Healthcare Pay Systems Affect Quality of Care

Remuneration in health care is a contested topic, with various pay systems rewarding equal services unequally. This study investigates the motives of 17 panel doctors in Austria and identifies dysfunctionalities in remuneration systems that do not guarantee optimal, outcome-oriented treatment. Using Vroom’s expectancy theory of motivation (1964), we analyse the behavioural motivation of doctors, considering both individual and environmental factors. We identify four types of panel doctors – profit maximisers, prestige seekers, altruists and system-compliant types – and explore how remuneration impacts their choices and outcome expectations. Our findings show that doctors’ motivations, shaped by their goals (e.g., quality assurance or leisure time), affect their performance. Regional context factors further inform the design of an outcome-oriented pay system. The study concludes with practical implications for health service providers and highlights future research directions.