Public-Private Sector Motivation Heterogeneity
RCTClinical Trial
Policy interventions often treat healthcare personnel as a homogenous group, ignoring how intrinsic pro-social motivations and responsiveness to incentives differ systematically between public sector and private sector workers.
Picture this
Think of the difference between a civic volunteer and a commission-based sales agent. The volunteer is driven by public duty and social reputation among peers, whereas the commercial worker is primarily motivated by direct financial gains and losses.
What the evidence says
Public sector providers exhibited significantly higher baseline reciprocity (returning 144% of transfers on average vs 100% for private providers, p = 0.019) and responded strongly to Peer Disclosure (p < 0.01), whereas private sector providers showed no significant behavioral change under Peer Disclosure (interaction coefficient = -0.632, p = 0.004).
- Who was studied
- N = 103 health providers (77 public facility providers, 26 private facility providers) across dispensaries and health centers in Nairobi, Kenya.
- How
- OLS regression analyzing provider returned-received ratios in a Baseline Trust Game and Reporting Game treatments, interacting treatment variables with a private sector binary indicator while clustering standard errors at the session level.
What to do
Differentiate healthcare workforce management by deploying reputational peer-review systems in public sector institutions while utilizing financial incentive or penalty structures in private sector clinics.
From the source
"public sector health workers are more generous toward patients, and more responsive to the Peer Disclosure mechanism than their private sector counterparts, whose reciprocity is only responsive to the Monetary Penalty system."
e7b318f7-c10f-44ea-935a-6f4ab3cde66a-Health Workers’ Behavior, Patient Reporting and Reputational Concerns- Lab-in-the-Field Experimental Evidence from Kenya.pdf