Do Institutional Logics Predict Interpretation of Contract Rules at the Dental Chair-side?

Rebecca Harris, Stephen Brown, Robin Holt, Elizabeth Perkins

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

In quasi-markets, contracts find purchasers influencing health care providers, although problems exist where providers use personal bias and heuristics to respond to written agreements, tending towards the moral hazard of opportunism. Previous research on quasi-market contracts typically understands opportunism as fully rational, individual responses selecting maximally efficient outcomes from a set of possibilities. We take a more emotive and collective view of contracting, exploring the influence of institutional logics in relation to the opportunistic behaviour of dentists. Following earlier qualitative work where we identified four institutional logics in English general dental practice, and six dental contract areas where there was scope for opportunism; in 2013 we surveyed 924 dentists to investigate these logics and whether they had predictive purchase over dentists' chair-side behaviour. Factor analysis involving 300 responses identified four logics entwined in (often technical) behaviour: entrepreneurial commercialism, duty to staff and patients, managerialism, public good.
Original languageEnglish
JournalSocial Science & Medicine
Volume122
Pages (from-to)81-89
ISSN0277-9536
DOIs
Publication statusPublished - 2014

Cite this

Harris, Rebecca ; Brown, Stephen ; Holt, Robin ; Perkins, Elizabeth. / Do Institutional Logics Predict Interpretation of Contract Rules at the Dental Chair-side?. In: Social Science & Medicine. 2014 ; Vol. 122. pp. 81-89.
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Do Institutional Logics Predict Interpretation of Contract Rules at the Dental Chair-side? / Harris, Rebecca; Brown, Stephen; Holt, Robin; Perkins, Elizabeth.

In: Social Science & Medicine, Vol. 122, 2014, p. 81-89.

Research output: Contribution to journalJournal articleResearchpeer-review

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T1 - Do Institutional Logics Predict Interpretation of Contract Rules at the Dental Chair-side?

AU - Harris, Rebecca

AU - Brown, Stephen

AU - Holt, Robin

AU - Perkins, Elizabeth

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N2 - In quasi-markets, contracts find purchasers influencing health care providers, although problems exist where providers use personal bias and heuristics to respond to written agreements, tending towards the moral hazard of opportunism. Previous research on quasi-market contracts typically understands opportunism as fully rational, individual responses selecting maximally efficient outcomes from a set of possibilities. We take a more emotive and collective view of contracting, exploring the influence of institutional logics in relation to the opportunistic behaviour of dentists. Following earlier qualitative work where we identified four institutional logics in English general dental practice, and six dental contract areas where there was scope for opportunism; in 2013 we surveyed 924 dentists to investigate these logics and whether they had predictive purchase over dentists' chair-side behaviour. Factor analysis involving 300 responses identified four logics entwined in (often technical) behaviour: entrepreneurial commercialism, duty to staff and patients, managerialism, public good.

AB - In quasi-markets, contracts find purchasers influencing health care providers, although problems exist where providers use personal bias and heuristics to respond to written agreements, tending towards the moral hazard of opportunism. Previous research on quasi-market contracts typically understands opportunism as fully rational, individual responses selecting maximally efficient outcomes from a set of possibilities. We take a more emotive and collective view of contracting, exploring the influence of institutional logics in relation to the opportunistic behaviour of dentists. Following earlier qualitative work where we identified four institutional logics in English general dental practice, and six dental contract areas where there was scope for opportunism; in 2013 we surveyed 924 dentists to investigate these logics and whether they had predictive purchase over dentists' chair-side behaviour. Factor analysis involving 300 responses identified four logics entwined in (often technical) behaviour: entrepreneurial commercialism, duty to staff and patients, managerialism, public good.

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KW - Opportunism

KW - Population health

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