Contract incentives and behaviours of medical consultants in Ireland.

In publicly funded healthcare systems that also allow private hospital treatment, there is often a concern that consultants might prioritize private patients. Here we examine how a 2014 reform in Ireland, which allowed public hospitals to accommodate private patients in public wards, affected consultant behaviours and patient outcomes. Using nationwide inpatient discharge data from 2009 to 2015 (2.3 million observations) and applying Little's Law with a difference-in-differences method, we find no evidence that the share of private patients increased. We attribute this pattern to contracts requiring consultants to treat an additional three or four public patients for each treated private patient. The reform incentivized consultants to treat more public patients by shortening the lengths of stay for both public and private patients. However, such efficiency gains may come at the expense of care quality for public patients.