What Can Providers' Motivations Tell Us About Healthcare Quality?

Agency theory suggests that variation in providers' quality of care may be explained by their heterogeneous motivations. We provide novel empirical evidence on the links between different sources of provider motivation and quality of care by combining a unique 4-year survey dataset on Danish general practitioners' motivations with quality indicators and control variables from rich register data. Using a within-between regression specification, we estimate the associations between two key sources of motivation (financial motivation and non-paternalistic altruism toward patients) and seven quality indicators related to accreditation standards in general practice. We find that providers' financial motivation is associated with high-quality care that relates to remunerated services. We further find that non-paternalistic altruism toward patients associates with lower-quality prescribing for drugs that may be highly demanded by patients and fewer annual control visits for chronic disease. These links are mostly found when we compare heterogeneously motivated practices (between estimates) rather than when we look at changes within the same practices over time (within estimates). The findings can help policymakers address agency problems that may arise from patient demands and design policies that motivate delivery of high-quality care.