Fünf Aufsätze über Anreizverträge

This thesis comprises five studies analyzing incentive contracts in complex production situations in which performance and payment play a seminal role. The first chapter analyzes which distribution norms are relevant in complex team production situations using a laboratory experiment. Chapter two and three investigate the effects of various monetary performance incentives physicians, whose performance is difficult to measure in the field, on their provision behavior using a laboratory experiment. The fourth chapter analyzes the impact of non-monetary performance incentives for physicians on the quality of care by also utilizing a laboratory experiment. The last chapter represents a theoretical model incorporating both financial and non-financial performance incentives for physicians, and explores whether the latter can reduce costs and increase quality in the health care market.Diese Doktorarbeit umfasst fünf Studien, die Anreizverträge in komplexen Produktionssituationen analysieren, in denen Performanz und Entlohnung eine wichtige Rolle spielen. Das erste Kapitel analysiert anhand eines Laborexperiments welche Aufteilungsnormen in komplexen Team-Produktionssituationen relevant sind. Kapitel zwei und drei untersuchen die Effekte von unterschiedlichen monetären Performanz-Anreizen für Ärzte, deren Performanz im Feld schwierig zu messen ist, auf ihr Leistungserbringungsverhalten in einem Laborexperiment. Das vierte Kapitel analysiert den Einfluss von nicht-monetären Performanz-Anreizen für Ärzte auf die Behandlungsqualität ebenfalls anhand eines Laborexperiments. Das letzte Kapitel stellt ein theoretisches Modell dar, das finanzielle und nicht-finanzielle Performanz-Anreize für Ärzte beinhaltet und untersucht, ob letztere im Gesundheitswesen Kosten senken und Qualität verbessern können

THE EFFECTS OF INTRODUCING MIXED PAYMENT SYSTEMS FOR PHYSICIANS: EXPERIMENTAL EVIDENCE

Mixed payment systems have become a prominent alternative to paying physicians through fee-for-service and capitation. While theory shows mixed payment systems to be superior, causal effects on physicians' behavior when introducing mixed systems are not well understood empirically. We systematically analyze the influence of fee-for-service, capitation, and mixed payment systems on physicians' service provision. In a controlled laboratory setting, we implement an exogenous variation of the payment method. Medical and non-medical students in the role of physicians in the lab (N = 213) choose quantities of medical services affecting patients' health outside the lab. Behavioral data reveal significant overprovision of medical services under fee-for-service and significant underprovision under capitation, although less than predicted when assuming profit maximization. Introducing mixed payment systems significantly reduces deviations from patient-optimal treatment. Although medical students tend to be more patient regarding, our results hold for both medical and non-medical students. Responses to incentive systems can be explained by a behavioral model capturing individual altruism. In particular, we find support that altruism plays a role in service provision and can partially mitigate agency problems, but altruism is heterogeneous in the population. Copyright (C) 2015 John Wiley & Sons, Ltd

Using artefactual field and lab experiments to investigate how fee-for-service and capitation affect medical service provision

We analyze how physicians, medical students, and non-medical students respond to financial incentives from fee-for-service and capitation. We employ a series of artefactual field and conventional lab experiments framed in a physician decision-making context. Physicians, participating in the field, and medical and non-medical students, participating in lab experiments, respond to the incentives in a consistent way: Significantly more medical services are provided under fee-for-service compared to capitation. The intensity by which subjects respond to incentives, however, differs by subject pool. Our findings are robust regarding subjects' gender, age, and personality traits. (C) 2015 Elsevier B.V. All rights reserved