Essays on healthcare providers' incentives and motivations.

Summary We study the incentive properties of physician contracts in different contexts and using different methods. In Chapter 1, we propose a "principal-agent" model in which there is adverse selection on the altruism of agents, limited liability and a technology provided by the regulator that can improve the quality of physicians' effort. In such a context (characterizing the health sector with access to personalized medicine for instance), we show that optimal contracts imply higher wages for altruistic agents and better quality effort-enhancing technology for selfish agents. In Chapter 2, we propose an experiment in which physicians can access personalized medicine techniques for free or at a given cost. We evaluate for different payment systems, the likelihood that physicians will make the decision to pay for access to personalized medicine, and we also focus on how they use these technologies, depending on whether they are free or costly to access. We find that physicians tend to make better use of personalized medicine techniques when they acquired it at a cost. In Chapter 3, we investigate the incentive properties of pay-for-performance systems. Using the same experiment from Chapter 2, we find that pay-for-performance systems enhance physicians' focus on what is relevant to the patient, but are associated with an erosion of their intrinsic motivation.