Public service motivation, user orientation, and prescription behaviour: Doing good for society or for the individual user?

Motivation to benefit individual recipients of public services (user orientation) can conflict with classic public service motivation linked to the interest of a collective entity. When actions intended to increase the well-being of an individual user can harm societal interests, the two types of motivation have different behavioural implications, but we know far too little about these potential trade-offs. This study analyses the relationships between public service motivation, user orientation, and antibiotic prescriptions for 407 general medical practitioners in Denmark. Use of antibiotics has a positive effect on the individual patient and (especially broad-spectrum antibiotics) a negative effect on society due to resistant bacteria. Combining survey and administrative data, we find that public service motivation and user orientation indeed are differently associated with prescription behaviour. This implies that it can be important for behaviour whether a public service provider is primarily inclined to help the individual user or society.