Three essays on hospital doctor incentives

This thesis comprises three essays on the effect of financial and non-financial incentives on the clinical behaviour and labour supply decisions of hospital doctors working in the English National Health Service (NHS). Chapter 1 examines how the hospital environment in which surgeons practice affects their treatment decisions between cemented and cementless hip replacements. Using quasi-random changes in hospital environment brought about by surgeons’ job moves, the analysis shows robust evidence of large effects of the clinical environment on surgeons’ treatment choices. Chapter 2 analyses whether the clinical activity of hospital doctors is affected by the receipt of performance-related financial awards known as the Clinical Excellence Awards. Using panel data information on NHS doctors’ characteristics and award status, it finds limited empirical evidence of a negative effect on clinical activity measures. Chapter 3 studies the responsiveness of doctors’ labour supply to changes in take-home pay from NHS work. It exploits the 2016 UK pension reform which reduced take-home pay disproportionately for high earners. The analysis shows that hospital doctors affected by the reform responded by reducing their clinical activity.