Motivations médicales et politiques d’incitations

One reason cited for the limited effect of financial incentives on physician behaviour is the assumption of substituability of motivations. Extrinsic motivations crowd out intrinsic motivation (IM). We seek to highlight the theorical conditions for this "crowding out effect" (COE). At first time it seems that the COE is consequently to an asymmetry of information between the authority and the physician. The latter is then likely to interpret the incentive as a bad news on his capabilities to succed the task or as a negative signal source of loss of social prestige. In a second step we highlight the difficulties raised by the assumption of IM. It assumes that the effort is not strictly « unuseful » and that the doctor is able of genuine selflessness.