Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Crown Prince Frederik Center for Public Leadership, Department of Political Science and Government, Aarhus University, Aarhus, Denmark.
Eur J Health Econ. 2024 Apr;25(3):525-537. doi: 10.1007/s10198-023-01605-7. Epub 2023 Jun 23.
Studies report an unexplained variation in physicians' care. This variation may to some extent be explained by differences in their work motivation. However, empirical evidence on the link between physician motivation and care is scarce. We estimate the associations between different types of work motivation and care. Motivation is measured using validated questions from a nation-wide survey of Danish general practices and linked to high-quality register data on their care in 2019. Using a series of regression models, we find that more financially motivated practices generate more fee-for-services per patient, whereas practices characterised by greater altruistic motivation towards the patient serve a larger share of high-need patients and issue more prescriptions for antibiotics per patient. Practices with higher altruism towards society generate lower medication costs per patient and prescribe a higher rate of narrow-spectrum penicillin, thereby reducing the risk of antimicrobial resistance in the population. Together, our results suggest that practices' motivation is associated with several dimensions of healthcare, and that both their financial motivation and altruism towards patients and society play a role. Policymakers should, therefore, consider targeting all provider motivations when introducing organisational changes and incentive schemes; for example, by paying physicians to adhere to clinical guidelines, while at the same time clearly communicating the guidelines' value from both a patient and societal perspective.
研究报告指出,医生的护理存在无法解释的差异。这种差异在一定程度上可以用他们工作动机的差异来解释。然而,关于医生动机与护理之间联系的经验证据却很少。我们估计了不同类型的工作动机与护理之间的关联。动机是使用丹麦全国范围内的一项普通实践调查中的经过验证的问题来衡量的,并与 2019 年他们的高质量登记数据相关联。使用一系列回归模型,我们发现,财务动机更强的实践为每个患者产生更多的服务费用,而对患者更具利他主义动机的实践则为更多高需求患者提供服务,并为每个患者开出更多的抗生素处方。对社会更具利他主义的实践为每个患者产生更低的药物费用,并开出更高比例的窄谱青霉素,从而降低了人群中抗菌素耐药性的风险。总之,我们的研究结果表明,实践的动机与医疗保健的几个方面有关,并且医生的财务动机以及对患者和社会的利他主义都起着作用。因此,政策制定者在引入组织变革和激励方案时,应该考虑到所有提供者的动机;例如,通过支付医生遵守临床指南的费用,同时从患者和社会的角度清楚地传达指南的价值。