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.