Distribution of monetary incentives in health insurance scheme influences acupuncture treatment choices: An experimental study

BACKGROUND: Understanding how doctors respond to occupational and monetary incentives in health care payment systems is important for determining the effectiveness of such systems. This study examined changes in doctors’ behaviors in response to monetary incentives within health care payment systems in a ceteris paribus setting. METHODS: An online experiment was developed to analyze the effect of monetary incentives similar to fee-for-service (FFS) and capitation (CAP) on doctors’ prescription patterns. In the first session, no monetary values were presented. In the second session conducted 1 week later, doctors were randomly assigned to one of two monetary incentive groups (FFS group: n = 25, CAP group: n = 25). In all sessions, doctors were presented with 10 cases and asked to determine the type and number of treatments. RESULTS: In the first session with no monetary incentives, there was no significant difference between the FFS and CAP groups in the number of treatments. When monetary incentives were provided, doctors in the CAP group prescribed fewer treatments than the FFS group. The perceived severity of the cases did not change significantly between sessions and between groups. linear mixed-effects regression model indicated the treatment choices were influenced by monetary incentives, but not by the perceived severity of the patient’s symptoms. CONCLUSION: The monetary values incentivized the doctors’ treatment choices, but not their professional evaluation of patients. Monetary values designed within health care systems influence the doctor’s decisions in the form of external rewards, in addition to occupational values, and can thus be adjusted by more effective incentives.