title: Do institutional logics predict interpretation of contract rules at the dental chair-side?
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.
authors.affiliation: Institute Psychology, Health and Society, University of Liverpool, UK. Electronic address: harrisrv@liverpool.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Harris
authors.affiliation: Institute Psychology, Health and Society, University of Liverpool, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Brown
authors.affiliation: School of Management, University of Liverpool, UK; Business School, University of Copenhagen, Denmark.
authors.forename: Robin
authors.initials: R
authors.lastname: Holt
authors.affiliation: Institute Psychology, Health and Society, University of Liverpool, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Perkins
mesh_terms: D000328:Adult; D032982:Contracts / Q000191:economics* / Q000941:ethics; D004739:England; D005163:Factor Analysis, Statistical; D005260:Female; D005792:General Practice, Dental / Q000191:economics* / Q000941:ethics / Q000458:organization & administration; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008128:Logic; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D036301:Qualitative Research
keywords: Contracts; Dental; England; Institutional theory; Managerialism; Opportunism; Population health; Professionalism