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The Bonus Scheme, Motivation Crowding-out and Quality of the Doctor-Patient Encounters in Chinese Public Hospitals

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Abstract

Methods of paying health providers have been extensively studied in health economics. Bonus as a powerful incentive has been widely used to boost staff morale and improve productivity in hospitals. This may, however, also create unintended consequences. This study analyzes primary data collected from a physician survey in China and demonstrates that the extensive use of quantity-based bonuses has not only led to the provision of unnecessary care but also crowded out physician’s intrinsic motivations, resulting in a decline in the quality of services. More appropriate physician remuneration mechanisms must be introduced in China’s ongoing health reform.

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Acknowledgments

This study was funded by the Early Career Scheme of the Research Grants Council (Ref. ECS859213), the Hong Kong SAR Government and the Dean’s Research Fund (Ref. ECR2) of the Faculty of Liberal Arts and Social Science, the Education University of Hong Kong. The authors are thankful to Lu Zhang, Luke Yuankun Luo, Jieyi Luo, and Mandy Sin-Man Wong for excellent assistance in data collection and entry. Constructive comments from Chung-An Chen and anonymous reviewers are gratefully acknowledged.

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Authors and Affiliations

  1. East Asian Institute, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, Singapore

    Jiwei Qian

  2. Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong

    Alex Jingwei He

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  1. Jiwei Qian
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  2. Alex Jingwei He
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Correspondence to Alex Jingwei He.

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Qian, J., He, A.J. The Bonus Scheme, Motivation Crowding-out and Quality of the Doctor-Patient Encounters in Chinese Public Hospitals. Public Organiz Rev 18, 143–158 (2018). https://doi.org/10.1007/s11115-016-0366-y

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