General Practitioners’ Behavior under Financial Incentives: A Theoretical and Empirical Analysis.

This thesis explores how financial incentives influence the behavior of general practitioners (GPs), a central issue in the design of primary care systems. Through a combination of theoretical framework and empirical analysis, the study investigates how different payment schemes—including feefor-service, capitation, fixed salary, and pay-for-performance—shape GPs’ clinical decision-making. The theoretical component builds on economic modeling to examine how GPs balance financial incentives with patient benefit. The empirical analysis combines a review of existing policy reforms with an original evaluation of the 2014/15 Quality and Outcomes Framework (QOF) reform in the UK, which removed a wide set of financial indicators. Results show that payment models significantly affect GP behavior in terms of service provision, consultation time, and testing intensity. Moreover, GPs adjust their behavior not only in response to institutional incentives but also based on patient characteristics, raising important considerations for equity in care delivery. These findings underscore the complexity of designing optimal payment systems for general practitioners, while also offering insights into how such schemes can be improved to better align incentives with health system objectives.