.e. general medical practices in Germany. Three data sets were used: (1) An anonymised behavioural economics experiment with controlled variation of incentives examined the service provision decisions of around one hundred general practitioners in a stylised practice-like setting. (2) The Zi-Praxis-Panel (ZiPP) of the "Zentralinstitut für kassenärztliche Versorgung", a representative repeat survey of more than 6,000 panel doctors in private practice on business management data, provided anonymised data on the annual surplus of the participating practice owners. (3) A specially conducted survey provided further insights into the attitudes and motivations of doctors.
Until now, there has been little scientific evidence that additional remuneration for good medical treatment also leads to better health outcomes for patients - the study contributes to closing this research gap and shows that performance-related, i.e. quality-based, remuneration improves the quality of treatment for every patient compared to flat-rate remuneration. The size of the effect increases with the severity of the illness. There is no positive correlation between higher annual net income of practice owners and better care - the opposite appears to be the case. The study also emphasises the importance of the personal attitudes and motivations of GPs: doctors who want to achieve the best result for their patients provide more patient-oriented services than those who are also driven by their own annual profit.
WiSo Professor Wiesen states: "Regardless of the question of what level of quality-based remuneration is appropriate or fair, the quality of healthcare depends to a large extent on the altruistic motivation of doctors towards their patients. However, this is only one behavioural channel. Further controlled, experimental research is needed to better understand the interplay between incentives, individual characteristics and physician behaviour."
