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Physician behavior and conditional altruism: the effects of payment system and uncertain health benefit

Journal article
Authors Peter Martinsson
E. Persson
Published in Theory and Decision
Volume 87
Issue 3
Pages 365–387
ISSN 0040-5833
Publication year 2019
Published at Department of Economics
Pages 365–387
Language en
Keywords Altruism, Experiment, Physician behavior, Principles for priority setting, Uncertainty, Experiments, Patient treatment, Altruistic behavior, Ethical principles, Health outcomes, Medical treatment, Priority setting, Health risks
Subject categories Economics and Business


This paper experimentally investigates the altruistic behavior of physicians and whether this behavior is affected by payment system and uncertainty in health outcome. Subjects in the experiment take on the role of physicians and decide on the provision of medical care for different types of patients, who are identical in all respects other than the degree to which a given level of medical treatment affects their health. We investigate physician altruism from the perspective of ethical principles, by categorizing physicians according to how well their treatment decisions align with different principles for priority setting. The experiment shows that many physicians are altruistic toward their patients but also that the degree of altruism varies across patients with different medical needs. We find a strong effect of payment system that is overall unaffected by the introduction of risk and ambiguity in patients’ health outcomes. There is, however, substantial heterogeneity across individuals, in particular under the capitation payment system where physicians’ responses to the introduction of uncertainty in patient health are modulated by their own generic risk and ambiguity preferences. © 2019, The Author(s).

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