Reproducibility package for Motivating Improved Healthcare Using Holistic Patient Contracts

The implicit contract in most primary healthcare provision has been the responsiveness of doctors to signals of ill-health by patients. For this to be socially optimal, patients must effectively identify underlying health issues or primary care doctors must effectively screen and identify latent conditions. This paper examines the impacts of doctors and patients writing an explicit contract for more holistic primary care. Without punishments for reneging on contract stipulations, the intervention aimed to shift the relational contract between the two parties away from episodic curative care and towards a holistic plan for patient welfare. In a large-scale randomized evaluation of these contracts tracked through the universe of patient records, the program caused changes in doctor activities towards greater screening, diagnosis and treatment of underlying health issues. For mild-risk patients, we see reductions in overall mortality of 40%. Thus, the paper provides evidence that shifts in the nature of the contracting relationship between patients and their care providers can have substantial welfare effects.