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Getting clinicians to do their best: Ability, Altruism and Incentives

The quality of health care services is an important factor in health outcomes. To what degree is the quality of care provided by a clinician in consultation limited by ability (capacity) as opposed to motivation? By measuring the ability and actual practice of a sample of clinicians in Tanzania and examining the terms of employment for these clinicians, we show that both ability and motivation are important to quality. Even after controlling for their ability, clinicians who work for organizations that use high–powered incentives are much more likely to properly diagnose and treat patients. We also show evidence that some clinicians behave in a manner that is consistent with altruism; they provide high quality independent of incentives. Changes in the incentives faced by clinicians have an important impact on quality. Significant effort has been devoted to improving the abilities of medical practitioners in developing countries; new attention should be focused on motivation.