Abstract
Standard theories of health provider behavior suggest that providers are motivated by both profit and an altruistic interest in patient health benefit. Detailed empirical data are seldom available to measure relative preferences between profit and patient health outcomes. Furthermore, it is difficult to empirically assess how these relative preferences affect quality of care. This study uses a unique dataset from rural Myanmar to assess heterogeneous preferences toward treatment efficacy relative to provider profit and the impact of these preferences on the quality of provider diagnosis and treatment. Using conjoint survey data from 187 providers, we estimated the marginal utilities of higher treatment efficacy and of higher profit, and the marginal rate of substitution between these outcomes. We also measured the quality of diagnosis and treatment for malaria among these providers using a previously validated observed patient simulation. There is substantial heterogeneity in providers’ utility from treatment efficacy versus utility from higher profits. Higher marginal utility from treatment efficacy is positively associated with the quality of treatment among providers, and higher marginal utility from profit are negatively associated with quality of diagnosis. We found no consistent effect of the ratio of marginal utility of efficacy vs marginal utility of profit on quality of care. Our findings suggest that providers vary in their preferences towards profit and treatment efficacy, with those providers that place greater weight on treatment efficacy providing higher quality of care.
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Acknowledgements
The authors would like to acknowledge Dr. Nyo Me Aye and her team for administering conjoint test and data entry.
Funding
Funding for this study was provided by the Bill and Melinda Gates Foundation and Future Health Systems, a research policy consortium supported by the Department for International Development of the UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Appendix
Appendix
See Fig. 4 and Tables 6, 7 and 8.
Standardized estimates of marginal rate of substitution between patient out-of-pocket expenditure and profit. The provider-specific marginal rate of substitution (MRS) was estimated as the ratio of provider-specific preference weights on patient out-of-pocket expenditure (OOP) to provider-specific preference weights on drug profit, and was standardized as a Z-score. This reflects the willingness of a provider to trade off a 1-unit increase in profit for an increase in OOP spending (50% vs. 0%). This histogram shows wide variation in the MRS, suggesting that there is heterogeneity in provider preferences. The OOP attribute was intended to reflect patient financial burden, but some providers believed this to be as a measure of the certainty with which they would receive payment. Given the unclear interpretation of this attribute, we control for it in the primary analysis but do not use preferences towards OOP to reflect provider altruism
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Kacker, S., Aung, T., Montagu, D. et al. Providers preferences towards greater patient health benefit is associated with higher quality of care. Int J Health Econ Manag. 21, 271–294 (2021). https://doi.org/10.1007/s10754-021-09298-2
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DOI: https://doi.org/10.1007/s10754-021-09298-2