There is the assumption for Pay-for- performance method if health care workers get paid to do something, could they do it more often to get an extra charge? This assumption is so obvious it is not so often questioned, there is fact, it is not always true. Experimental evidence from both social psychology and econometrics showed that usually when an activity driven by internal motivations, such as professionalism or pride in the quality of work one achieves adding an external motivator can actually backfire very often dramatically. The still most famous example of this was investigated in the Titumuss landmark book. The Gift Relationship. He compared England's voluntary, unpaid blood donation system with …show more content…
There are several related theories about how extrinsic rewards can undermine intrinsic motivation. Individuals might experience financial rewards as an external shift in the locus of control for their actions, causing a sense of impaired selfdetermination. When rewards are perceived as controlling, people “take less responsibility for motivating themselves.” Self-esteem is also weakened when it is no longer one’s own idea to perform at a high standard. Deprived of the opportunity to demonstrate personal interest and motivation, individuals might reduce their work effort. Financial rewards can even make individuals feel their competence is being questioned or that their intrinsic motivation is unappreciated or is being rejected. Finally, Deci and Ryan have postulated that “relatedness” is an innate psychological need, suggesting that incentives that functionally separate out individuals from the groups within which they work can be destructive of intrinsic motivation, self-regulation and well-being. This last theory may hold special importance in professions that rely on the existence of a collegial, mutually supporting and self-regulatory community for their existence. Physicians are just the sort of people, and medical work is exactly the type of work, where external performance-contingent rewards are most likely to backfire. Practicing medicine is intrinsically interesting, difficult and creative, and it demands a strong commitment to professional excellence to do it well. Yet, as Kohn notes,“In general, the more cognitive sophistication and open-ended thinking that is required for a task, the worse people tend to do when they have been led to perform