The existence and the role of social preferences in influencing individual decisions have been widely described. Research has also underlined how critical it is to take into account social preferences when designing incentives to influence individual choices. Social preferences are potentially very relevant to the analysis of decisions made by health care workers. Governments in developed and developing countries have tried to create incentives to shape health workers? behaviours in various areas, and in particular to encourage them to take up posts in under-served areas. We designed a within-subject lab experiment to test the impact of various incentives designed to encourage decisions that benefit patients and are costly to health workers. We played the experiment with 1,064 nursing students: 377 from South Africa; 342 from Kenya; and 345 from Thailand. Each participant in our experiment had to make a series of allocation decisions which differed in the distribution of payoffs between themselves and a patient, in five different treatments. The design of treatments was guided by considering their relevance to potential regulations that could be enforced to alter job choices made by nurses, and their relevance to contextual factors that are more likely to affect nurses? choices. The results showed a large variation in the extent to which the four types of incentives could encourage the devotion of nursing students, in their willingness to accept a reduction in their benefits to yield greater welfare for patients. The prospect of delayed rewards was only effective in Thailand, but even there it was much less persuasive than incentives that used information, either to convey indirectly the deservingness of patients, or to encourage generosity through indirect peer-pressure. Interestingly, an arbitrarily unfair environment where some participants were offered less favourable benefits than the others had the cumulative effect of crowding out the altruistic motives of the victims of the unfair decisions, as well as the others. These findings provide interesting elements for policy-makers to design measures to increase the devotion of nurses, and caution them to avoid creating an institutional environment that could be perceived as unfair.
Lagarde, M.; Blaauw, D. Can we encourage the devotion of nurses?An experimental investigation of the effects of various incentives. (2011) 23 pp.