An Experimental Analysis of Patient Dumping Under Different Payment Systems

Abstract

Physicians behave differently depending on the payment systems, giving rise to several problems such as patient dumping in which patients are refused because of economic or liability reasons. This paper tests whether and to which extent the adoption of either fee-for-service or Salary system induces physicians to practice patient dumping. Through the combination of an artefactual field experiment and a laboratory experiment, we test whether the risk of being sued for having practiced dumping can affect physicians’ behavior. Dumping is more often observed under Salary than under FFS. The introduction of dumping liability only mildly reduced dumping practice, though the provision of services increased. Our findings call for healthcare policy makers looking at the interplay between remuneration schemes and liability risks, and accounting for the trade-off between the reduction of the risk of being sued for patient dumping and the increase of the costs of the provision of medical services.