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Intrinsic and extrinsic motivations in primary care: an explanatory study among French general practitioners
Jonathan Sicsic1, Marc Le Vaillant, Carine Franc
1CERMES3, UMR8211, Inserm U988, Site CNRS, 7, rue Guy Moquet, 94801 Villejuif Cedex, France.
Background:
Like many other OECD nations, France has implemented a pay-for-performance (P4P) model in primary care. However, the benefits have been debated, particularly regarding the possibly undesirable effects of extrinsic motivation (EM) on intrinsic motivation (IM).
Objective:
To examine the relationship between French GPs' IM and EM based on an intrinsic motivation composite score (IMCS) developed for this purpose. If a negative relationship is found, P4P schemes could have side effects on GPs' IM that is a key determinant of quality of care.
Method:
From data on 423 GPs practicing in a region of France, IM indicators are selected using a multiple correspondence analysis and aggregated from a multilevel model.
Results:
Several doctors' characteristics have significant impacts on IMCS variability, especially group practice and salaried practice. Qualitative EM variables are negatively correlated with the IMCS: GPs who report not being satisfied with their income or feeling "often" constrained by patients' requests in terms of consultations length and office appointments obtain a lower mean IMCS than other GPs.
Conclusion:
Our results provide a cautionary message to regulators who should take into account the potential side effects of increasing EM through policies such as P4P.
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