Generosity norms and intrinsic motivation in health care provision: evidence from the laboratory and the field

We examine the correlation between the generosity of clinicians – as measured in a laboratory experiment – and the quality of care in their normal practices under three different intrinsic incentive schemes. Specifically, we observe clinicians in their normal work environment, when a peer observes them and six weeks after an encouragement visit from a peer. Clinicians who give at least half of their endowment to a stranger in the laboratory (generous) provide 10 per cent better quality care than those who do not. In addition, the average clinician provides about 4 per cent better quality when observed by a peer and 10 per cent higher quality care after the encouragement visit. Importantly, we find that generous clinicians react to peer scrutiny and encouragement in the same way as non-generous clinicians. Many clinicians are intrinsically motivated to provide higher quality care. However, most clinicians respond to increased intrinsic incentives in the form of scrutiny and encouragement from peers.