{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:14:28Z","timestamp":1760145268745,"version":"build-2065373602"},"reference-count":42,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T00:00:00Z","timestamp":1719532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010114","name":"Yrj\u00f6 Jahnsson Foundation","doi-asserted-by":"publisher","award":["20217452","00220457"],"award-info":[{"award-number":["20217452","00220457"]}],"id":[{"id":"10.13039\/100010114","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003125","name":"Finnish Cultural Foundation","doi-asserted-by":"publisher","award":["20217452","00220457"],"award-info":[{"award-number":["20217452","00220457"]}],"id":[{"id":"10.13039\/501100003125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Games"],"abstract":"<jats:p>Background: This study aims to examine the impact of different healthcare payment systems, specifically salary and fee-for-service (FFS) models, on service provision, patient welfare, and quality of care. The influence of payment models on healthcare delivery and patient outcomes, as well as how these models affect doctors\u2019 decision-making based on patients\u2019 insurance coverage, is not well understood. Methods: A medically framed real-effort task experiment was conducted. This study compared two payment systems: salary and FFS models. Key outcomes measured included the level of service provision, patient welfare, and quality of care. The analysis focused on how financial incentives and patient insurance coverage influenced healthcare decisions. Results: This study found overtreatment in FFS models and undertreatment in salary-based models. Healthcare decisions are significantly influenced by financial incentives and patient needs. Specifically, in FFS models, decisions are driven by self-interest, while in salary models, they are guided by patient needs. Within the FFS model, insurance coverage affects doctors\u2019 decisions and patients\u2019 benefits. Insured patients often receive unnecessary or incorrect procedures, indicating a supply-side moral hazard. Conclusions: Financial incentives and patient insurance coverage significantly influence healthcare decisions, with FFS models promoting self-interested decision-making and salary models focusing more on patient needs. This study contributes to the literature on supply-side moral hazard to health economics studies that use laboratory experiments to model medical decision-making.<\/jats:p>","DOI":"10.3390\/g15040023","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T03:42:30Z","timestamp":1719546150000},"page":"23","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Payment Systems, Insurance, and Agency Problems in Healthcare: A Medically Framed Real-Effort Experiment"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7206-3228","authenticated-orcid":false,"given":"Manela","family":"Karunadasa","sequence":"first","affiliation":[{"name":"Faculty of Social Sciences, Tampere University, Kanslerinrinne 1, 33014 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7215-7272","authenticated-orcid":false,"given":"Katri K.","family":"Sieberg","sequence":"additional","affiliation":[{"name":"Faculty of Social Sciences, Tampere University, Kanslerinrinne 1, 33014 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1086\/466756","article-title":"Free Competition and the Optimal Amount of Fraud","volume":"16","author":"Darby","year":"1973","journal-title":"J. Law Econ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/0167-6296(86)90002-0","article-title":"Provider Behavior under Prospective Reimbursement: Cost Sharing and Supply","volume":"5","author":"Ellis","year":"1986","journal-title":"J. Health Econ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1093\/restud\/rds049","article-title":"What Drives Taxi Drivers? A Field Experiment on Fraud in a Market for Credence Goods","volume":"80","author":"Balafoutas","year":"2013","journal-title":"Rev. Econ. Stud."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7454","DOI":"10.1073\/pnas.1518015113","article-title":"Insurance Coverage of Customers Induces Dishonesty of Sellers in Markets for Credence Goods","volume":"113","author":"Kerschbamer","year":"2016","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/0168-8510(95)00731-7","article-title":"Abnormal Economics in the Health Sector","volume":"32","author":"Hsiao","year":"1995","journal-title":"Health Policy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102917","DOI":"10.1016\/j.jdeveco.2022.102917","article-title":"Overtreatment and Benevolent Provider Moral Hazard: Evidence from South African Doctors","volume":"158","author":"Lagarde","year":"2022","journal-title":"J. Dev. Econ."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1002\/hec.4152","article-title":"A Moneymaking Scan: Dual Reimbursement Systems and Supplier-Induced Demand for Diagnostic Imaging","volume":"29","author":"Zabrodina","year":"2020","journal-title":"Health Econ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/S0167-6296(00)00033-3","article-title":"Moral Hazard in Physician Prescription Behavior","volume":"19","author":"Lundin","year":"2000","journal-title":"J. Health Econ."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jdeveco.2013.09.001","article-title":"Insurance Coverage and Agency Problems in Doctor Prescriptions: Evidence from a Field Experiment in China","volume":"106","author":"Lu","year":"2014","journal-title":"J. Dev. Econ."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Syafrawati, S., Machmud, R., Aljunid, S.M., and Semiarty, R. (2023). Incidence of Moral Hazards among Health Care Providers in the Implementation of Social Health Insurance toward Universal Health Coverage: Evidence from Rural Province Hospitals in Indonesia. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1147709"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.jhealeco.2011.05.001","article-title":"How Payment Systems Affect Physicians\u2019 Provision Behaviour\u2014An Experimental Investigation","volume":"30","author":"Selten","year":"2011","journal-title":"J. Health Econ."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Karunadasa, M., Sieberg, K.K., and Jantunen, T.T.K. (2023). Payment Systems, Supplier-Induced Demand, and Service Quality in Credence Goods: Results from a Laboratory Experiment. Games, 14.","DOI":"10.3390\/g14030046"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.jebo.2014.05.009","article-title":"Payment Systems in the Healthcare Industry: An Experimental Study of Physician Incentives","volume":"106","author":"Green","year":"2014","journal-title":"J. Econ. Behav. Organ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.socscimed.2017.03.002","article-title":"Physicians\u2019 Responses to Financial and Social Incentives: A Medically Framed Real Effort Experiment","volume":"179","author":"Lagarde","year":"2017","journal-title":"Soc. Sci. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s10683-011-9283-7","article-title":"Dictator Games: A Meta Study","volume":"14","author":"Engel","year":"2011","journal-title":"Exp. Econ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1006\/game.1996.0081","article-title":"Altruism in Anonymous Dictator Games","volume":"16","author":"Eckel","year":"1996","journal-title":"Games Econ. Behav."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101973","DOI":"10.1016\/j.socec.2022.101973","article-title":"Framing and Subject Pool Effects in Healthcare Credence Goods","volume":"103","author":"Angerer","year":"2023","journal-title":"J. Behav. Exp. Econ."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1002\/hec.3292","article-title":"The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence: The Effects of Introducing Mixed Payment Systems for Physicians","volume":"26","author":"Wiesen","year":"2017","journal-title":"Health Econ."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jpubeco.2015.08.009","article-title":"Professional Norms and Physician Behavior: Homo Oeconomicus or Homo Hippocraticus?","volume":"131","author":"Kesternich","year":"2015","journal-title":"J. Public Econ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.socscimed.2014.03.001","article-title":"Other-Regarding Behavior and Motivation in Health Care Provision: An Experiment with Medical and Non-Medical Students","volume":"108","author":"Wiesen","year":"2014","journal-title":"Soc. Sci. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2191-1991-2-1","article-title":"Which Patients Do I Treat? An Experimental Study with Economists and Physicians","volume":"2","author":"Ahlert","year":"2012","journal-title":"Health Econ. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e892","DOI":"10.1002\/hpm.2565","article-title":"What Characteristics of Provider Payment Mechanisms Influence Health Care Providers\u2019 Behaviour? A Literature Review","volume":"33","author":"Kazungu","year":"2018","journal-title":"Int. J. Health Plan. Manag."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.jhealeco.2010.05.007","article-title":"System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia","volume":"29","author":"Wagstaff","year":"2010","journal-title":"J. Health Econ."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S0168-8510(01)00216-0","article-title":"A Typology for Provider Payment Systems in Health Care","volume":"60","author":"Jegers","year":"2002","journal-title":"Health Policy"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ellis, R.P., and Miller, M.M. (2008). Provider Payment Methods and Incentives, Elsevier.","DOI":"10.1016\/B978-012373960-5.00173-8"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Vengberg, S., Fredriksson, M., Burstr\u00f6m, B., Burstr\u00f6m, K., and Winblad, U. (J. Health Organ. Manag., 2021). Money Matters\u2014Primary Care Providers\u2019 Perceptions of Payment Incentives, J. Health Organ. Manag., ahead-of-print.","DOI":"10.1108\/JHOM-06-2020-0225"},{"key":"ref_27","unstructured":"Abelson, R. (New York Times, 2023). Corporate Giants Buy Up Primary Care Practices at Rapid Pace, New York Times."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1056\/NEJMp2212841","article-title":"Corporate Investors in Primary Care\u2014Profits, Progress, and Pitfalls","volume":"388","author":"Shah","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1258\/1355819011927198","article-title":"Impact of Payment Method on Behaviour of Primary Care Physicians: A Systematic Review","volume":"6","author":"Gosden","year":"2001","journal-title":"J. Health Serv. Res. Policy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s13561-020-00299-4","article-title":"Custom-Made Health-Care: An Experimental Investigation","volume":"10","author":"Keser","year":"2020","journal-title":"Health Econ. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1177\/0043820019841436","article-title":"Moral Hazard: It\u2019s the Supply Side, Stupid","volume":"182","author":"Kreier","year":"2019","journal-title":"World Aff. Wash. World Aff."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jebo.2016.06.009","article-title":"Medical Insurance and Free Choice of Physician Shape Patient Overtreatment: A Laboratory Experiment","volume":"131","author":"Huck","year":"2016","journal-title":"J. Econ. Behav. Organ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.jebo.2022.06.004","article-title":"Agent Sorting by Incentive Systems in Mission Firms: Implications for Healthcare and Other Credence Goods Markets","volume":"200","author":"Green","year":"2022","journal-title":"J. Econ. Behav. Organ."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jbef.2015.12.001","article-title":"oTree\u2014An Open-Source Platform for Laboratory, Online, and Field Experiments","volume":"9","author":"Chen","year":"2016","journal-title":"J. Behav. Exp. Financ."},{"key":"ref_35","unstructured":"R Studio Team (2020). RStudio: Integrated Development for R, R Studio Team."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Wickham, H. (2016). Ggplot2: Elegant Graphics for Data Analysis, Springer.","DOI":"10.1007\/978-3-319-24277-4_9"},{"key":"ref_37","unstructured":"Hlavac, M. (2022). Stargazer: Well-Formatted Regression and Summary Statistics Tables, R Studio Team."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Twisk, J.W.R. (2019). Applied Mixed Model Analysis: A Practical Guide, Cambridge University Press. [2nd ed.].","DOI":"10.1017\/9781108635660"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1162\/003355300555448","article-title":"The Proper Scope of Government: Theory and an Application to Prisons","volume":"112","author":"Hart","year":"1997","journal-title":"Q. J. Econ."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Lindqvist, E. (2008). Privatization of Credence Goods: Theory and an Application to Residential Youth Care. SSRN Electron. J.","DOI":"10.2139\/ssrn.1264977"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.0022-4367.2005.00119.x","article-title":"Insurance in a Market for Credence Goods","volume":"72","author":"Wambach","year":"2005","journal-title":"J. Risk Insur."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"100285","DOI":"10.1016\/j.jbef.2020.100285","article-title":"Credence Goods in the Literature: What the Past Fifteen Years Have Taught Us about Fraud, Incentives, and the Role of Institutions","volume":"26","author":"Balafoutas","year":"2020","journal-title":"J. Behav. Exp. Financ."}],"container-title":["Games"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-4336\/15\/4\/23\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:06:45Z","timestamp":1760108805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-4336\/15\/4\/23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,28]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["g15040023"],"URL":"https:\/\/doi.org\/10.3390\/g15040023","relation":{},"ISSN":["2073-4336"],"issn-type":[{"type":"electronic","value":"2073-4336"}],"subject":[],"published":{"date-parts":[[2024,6,28]]}}}