PMID- 33182846
OWN - NLM
STAT- MEDLINE
DCOM- 20210127
LR  - 20210127
IS  - 1660-4601 (Electronic)
IS  - 1661-7827 (Print)
IS  - 1660-4601 (Linking)
VI  - 17
IP  - 22
DP  - 2020 Nov 10
TI  - Performance Pay in Hospitals: An Experiment on Bonus-Malus Incentives.
LID - 10.3390/ijerph17228320 [doi]
LID - 8320
AB  - Recent policy reforms in Germany require the introduction of a performance pay 
      component with bonus-malus incentives in the inpatient care sector. We conduct a 
      controlled online experiment with real hospital physicians from public hospitals 
      and medical students in Germany, in which we investigate the effects of 
      introducing a performance pay component with bonus-malus incentives to a 
      simplified version of the German Diagnosis Related Groups (DRG) system using a 
      sequential design with stylized routine cases. In both parts, participants choose 
      between the patient optimal and profit maximizing treatment option for the same 
      eight stylized routine cases. We find that the introduction of bonus-malus 
      incentives only statistically significantly increases hospital physicians' 
      proportion of patient optimal choices for cases with high monetary baseline DRG 
      incentives to choose the profit maximizing option. Medical students behave 
      qualitatively similar. However, they are statistically significantly less patient 
      oriented than real hospital physicians, and statistically significantly increase 
      their patient optimal decisions with the introduction of bonus-malus incentives 
      in all stylized routine cases. Overall, our results indicate that whether the 
      introduction of a performance pay component with bonus-malus incentives to the 
      (German) DRG system has a positive effect on the quality of care or not 
      particularly depends on the monetary incentives implemented in the DRG system as 
      well as the type of participants and their initial level of patient orientation.
FAU - Kairies-Schwarz, Nadja
AU  - Kairies-Schwarz N
AD  - Faculty of Economics and Business Administration & CINCH-Health Economics 
      Research Center, University of Duisburg-Essen, 45127 Essen, Germany.
FAU - Soucek, Claudia
AU  - Soucek C
AD  - Faculty of Economics and Business Administration & CINCH-Health Economics 
      Research Center, University of Duisburg-Essen, 45127 Essen, Germany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20201110
PL  - Switzerland
TA  - Int J Environ Res Public Health
JT  - International journal of environmental research and public health
JID - 101238455
SB  - IM
MH  - Female
MH  - Germany
MH  - *Hospitals/standards/trends
MH  - Humans
MH  - Male
MH  - *Motivation
MH  - *Physicians/economics/standards
MH  - *Quality of Health Care/economics
MH  - Students, Medical
PMC - PMC7697549
OTO - NOTNLM
OT  - artefactual field experiment
OT  - bonus-malus incentives
OT  - diagnosis related groups
OT  - laboratory experiment
OT  - pay for performance
COIS- The authors declare no conflict of interest. The funders had no role in the 
      design of the study; in the collection, analyses, or interpretation of data; in 
      the writing of the manuscript, or in the decision to publish the result.
EDAT- 2020/11/14 06:00
MHDA- 2021/01/28 06:00
PMCR- 2020/11/01
CRDT- 2020/11/13 01:04
PHST- 2020/09/29 00:00 [received]
PHST- 2020/11/06 00:00 [revised]
PHST- 2020/11/06 00:00 [accepted]
PHST- 2020/11/13 01:04 [entrez]
PHST- 2020/11/14 06:00 [pubmed]
PHST- 2021/01/28 06:00 [medline]
PHST- 2020/11/01 00:00 [pmc-release]
AID - ijerph17228320 [pii]
AID - ijerph-17-08320 [pii]
AID - 10.3390/ijerph17228320 [doi]
PST - epublish
SO  - Int J Environ Res Public Health. 2020 Nov 10;17(22):8320. doi: 
      10.3390/ijerph17228320.