Doctors' Remuneration Schemes and Hospital Competition in a Two-Sided Market

  • 1 University of Los Andes and Toulouse School of Economics
  • 2 Toulouse School of Economics (IDEI, IuF and GREMAQ)
  • 3 Toulouse School of Economics (CNRS, IDEI and GREMAQ)


This paper studies the design of doctors' remuneration schemes. Two for-profit hospitals compete to attract patients and to affiliate doctors. The numbers of patients and doctors determine an hospital's quality level which is valued on both sides. Quality can be enhanced by doctors through a (costly) effort. We first consider pure salary, case payment or fee-for-service schemes on the doctors' side. Then, we study schemes that mix fee-for-service with either salary or case payments. We show that case payment schemes (either pure or in combination with fee-for-service) are more patient friendly than (pure or mixed) salary schemes. This comparison is exactly reversed on the doctors' side. Quite surprisingly, patients always lose when a fee-for-service scheme is introduced (pure or mixed). This is true even though the fee-for-service is the only way to induce the doctors to exert effort, and whatever the patients' valuation of this effort. In other words, the increase in doctors' effort brought about by the fee-for-service is more than compensated by the increase in fees faced by patients.

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The B.E. Journal of Economic Analysis & Policy (BEJEAP) is an international forum for scholarship that employs microeconomics to analyze issues in business, consumer behavior and public policy. Topics include the interaction of firms, the functioning of markets, the effects of domestic and international policy and the design of organizations and institutions.