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Theories about professions, public service motivation (PSM) and economic incentives provide different explanations for the behaviour and performance of the producers of public services. PSM theory expects higher performance in the public sector due to the higher levels of public service motivation among public employees, whereas the economic incentive perspective expects performance and behaviour to depend on economic incentives, and the sociology of professions stresses the importance of the employees' occupation. Few have attempted to integrate these three theories, and little is known about the relative strength of the motives. This article aims to analyse the effects of PSM, professional norms and economic incentives on the behaviour and performance of health professionals. Interviews, surveys and register data are used to investigate how professional norms, public service motivation and economic incentives affect the behaviour and performance of Danish dentists, GPs and orthopaedic surgeons. The results indicate that when strong professional norms exist, economic incentives are unimportant. As this is not always the case, however, the perspectives ought to be combined. Points for practitioners The article will be of interest to practitioners working with professionals, not only healthcare professionals, but all kinds of occupations with specialized, theoretical knowledge and occupational norms. Practitioners, especially those who design incentive systems for professionals, will find the article helpful, as it shows how both economic incentives and professional norms should be taken into consideration when such systems are designed. The key finding is that the performance and behaviour of professionals with different incentives is almost similar for services governed by firm norms within the profession, whereas performance and behaviour depend on the economic incentives in the absence of professional norms. This implies that while we may depend on the professional norms to constrain some behaviour, even highly professionalized employees can be moved by selfish motives.

Rational choice institutionalism underexposes institutional change as well as the interaction between institutions at different levels, & this article therefore investigates national & local institutional change. In the Danish dental care sector, private & public provision of services have coexisted since the establishment of a publicly financed dental health care system, & the fight between supporters of the two solutions has generated many institutional changes, both nationally & locally. This article analyzes all Danish parliamentary proposals & local decisions regarding dental care coverage & provision. The general finding is that increasing pro-public bargaining power seems to promote higher coverage & public provision, while increasing pro-private bargaining power leads to stable coverage & private provision. The institutions do not, however, change whenever bargaining power changes, & national institutional change does not necessarily result in local change. The article explains this in terms of political transaction costs. These costs might also explain why national institutions change more often than local ones, & why local pro-public changes are faster & more frequent than local pro-private changes. 1 Table, 1 Appendix, 45 References. Adapted from the source document.

In terms of clinical procedures (to take the example used in this article, hip operations), both public and private organizations provide highly professionalized services. For this service type, our knowledge about ownership differences is sparse. To begin to fill this gap, we investigate how the ownership of hip clinics affects professional behaviour, treatment quality and patient satisfaction. The comparison of private and public hip clinics is based on data from the Danish Hip Arthroplasty Register and the Danish Central Patient Register combined with 20 semi-structured interviews. We find that private clinics employ stronger individual financial incentives and try harder to increase the income/costs ratio than do public clinics. Private clinics optimize non-clinical factors such as waiting time much more than public clinics and have fewer complication-prone patients than public clinics. However, the clinical procedures are very similar in the two types of clinics. Private clinics do not achieve better clinical results, but patient satisfaction is nevertheless higher with private clinics. The implication is that ownership matters for highly professionalized services, but professionalism neutralizes some -- but not all -- ownership differences. Adapted from the source document.

Employees' pro-social motivation has been shown to be positively related to job satisfaction, especially when the perceived usefulness of the job to society and other people is high. There is, however, a lack of analyses which include both public and private employees, and it has not yet been studied whether the relationships are robust across welfare state regimes. This study therefore examines the moderated relationship between pro-social motivation and job satisfaction. Using data from the cross-national 2005 ISSP survey (14 countries, N = 10,630), it confirms that the relationship between pro-social motivation and job satisfaction is moderated by perceived usefulness of the job for society and other people. Usefulness again depends on the individual's employment sector (public versus private), and this public-private difference in perceived usefulness also varies between different welfare state regimes. This indicates that sector differences in how pro-social motivation affects job satisfaction depends on the broader institutional context, and the article therefore contributes with important knowledge for the recruitment and retention of motivated and satisfied employees in a period of changing public-private responsibilities in the provision of welfare services. Adapted from the source document.

Motivated employees are crucial to organizations, but external interventions such as command systems and financial incentives may decrease motivation. If these external interventions are perceived to be controlling, they are expected to crowd out intrinsic motivation. This may also apply to other types of autonomous motivation such as public service motivation. The perception of external interventions is thus expected to be pivotal. This article investigates how the perception of a specific command system (obligatory student plans) is associated with intrinsic motivation and public service motivation. Using a dataset consisting of 3230 schoolteachers in Denmark, a structural equation model shows that the perception of obligatory student plans as controlling is negatively associated with all of the investigated types of employee motivation, supporting the idea that motivation crowding can occur. Adapted from the source document.