Exploring physician altruism to improve quality of care (360G-Wellcome-213158_Z_18_Z)

Physicians’ concern for patient well-being (altruism) is commonly considered an important driver of quality in healthcare. Despite this theoretical recognition, interventions to improve care quality are often guided by the notion that physicians must receive extrinsic incentives (rewards, sanctions, etc.) to do the right thing. A reason is that empirical evidence on the influence of altruism in real-world clinical settings is scarce, given a number of methodological challenges. We argue for a new research agenda to explore physician altruism in applied research and encourage its recognition in care quality regulatory practice. First, we propose an innovative approach for identifying altruism in real-world settings, which addresses existing methodological challenges: we employ ‘mystery’ standardised patients to test whether patients’ financial well-being, as signalled by their insurance status, plays a role in physicians’ care quality and prescribing behaviour. Second, we study the extent to which altruism mediates care quality responses to private performance feedback (a regulatory intervention that specifically excludes extrinsic incentives, by design). The novelty of our study design and expected outputs will be disseminated to relevant academics and policymakers, to inform future research and policy practice.