What determines the behaviour and performance of health professionals? Public service motivation, professional norms and/or economic incentives

Theories about professions, public service motivation (PSM) and economic incentives provide different explanations for the behaviour and performance of the producers of public services. PSM theory expects higher performance in the public sector due to the higher levels of public service motivation among public employees, whereas the economic incentive perspective expects performance and behaviour to depend on economic incentives, and the sociology of professions stresses the importance of the employees' occupation. Few have attempted to integrate these three theories, and little is known about the relative strength of the motives. This article aims to analyse the effects of PSM, professional norms and economic incentives on the behaviour and performance of health professionals. Interviews, surveys and register data are used to investigate how professional norms, public service motivation and economic incentives affect the behaviour and performance of Danish dentists, GPs and orthopaedic surgeons. The results indicate that when strong professional norms exist, economic incentives are unimportant. As this is not always the case, however, the perspectives ought to be combined. Points for practitioners The article will be of interest to practitioners working with professionals, not only healthcare professionals, but all kinds of occupations with specialized, theoretical knowledge and occupational norms. Practitioners, especially those who design incentive systems for professionals, will find the article helpful, as it shows how both economic incentives and professional norms should be taken into consideration when such systems are designed. The key finding is that the performance and behaviour of professionals with different incentives is almost similar for services governed by firm norms within the profession, whereas performance and behaviour depend on the economic incentives in the absence of professional norms. This implies that while we may depend on the professional norms to constrain some behaviour, even highly professionalized employees can be moved by selfish motives.