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Modelling Nonlinearities and Reference Dependence in General Practitioners' Income Preferences.

Jon Helgheim Holte1, Peter Sivey2, Birgit Abelsen1

  • 1Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.

Health Economics
|June 23, 2015
PubMed
Summary

Norwegian general practitioners exhibit reference dependence in income preferences, valuing losses approximately three times more than equivalent gains. This finding impacts the design of physician incentive schemes.

Keywords:
contingent valuationdiscrete choice experimentsgeneral practitionersincome preferencesnonlinearityreference dependence

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Area of Science:

  • Behavioral Economics
  • Health Economics
  • Decision Science

Background:

  • Understanding physician income preferences is crucial for designing effective healthcare incentive systems.
  • The theory of reference-dependent utility suggests individuals evaluate outcomes relative to a reference point, with losses having a greater impact than gains.
  • Previous research has explored physician preferences, but specific nonlinearity and reference dependence in income remain less understood.

Purpose of the Study:

  • To investigate nonlinearity and reference dependence in income preferences among general practitioners.
  • To quantify the extent to which losses loom larger than gains for physicians.
  • To inform the design of financial incentive schemes in healthcare.

Main Methods:

  • A discrete choice experiment was employed to model physician income preferences.
  • Contingent valuation methods were used to validate findings by assessing marginal willingness to pay and accept compensation.
  • The study focused on Norwegian general practitioners.

Main Results:

  • Evidence of nonlinearity and reference dependence in income preferences was confirmed for general practitioners.
  • Losses from the current income level were valued approximately three times higher than equivalent gains.
  • Results were consistent with contingent valuation data.

Conclusions:

  • Physicians exhibit loss aversion regarding income, a key factor influencing their response to financial incentives.
  • The findings suggest that standard incentive schemes focused solely on increasing income may be less effective due to this reference dependence.
  • Understanding these preferences is vital for optimizing 'pay for performance' and other incentive structures in healthcare.