Sample records for network physician incentives

  1. Emergency Department Coverage by Primary Care Physicians in a Rural Practice-Based Research Network: Incentives, Confidence, and Training (United States)

    Lew, Edward; Fagnan, Lyle J.; Mattek, Nora; Mahler, Jo; Lowe, Robert A.


    Context: In rural areas of the United States, emergency departments (EDs) are often staffed by primary care physicians, as contrasted to urban and suburban hospitals where ED coverage is usually provided by physicians who are residency-trained in emergency medicine. Purpose: This study examines the reasons and incentives for rural Oregon primary…

  2. Network versus Economic Incentives

    DEFF Research Database (Denmark)

    Larsen, Christian Albrekt

    might be an important part of the vicious circles of unemployment. Finally, the article analyse the importance of network versus the importance of economic incentives. The result supports the thesis that economic sociology provides a better account of the transition from unemployment to employment than...

  3. Network unites payers, physicians, hospitals. System participants work together to improve access to care and to design cost-saving incentives. (United States)

    Cassidy, J


    Through Sacred Heart Health System (SHHS), Eugene, OR, physicians, payers, and hospitals are designing a network that will integrate care and improve access by reducing healthcare costs. Together, system members design cost-saving incentives and the products the system offers the community. They promote managed care as the most efficient means to coordinate care and reduce costs. All participants share in the risks of a capitated payment system. Since the system pulled together the payers, physician groups, and hospitals, many of these entities' management functions were consolidated at the system level to avoid duplication and reduce administrative costs. Bringing in physicians was the most difficult yet important aspect of forming a successful network. Working with two physician groups in the community, the system's sponsor-the Sisters of St. Joseph of Peace, Health and Hospital Services-developed the Physician Practice Board. The board, representing 300 physicians, meets weekly and makes recommendations on issues that affect physicians. SHHS also added innovative new functions such as an integrated medical cost management and continuous quality improvement program. Another key to success is a clinically oriented information system, which will allow the system to track patients once they leave the hospital. It also will provide a better understanding of what things have an impact on outcomes and will reduce paperwork. A portion of the system's revenue is designated for initiatives to improve access. And the system recently appointed a tack force on access to explore what they can do in cooperation with others in the community.

  4. Incumbent's Incentive under Network Externalities


    Kim, Jaehong


    This paper shows that an incumbent monopolist's incentive confronting a new entrant depends on the degree of product differentiation and the strength of network externality. If products are homogeneous, the incumbent never wants to invite entry regardless of the degree of network externality. On the other hand, if products are differentiated, duopoly profit is higher than the monopoly profit when products are more differentiated and/or the network externality is weak. Conversely, the incumben...

  5. The effect of explicit financial incentives on physician behavior. (United States)

    Armour, B S; Pitts, M M; Maclean, R; Cangialose, C; Kishel, M; Imai, H; Etchason, J


    Managed care organizations use explicit financial incentives to influence physicians' use of resources. This has contributed to concerns regarding conflicts of interest for physicians and adverse effects on the quality of patient care. In light of recent publicized legislative and legal battles about this issue, we reviewed the literature and analyzed studies that examine the effect of these explicit financial incentives on the behavior of physicians. The method used to undertake the literature review followed the approach set forth in the Cochrane Collaboration handbook. Our literature review revealed a paucity of data on the effect of explicit financial incentives. Based on this limited evidence, explicit incentives that place individual physicians at financial risk appear to be effective in reducing physician resource use. However, the empirical evidence regarding the effectiveness of bonus payments on physician resource use is mixed. Similarly, our review revealed mixed effects of the influence of explicit financial incentives on the quality of patient care. The effect of explicit financial incentives on physician behavior is complicated by a lack of understanding of the incentive structure by the managed care organization and the physician. The lack of a universally acceptable definition of quality renders it important that future researchers identify the term explicitly.

  6. Networks versus Economic Incentives

    DEFF Research Database (Denmark)

    Larsen, Christian Albrekt

    The article analyses the neglected relationship between networks and unemployment. It challenges the neo-classic understanding of the transition from unemployment to employment and elaborates the line of reasoning within economic sociology. Based on theories of information problems at the labour ...

  7. The effect of physician disclosure of financial incentives on trust. (United States)

    Levinson, Wendy; Kao, Audiey; Kuby, Alma M; Thisted, Ronald A


    Many physicians receive financial incentives to limit their ordering of expensive tests and procedures. While Medicare mandates disclosure of incentives, it is not clear how to inform patients without undermining trust. Our objective was to determine public opinion about physician disclosure of financial incentives and how this might be best communicated to patients. The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households. The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image. Respondents heard 1 of 6 randomly selected disclosure strategies. The measurements included ratings of trust, satisfaction, agreement with the physician's decision, and likelihood of remaining with the physician/health plan or seeking a second opinion. Nearly half (48.8%) of respondents had previously heard of financial incentives to limit test ordering. Of the respondents, 94.8% wanted to be told about incentives, at the time of enrollment in a health plan (80.5%), by a health plan representative (44.8%), their physician (17.1%), or both (38.1%). Of the 6 different disclosure strategies, "addressing emotions" and "negotiation" were associated with the best outcomes, while "common enemy" and "denying influences" were most negatively perceived. Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion. The public wants information about physician financial incentives. Specific communication styles enhance how this information is conveyed to patients, increasing trust and supporting the physician-patient relationship.

  8. Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care. (United States)

    Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G


    Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

  9. Financial Incentives and Physician Practice Participation in Medicare's Value-Based Reforms. (United States)

    Markovitz, Adam A; Ramsay, Patricia P; Shortell, Stephen M; Ryan, Andrew M


    To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013). We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures. We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey. There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data (SE, 0.1, p financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment

  10. Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels (United States)

    Asch, David A.; Troxel, Andrea B.; Stewart, Walter F.; Sequist, Thomas D.; Jones, James B.; Hirsch, AnneMarie G.; Hoffer, Karen; Zhu, Jingsan; Wang, Wenli; Hodlofski, Amanda; Frasch, Antonette B.; Weiner, Mark G.; Finnerty, Darra D.; Rosenthal, Meredith B.; Gangemi, Kelsey; Volpp, Kevin G.


    IMPORTANCE Financial incentives to physicians or patients are increasingly used, but their effectiveness is not well established. OBJECTIVE To determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective than control in reducing levels of low-density lipoprotein cholesterol (LDL-C) among patients with high cardiovascular risk. DESIGN, SETTING, AND PARTICIPANTS Four-group, multicenter, cluster randomized clinical trial with a 12-month intervention conducted from 2011 to 2014 in 3 primary care practices in the northeastern United States. Three hundred forty eligible primary care physicians (PCPs) were enrolled from a pool of 421. Of 25 627 potentially eligible patients of those PCPs, 1503 enrolled. Patients aged 18 to 80 years were eligible if they had a 10-year Framingham Risk Score (FRS) of 20% or greater, had coronary artery disease equivalents with LDL-C levels of 120 mg/dL or greater, or had an FRS of 10% to 20% with LDL-C levels of 140 mg/dL or greater. Investigators were blinded to study group, but participants were not. INTERVENTIONS Primary care physicians were randomly assigned to control, physician incentives, patient incentives, or shared physician-patient incentives. Physicians in the physician incentives group were eligible to receive up to $1024 per enrolled patient meeting LDL-C goals. Patients in the patient incentives group were eligible for the same amount, distributed through daily lotteries tied to medication adherence. Physicians and patients in the shared incentives group shared these incentives. Physicians and patients in the control group received no incentives tied to outcomes, but all patient participants received up to $355 each for trial participation. MAIN OUTCOMES AND MEASURES Change in LDL-C level at 12 months. RESULTS Only patients in the shared physician-patient incentives group achieved reductions in LDL-C levels statistically different from those in the control

  11. Do family physicians need more payment for working better? Financial incentives in primary care. (United States)

    Kolozsvári, László Róbert; Orozco-Beltran, Domingo; Rurik, Imre


    Financial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries. Our study aims to describe and compare recent existing primary care indicators and related financing in European countries. Literature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network. Ten countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income. The implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  12. 42 CFR 417.479 - Requirements for physician incentive plans. (United States)


    ... medical services to enrollees. The requirements in this section also apply to subcontracting arrangements... orders or arranges, but does not furnish directly. Risk threshold means the maximum risk, if the risk is... incentive plan without being at substantial financial risk. Withhold means a percentage of payments or set...

  13. Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction. (United States)

    Hadley, J; Mitchell, J M; Sulmasy, D P; Bloche, M G


    To estimate the effects of physicians' personal financial incentives and other measures of involvement with HMOs on three measures of satisfaction and practice style: overall practice satisfaction, the extent to which prior expectations about professional autonomy and the ability to practice good-quality medicine are met, and several specific measures of practice style. A telephone survey conducted in 1997 of 1,549 physicians who were located in the 75 largest Metropolitan Statistical Areas in 1991. Eligible physicians were under age 52, had between 8 and 17 years of post-residency practice experience, and spent at least 20 hours per week in patient care. The response rate was 74 percent. Multivariate binomial and multinomial ordered logistic regression models were estimated. Independent variables included physicians' self-reported financial incentives, measured by the extent to which their overall financial arrangements created an incentive to either reduce or increase services to patients, the level of HMO penetration in the market, employment setting, medical specialty, exposure to managed care while in medical training, and selected personal characteristics. About 15 percent of survey respondents reported a moderate or strong incentive to reduce services; 70 percent reported a neutral incentive; and 15 percent reported an incentive to increase services. Compared to physicians with a neutral incentive, physicians with an incentive to reduce services were from 1.5 to 3.5 times more likely to be very dissatisfied with their practices and were 0.2 to 0.5 times as likely to report that their expectations regarding professional autonomy and ability to practice good-quality medicine were met. They were also 0.2 to 0.6 times as likely to report having the freedom to care for patients the way they would like along several specific measures of practice style, such as sufficient time with patients, ability to hospitalize, ability to order tests and procedures, and ability

  14. Do financial incentives linked to ownership of specialty hospitals affect physicians' practice patterns? (United States)

    Mitchell, Jean M


    Although physician-owned specialty hospitals have become increasingly prevalent in recent years, little research has examined whether the financial incentives linked to ownership influence physicians' referral rates for services performed at the specialty hospital. We compared the practice patterns of physician owners of specialty hospitals in Oklahoma, before and after ownership, to the practice patterns of physician nonowners who treated similar cases over the same time period in Oklahoma markets without physician-owned specialty hospitals. We constructed episodes of care for injured workers with a primary diagnosis of back/spine disorders. We used pre-post comparisons and difference-in-differences analysis to evaluate changes in practice patterns for physician owners and nonowners over the time period spanned by the entry of the specialty hospital. Findings suggest the introduction of financial incentives linked to ownership coincided with a significant change in the practice patterns of physician owners, whereas such changes were not evident among physician nonowners. After physicians established ownership interests in a specialty hospital, the frequency of use of surgery, diagnostic, and ancillary services used in the treatment of injured workers with back/spine disorders increased significantly. Physician ownership of specialty hospitals altered the frequency of use for an array of procedures rendered to patients treated at these hospitals. Given the growth in physician-owned specialty hospitals, these findings suggest that health care expenditures will be substantially greater for patients treated at these institutions relative to persons who obtain care from nonself-referral providers.

  15. Physician practice responses to financial incentive programs: exploring the concept of implementation mechanisms. (United States)

    Cohen, Genna R; Erb, Natalie; Lemak, Christy Harris


    To develop a framework for studying financial incentive program implementation mechanisms, the means by which physician practices and physicians translate incentive program goals into their specific office setting. Understanding how new financial incentives fit with the structure of physician practices and individual providers' work may shed some insight on the variable effects of physician incentives documented in numerous reviews and meta-analyses. Reviewing select articles on pay-for-performance evaluations to identify and characterize the presence of implementation mechanisms for designing, communicating, implementing, and maintaining financial incentive programs as well as recognizing participants' success and effects on patient care. Although uncommonly included in evaluations, evidence from 26 articles reveals financial incentive program sponsors and participants utilized a variety of strategies to facilitate communication about program goals and intentions, to provide feedback about participants' progress, and to assist-practices in providing recommended services. Despite diversity in programs' geographic locations, clinical targets, scope, and market context, sponsors and participants deployed common strategies. While these methods largely pertained to communication between program sponsors and participants and the provision of information about performance through reports and registries, they also included other activities such as efforts to engage patients and ways to change staff roles. This review covers a limited body of research to develop a conceptual framework for future research; it did not exhaustively search for new articles and cannot definitively link particular implementation mechanisms to outcomes. Our results underscore the effects implementation mechanisms may have on how practices incorporate new programs into existing systems of care which implicates both the potential rewards from small changes as well as the resources which may be

  16. Incentive-Based Voltage Regulation in Distribution Networks

    Energy Technology Data Exchange (ETDEWEB)

    Dall-Anese, Emiliano [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Baker, Kyri A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Zhou, Xinyang [University of Colorado; Chen, Lijun [University of Colorado


    This paper considers distribution networks fea- turing distributed energy resources, and designs incentive-based mechanisms that allow the network operator and end-customers to pursue given operational and economic objectives, while concurrently ensuring that voltages are within prescribed limits. Two different network-customer coordination mechanisms that require different amounts of information shared between the network operator and end-customers are developed to identify a solution of a well-defined social-welfare maximization prob- lem. Notably, the signals broadcast by the network operator assume the connotation of prices/incentives that induce the end- customers to adjust the generated/consumed powers in order to avoid the violation of the voltage constraints. Stability of the proposed schemes is analytically established and numerically corroborated.

  17. Incentive-Based Voltage Regulation in Distribution Networks: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Xinyang; Chen, Lijun; Dall' Anese, Emiliano; Baker, Kyri


    This paper considers distribution networks fea- turing distributed energy resources, and designs incentive-based mechanisms that allow the network operator and end-customers to pursue given operational and economic objectives, while concurrently ensuring that voltages are within prescribed limits. Two different network-customer coordination mechanisms that require different amounts of information shared between the network operator and end-customers are developed to identify a solution of a well-defined social-welfare maximization prob- lem. Notably, the signals broadcast by the network operator assume the connotation of prices/incentives that induce the end- customers to adjust the generated/consumed powers in order to avoid the violation of the voltage constraints. Stability of the proposed schemes is analytically established and numerically corroborated.

  18. Node-Dependence-Based Dynamic Incentive Algorithm in Opportunistic Networks

    Directory of Open Access Journals (Sweden)

    Ruiyun Yu


    Full Text Available Opportunistic networks lack end-to-end paths between source nodes and destination nodes, so the communications are mainly carried out by the “store-carry-forward” strategy. Selfish behaviors of rejecting packet relay requests will severely worsen the network performance. Incentive is an efficient way to reduce selfish behaviors and hence improves the reliability and robustness of the networks. In this paper, we propose the node-dependence-based dynamic gaming incentive (NDI algorithm, which exploits the dynamic repeated gaming to motivate nodes relaying packets for other nodes. The NDI algorithm presents a mechanism of tolerating selfish behaviors of nodes. Reward and punishment methods are also designed based on the node dependence degree. Simulation results show that the NDI algorithm is effective in increasing the delivery ratio and decreasing average latency when there are a lot of selfish nodes in the opportunistic networks.

  19. Contract-Based Incentive Mechanism for Mobile Crowdsourcing Networks

    Directory of Open Access Journals (Sweden)

    Nan Zhao


    Full Text Available Mobile crowdsourcing networks (MCNs are a promising method of data collecting and processing by leveraging the mobile devices’ sensing and computing capabilities. However, because of the selfish characteristics of the service provider (SP and mobile users (MUs, crowdsourcing participants only aim to maximize their own benefits. This paper investigates the incentive mechanism between the above two parties to create mutual benefits. By modeling MCNs as a labor market, a contract-based crowdsourcing model with moral hazard is proposed under the asymmetric information scenario. In order to incentivize the potential MUs to participate in crowdsourcing tasks, the optimization problem is formulated to maximize the SP’s utility by jointly examining the crowdsourcing participants’ risk preferences. The impact of crowdsourcing participants’ attitudes of risks on the incentive mechanism has been studied analytically and experimentally. Numerical simulation results demonstrate the effectiveness of the proposed contract design scheme for the crowdsourcing incentive.

  20. Is the Road to Mental Health Paved With Good Incentives? Estimating the Population Impact of Physician Incentives on Mental Health Care Using Linked Administrative Data. (United States)

    Puyat, Joseph H; Kazanjian, Arminee; Wong, Hubert; Goldner, Elliot M


    The use of physician incentives to improve health care, in general, has been extensively studied but its value in mental health care has rarely been demonstrated. In this study the population-level impact of physician incentives on mental health care was estimated using indicators for receipt of counseling/psychotherapy (CP); antidepressant therapy (AT); minimally adequate counseling/psychotherapy; and minimally adequate antidepressant therapy. The incentives' impacts on overall continuity of care and of mental health care were also examined. Monthly cohorts of individuals diagnosed with major depression were identified between January 2005 and December 2012 and their use of mental health services tracked for 12 months following initial diagnosis. Linked health administrative data were used to ascertain cases and measure health service use. Pre-post changes associated with the introduction of physician incentives were estimated using segmented regression analyses, after adjusting for seasonal variation. Physician incentives reversed the downward and upward trends in CP and AT. Five years postintervention, the estimated impacts in percentage points for CP, AT, minimally adequate counseling/psychotherapy, and minimally adequate antidepressant therapy were +3.28 [95% confidence interval (CI), 2.05-4.52], -4.47 (95% CI, -6.06 to -2.87), +1.77 (95% CI, 0.94-2.59), and -2.24 (95% CI, -4.04 to -0.45). Postintervention, the downward trends in continuity of care failed to reverse, but were disrupted, netting estimated impacts of +7.53 (95% CI, 4.54-10.53) and +4.37 (95% CI, 2.64-6.09) for continuity of care and of mental health care. The impact of physician incentives on mental health care was modest at best. Other policy interventions are needed to close existing gaps in mental health care.

  1. Merit-Based Incentive Payment System (MIPS): Harsh Choices For Interventional Pain Management Physicians. (United States)

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A


    The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score. Additionally, Clinical Practice Improvement Activities (CPIA), contributing 15% of the composite score, create multiple strategic goals to design incentives that drive movement toward delivery system reform principles with inclusion of Advanced Alternative Payment Models (APMs). Under the present proposal, the Centers for Medicare and Medicaid Services (CMS) has estimated approximately 30,000 to 90,000 providers from a total of over 761,000 providers will be exempt from MIPS. About 87% of solo practitioners and 70% of practitioners in groups of less than 10 will be subjected to negative payments or penalties ranging from 4% to 9%. In addition, MIPS also will affect a provider's reputation by making performance measures accessible to consumers and third-party physician rating Web sites.The MIPS composite performance scoring method, at least in theory, utilizes weights for each performance category, exceptional performance factors to earn bonuses, and incorporates the special circumstances of small practices.In conclusion, MIPS has the potential to affect practitioners negatively. Interventional Pain Medicine practitioners must understand the various MIPS measures and how they might participate in order to secure a brighter future. Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, clinical practice

  2. Embedded generation connection incentives for distribution network operators

    Energy Technology Data Exchange (ETDEWEB)

    Williams, P.; Andrews, S.


    This is the final report with respect to work commissioned by the Department of Trade and Industry (DTI) as part of the New and Renewable Energy Programme into incentives for distribution network operators (DNOs) for the connection of embedded generation. This report, which incorporates the contents of the interim report submitted in February 2002, considers the implications of changes in the structure and regulation in the UK electricity industry on the successful technical and commercial integrated of embedded generation into distribution networks. The report examines: the obligations of public electricity suppliers (PESs); current DNO practices regarding the connection of embedded generation; the changes introduced by the Utilities Act 2000, including the impact of new obligations placed on DNOs on the connection of embedded generation and the requirements of the new Electricity Distribution Standard Licence conditions; and problems and prospects for DNO incentives.

  3. The effect of financial incentives on the quality of health care provided by primary care physicians. (United States)

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris


    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome

  4. Online professional networks for physicians: risk management. (United States)

    Hyman, Jon L; Luks, Howard J; Sechrest, Randale


    The rapidly developing array of online physician-only communities represents a potential extraordinary advance in the availability of educational and informational resources to physicians. These online communities provide physicians with a new range of controls over the information they process, but use of this social media technology carries some risk. The purpose of this review was to help physicians manage the risks of online professional networking and discuss the potential benefits that may come with such networks. This article explores the risks and benefits of physicians engaging in online professional networking with peers and provides suggestions on risk management. Through an Internet search and literature review, we scrutinized available case law, federal regulatory code, and guidelines of conduct from professional organizations and consultants. We reviewed the site as a case example because it is currently the only online social network exclusively for orthopaedic surgeons. Existing case law suggests potential liability for orthopaedic surgeons who engage with patients on openly accessible social network platforms. Current society guidelines in both the United States and Britain provide sensible rules that may mitigate such risks. However, the overall lack of a strong body of legal opinions, government regulations as well as practical experience for most surgeons limit the suitability of such platforms. Closed platforms that are restricted to validated orthopaedic surgeons may limit these downside risks and hence allow surgeons to collaborate with one another both as clinicians and practice owners. Educating surgeons about the pros and cons of participating in these networking platforms is helping them more astutely manage risks and optimize benefits. This evolving online environment of professional interaction is one of few precedents, but the application of risk management strategies that physicians use in daily practice carries over

  5. Use of care management practices in small- and medium-sized physician groups: do public reporting of physician quality and financial incentives matter? (United States)

    Alexander, Jeffrey A; Maeng, Daniel; Casalino, Lawrence P; Rittenhouse, Diane


    To examine the effect of public reporting (PR) and financial incentives tied to quality performance on the use of care management practices (CMPs) among small- and medium-sized physician groups. Survey data from The National Study of Small and Medium-sized Physician Practices were used. Primary data collection was also conducted to assess community-level PR activities. The final sample included 643 practices engaged in quality reporting; about half of these practices were subject to PR. We used a treatment effects model. The instrumental variables were the community-level variables that capture the level of PR activity in each community in which the practices operate. (1) PR is associated with increased use of CMPs, but the estimate is not statistically significant; (2) financial incentives are associated with greater use of CMPs; (3) practices' awareness/sensitivity to quality reports is positively related to their use of CMPs; and (4) combined PR and financial incentives jointly affect CMP use to a greater degree than either of these factors alone. Small- to medium-sized practices appear to respond to PR and financial incentives by greater use of CMPs. Future research needs to investigate the appropriate mix and type of incentive arrangements and quality reporting. © Health Research and Educational Trust.

  6. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period. (United States)


    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

  7. Optimal Incentive Pricing on Relaying Services for Maximizing Connection Availability in Multihop Cellular Networks

    Directory of Open Access Journals (Sweden)

    Ming-Hua Lin


    Full Text Available This paper investigates an incentive pricing problem for relaying services in multihop cellular networks. Providing incentives to encourage mobile nodes to relay data is a critical factor in building successful multihop cellular networks. Most existing approaches adopt fixed-rate or location-based pricing on rewarding packets forwarding. This study applies a mathematical programming model to determine an optimal incentive price for each intermediate node that provides relaying services. Under the obtained incentive price, the connection availability of the networks is maximized by using the same relaying costs as other pricing schemes. A signomial geometric programming problem is constructed, and a deterministic optimization approach is employed to solve the problem. Besides, quality-of-service constraints are added in the proposed model to mitigate the unfairness between connection availabilities of individual nodes. Computational results demonstrate that the proposed model obtains the optimal incentive price on relaying services to maximize connection availability of the networks.

  8. Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System. (United States)

    Squitieri, Lee; Chung, Kevin C


    In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

  9. A Dynamic Incentive Mechanism for Transmission Expansion in Electricity Networks – Theory, Modeling and Application


    Rosellon, Juan; Weigt, Hannes


    This paper examines the Hogan-Rosellón-Vogelsang (2007) (HRV) incentive mechanism for transmission expansion, and tests it for different network topologies. This new mechanism is based upon redefining transmission output in terms of point-to-point transactions or financial transmission rights (FTRs) and applies Vogelsang’s (2001) incentive-regulation logic that proposes rebalancing the variable and fixed parts of a two-part tariff to promote efficient, long-term expansion. We anal...

  10. Toward a theory of extended contact : The incentives and opportunities for bridging across network communities

    NARCIS (Netherlands)

    Sytch, M.; Tatarynowicz, A.; Gulati, R.


    This study investigates the determinants of bridging ties within networks of interconnected firms. Bridging ties are defined as nonredundant connections between firms located in different network communities. We highlight how firms can enter into these relationships because of the incentives and

  11. 42 CFR 422.208 - Physician incentive plans: requirements and limitations. (United States)


    ... that are not based on use of referrals, such as quality of care furnished, patient satisfaction or... dollar payment per patient per unit of time (usually per month) paid to a physician or physician group to... have either aggregate or per-patient stop-loss protection in accordance with paragraph (f) of this...

  12. Effectiveness of a financial incentive to physicians for timely follow-up after hospital discharge: a population-based time series analysis. (United States)

    Lapointe-Shaw, Lauren; Mamdani, Muhammad; Luo, Jin; Austin, Peter C; Ivers, Noah M; Redelmeier, Donald A; Bell, Chaim M


    Timely follow-up after hospital discharge may decrease readmission to hospital. Financial incentives to improve follow-up have been introduced in the United States and Canada, but it is unknown whether they are effective. Our objective was to evaluate the impact of an incentive program on timely physician follow-up after hospital discharge. We conducted an interventional time series analysis of all medical and surgical patients who were discharged home from hospital between Apr. 1, 2002, and Jan. 30, 2015, in Ontario, Canada. The intervention was a supplemental billing code for physician follow-up within 14 days of discharge from hospital, introduced in 2006. The primary outcome was an outpatient visit within 14 days of discharge. Secondary outcomes were 7-day follow-up and a composite of emergency department visits, nonelective hospital readmission and death within 14 days. We included 8 008 934 patient discharge records. The incentive code was claimed in 31% of eligible visits by 51% of eligible physicians, and cost $17.5 million over the study period. There was no change in the average monthly rate of outcomes in the year before the incentive was introduced compared with the year following introduction: 14-day follow-up (66.5% v. 67.0%, overall p = 0.5), 7-day follow-up (44.9% v. 44.9%, overall p = 0.5) and composite outcome (16.7% v. 16.9%, overall p = 0.2). Despite uptake by physicians, a financial incentive did not alter follow-up after hospital discharge. This lack of effect may be explained by features of the incentive or by extra-physician barriers to follow-up. These barriers should be considered by policymakers before introducing similar initiatives. © 2017 Canadian Medical Association or its licensors.

  13. Viable Reserve Networks Arise From Individual Landholder Responses To Conservation Incentives

    Directory of Open Access Journals (Sweden)

    Kenneth M. Chomitz


    Full Text Available Conservation in densely settled biodiversity hotspots often requires setting up reserve networks that maintain sufficient contiguous habitat to support viable species populations. Because it is difficult to secure landholder compliance with a tightly constrained reserve network design, attention has shifted to voluntary incentive mechanisms, such as purchase of conservation easements by reverse auction or through a fixed-price offer. These mechanisms carry potential advantages of transparency, simplicity, and low cost. However, uncoordinated individual response to these incentives has been assumed incompatible with the conservation goal of viability, which depends on contiguous habitat and biodiversity representation. We model such incentives for southern Bahia in the Brazilian Atlantic Forest, one of the biologically richest and most threatened global biodiversity hotspots. Here, forest cover is spatially autocorrelated and associated with depressed land values, a situation that may be characteristic of long-settled areas with forests fragmented by agriculture. We find that in this situation, a voluntary incentive system can yield a reserve network characterized by large, viable patches of contiguous forest, and representation of subregions with distinct vegetation types and biotic assemblages, without explicit planning for those outcomes.

  14. Financial incentives for lumbar surgery: a critical analysis of physician reimbursement for decompression and fusion procedures. (United States)

    Whang, Peter G; Lim, Moe R; Sasso, Rick C; Skelton, Alta; Brown, Zoe B; Greg Anderson, David; Albert, Todd J; Hilibrand, Alan S; Vaccaro, Alexander R


    Retrospective case-control study/economic analysis. To determine the treatment times required for isolated lumbar decompressions and for combined decompression and instrumented fusion procedures to compare the relative reimbursements for each type of operation as a function of time expenditure by the surgeon. Under current Medicare fee schedules, the payment for a fusion procedure is higher than of an isolated decompression. It has been recently suggested in the lay press that the greater reimbursement for a lumbar arthrodesis may inappropriately influence the manner in which surgeons elect to treat lumbar degenerative conditions, resulting in what they believe to be a substantial number of unnecessary spinal fusions. A consecutive series of 50 single-level decompression cases performed by single surgeon were retrospectively analyzed and compared with an equivalent cohort of subjects who underwent single-level decompression and instrumented posterolateral fusion with autogenous iliac crest bone grafting. The operative reports, office charts, and billing records were reviewed to determine the total clinical time invested by the surgeon and the Medicare reimbursement for each surgery. Relative to the corresponding values of the decompression group, combined decompression and fusion procedures were associated with a longer mean surgical time (134.6 min vs. 47.3 min, Pundue financial incentive to recommend a combined decompression and instrumented fusion procedure over an isolated decompression to patients with symptomatic lumbar degeneration, especially when considering the greater time, effort, and risk characteristic of this more complex operation.

  15. "Us and them": a social network analysis of physicians' professional networks and their attitudes towards EBM. (United States)

    Mascia, Daniele; Cicchetti, Americo; Damiani, Gianfranco


    Extant research suggests that there is a strong social component to Evidence-Based Medicine (EBM) adoption since professional networks amongst physicians are strongly associated with their attitudes towards EBM. Despite this evidence, it is still unknown whether individual attitudes to use scientific evidence in clinical decision-making influence the position that physicians hold in their professional network. This paper explores how physicians' attitudes towards EBM is related to the network position they occupy within healthcare organizations. Data pertain to a sample of Italian physicians, whose professional network relationships, demographics and work-profile characteristics were collected. A social network analysis was performed to capture the structural importance of physicians in the collaboration network by the means of a core-periphery analysis and the computation of network centrality indicators. Then, regression analysis was used to test the association between the network position of individual clinicians and their attitudes towards EBM. Findings documented that the overall network structure is made up of a dense cohesive core of physicians and of less connected clinicians who occupy the periphery. A negative association between the physicians' attitudes towards EBM and the coreness they exhibited in the professional network was also found. Network centrality indicators confirmed these results documenting a negative association between physicians' propensity to use EBM and their structural importance in the professional network. Attitudes that physicians show towards EBM are related to the part (core or periphery) of the professional networks to which they belong as well as to their structural importance. By identifying virtuous attitudes and behaviors of professionals within their organizations, policymakers and executives may avoid marginalization and stimulate integration and continuity of care, both within and across the boundaries of healthcare

  16. Online Networks as Societies : User Behaviors and Contribution Incentives

    NARCIS (Netherlands)

    Jia, L.


    Online networks like email, Facebook, LinkedIn, Wikipedia, eBay, and BitTorrent-like Peer-to-Peer (P2P) systems have become popular and powerful infrastructures for communication. They involve potentially large numbers of humans with their collective inputs and decisions, and they often rely on the

  17. Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability. (United States)

    Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H


    Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.

  18. Study on Selfish Node Incentive Mechanism with a Forward Game Node in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Mohammed Ahmed Ahmed Al-Jaoufi


    Full Text Available In a wireless sensor network, some nodes may act selfishly and noncooperatively, such as not forwarding packets, in response to their own limited resources. If most of the nodes in a network exhibit this selfish behavior, the entire network will be paralyzed, and it will not be able to provide normal service. This paper considers implementing the idea of evolutionary game theory into the nodes of wireless sensor networks to effectively improve the reliability and stability of the networks. We present a new model for the selfish node incentive mechanism with a forward game node for wireless sensor networks, and we discuss applications of the replicator dynamics mechanism to analyze evolutionary trends of trust relationships among nodes. We analyzed our approach theoretically and conducted simulations based on the idea of evolutionary game theory. The results of the simulation indicated that a wireless sensor network that uses the incentive mechanism can forward packets well while resisting any slight variations. Thus, the stability and reliability of wireless sensor networks are improved. We conducted numerical experiments, and the results verified our conclusions based on the theoretical analysis.

  19. Incentive Mechanism for P2P Content Sharing over Heterogenous Access Networks (United States)

    Sato, Kenichiro; Hashimoto, Ryo; Yoshino, Makoto; Shinkuma, Ryoichi; Takahashi, Tatsuro

    In peer-to-peer (P2P) content sharing, users can share their content by contributing their own resources to one another. However, since there is no incentive for contributing contents or resources to others, users may attempt to obtain content without any contribution. To motivate users to contribute their resources to the service, incentive-rewarding mechanisms have been proposed. On the other hand, emerging wireless technologies, such as IEEE 802.11 wireless local area networks, beyond third generation (B3G) cellular networks and mobile WiMAX, provide high-speed Internet access for wireless users. Using these high-speed wireless access, wireless users can use P2P services and share their content with other wireless users and with fixed users. However, this diversification of access networks makes it difficult to appropriately assign rewards to each user according to their contributions. This is because the cost necessary for contribution is different in different access networks. In this paper, we propose a novel incentive-rewarding mechanism called EMOTIVER that can assign rewards to users appropriately. The proposed mechanism uses an external evaluator and interactive learning agents. We also investigate a way of appropriately controlling rewards based on the system service's quality and managing policy.

  20. [Networking physicians' practices: teleconsultation/teleconferencing]. (United States)

    Richter-Reichhelm, M


    Tele-medicine offers clear possibilities to improve the work of the doctor, in order to ensure the optimal treatment of the patient. In particular, cooperation between outpatient and inpatient doctors can be organised more efficiently using new forms of communication and information via the electronic network and EDP-based information processing. Problems with the utilisation of tele-medicine lie in both the design of the fundamentals and standards with regard to legal unity as well as in a lack of knowledge of many doctors in the utilisation of these new techniques.

  1. Game Theoretical Analysis on Cooperation Stability and Incentive Effectiveness in Community Networks.

    Directory of Open Access Journals (Sweden)

    Kaida Song

    Full Text Available Community networks, the distinguishing feature of which is membership admittance, appear on P2P networks, social networks, and conventional Web networks. Joining the network costs money, time or network bandwidth, but the individuals get access to special resources owned by the community in return. The prosperity and stability of the community are determined by both the policy of admittance and the attraction of the privileges gained by joining. However, some misbehaving users can get the dedicated resources with some illicit and low-cost approaches, which introduce instability into the community, a phenomenon that will destroy the membership policy. In this paper, we analyze on the stability using game theory on such a phenomenon. We propose a game-theoretical model of stability analysis in community networks and provide conditions for a stable community. We then extend the model to analyze the effectiveness of different incentive policies, which could be used when the community cannot maintain its members in certain situations. Then we verify those models through a simulation. Finally, we discuss several ways to promote community network's stability by adjusting the network's properties and give some proposal on the designs of these types of networks from the points of game theory and stability.

  2. A Mixed-Methods Randomized Controlled Trial of Financial Incentives and Peer Networks to Promote Walking among Older Adults (United States)

    Kullgren, Jeffrey T.; Harkins, Kristin A.; Bellamy, Scarlett L.; Gonzales, Amy; Tao, Yuanyuan; Zhu, Jingsan; Volpp, Kevin G.; Asch, David A.; Heisler, Michele; Karlawish, Jason


    Background: Financial incentives and peer networks could be delivered through eHealth technologies to encourage older adults to walk more. Methods: We conducted a 24-week randomized trial in which 92 older adults with a computer and Internet access received a pedometer, daily walking goals, and weekly feedback on goal achievement. Participants…

  3. Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives among Office-based Physician ... (United States)

    ... transmit Centers for Medicare & Medicaid Services quality measure … Electronic copy of health information … Clinical summaries … Exchange key clinical information … Privacy/security … Menu set Physician has computerized system for: Implement drug ...

  4. The push to increase the use of EHR technology by hospitals and physicians in the United States through the HITECH Act and the Medicare incentive program. (United States)

    Pipersburgh, Jessica


    This article reviews key health care spending and electronic health records (EHR) statistics in the United States (Section II); highlights positive and negative aspects of EHR technology (Sections III and IV); briefly reviews the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) (Section V); discusses the rule passed by the Office of the National Coordinator for Health Information Technology (ONCHIT) and to implement the goals of HITECH (Section VI); discusses the rule passed by the Centers for Medicare & Medicaid Services (CMS) to implement the goals of HITECH and focuses on significant requirements of the Medicare incentive program rule as it applies to hospitals and physicians (Section VII); and finally, concludes by highlighting certain issues that have been raised regarding the goals of HITECH (Section VIII).

  5. Comparative study about social support network among familiar physicians and traffic officers, México


    Aranda B., Carolina; Instituto de Investigación en Salud Ocupacional, Universidad de Guadalajara, México; Torres L., Teresa; Instituto de Investigación en Salud Ocupacional, Universidad de Guadalajara, México; Salazar E., José; Instituto de Investigación en Salud Ocupacional, Universidad de Guadalajara, México; Pando M., Manuel; Instituto de Investigación en Salud Ocupacional, Universidad de Guadalajara, México; Aldrete R., María Guadalupe; Instituto de Investigación en Salud Ocupacional, Universidad de Guadalajara, México


    The social support is the process that occurs between people that make up the social network of a subject. Actions such as listening, estimate, assess, and so on, are behaviors that occur among individuals who make up the network. The aim of this study analyze the situation of social support and social support networks on family physicians and traffic agents of a city in Mexico. 197 physicians and 875 traffic agents participated voluntarily with an informed consent. The information was collec...

  6. Interpreting the 1996 federal antitrust guidelines for physician joint venture networks. (United States)

    Hirshfeld, E


    The Statements of Antitrust Enforcement Policy in Health Care, issued by the FTC and the DOJ, dramatically change how the agencies evaluate physician joint venture networks. This article analyzes the Statements, providing useful guidance to the health lawyer.

  7. Marshfield Clinic, physician networks, and the exercise of monopoly power. (United States)

    Greenberg, W


    Antitrust enforcement can improve the performance of large, vertically integrated physician-hospital organizations (PHOs). Objective: To examine the recent court decisions in the Blue Cross and Blue Shield United of Wisconsin v. Marshfield Clinic antitrust case to understand better the benefits and costs of vertical integration in healthcare. Vertical integration in the Marshfield Clinic may have had the benefits of reducing transactions and uncertainty costs while improving the coordination between ambulatory and inpatient visits, but at the cost of Marshfield Clinic's monopolizing of physician services and foreclosing of HMO entry in northwest Wisconsin. The denial of hospital staff privileges to non-Marshfield Clinic physicians combined with certificate-of-need regulations impeded physician entry and solidified Marshfield Clinic's monopoly position. Enforcement efforts of recent antitrust guidelines by the U.S. Department of Justice and the Federal Trade Commission will need to address carefully the benefits and costs of vertically integrated systems.

  8. CreditCoin: A Privacy-Preserving Blockchain-Based Incentive Announcement Network for Communications of Smart Vehicles

    KAUST Repository

    Li, Lun


    The vehicular announcement network is one of the most promising utilities in the communications of smart vehicles and in the smart transportation systems. In general, there are two major issues in building an effective vehicular announcement network. First, it is difficult to forward reliable announcements without revealing users\\' identities. Second, users usually lack the motivation to forward announcements. In this paper, we endeavor to resolve these two issues through proposing an effective announcement network called CreditCoin, a novel privacy-preserving incentive announcement network based on Blockchain via an efficient anonymous vehicular announcement aggregation protocol. On the one hand, CreditCoin allows nondeterministic different signers (i.e., users) to generate the signatures and to send announcements anonymously in the nonfully trusted environment. On the other hand, with Blockchain, CreditCoin motivates users with incentives to share traffic information. In addition, transactions and account information in CreditCoin are tamper-resistant. CreditCoin also achieves conditional privacy since Trace manager in CreditCoin traces malicious users\\' identities in anonymous announcements with related transactions. CreditCoin thus is able to motivate users to forward announcements anonymously and reliably. Extensive experimental results show that CreditCoin is efficient and practical in simulations of smart transportation.

  9. Commentary: physician-scientist attrition: stemming the tide through national networks for training and development. (United States)

    Schwartz, Alan L


    Future advances in medicine depend on a reliable pipeline of physician-scientists. However, the changing demographics of physician-scientists, including the advanced age of new MD investigators, and attrition along the physician-scientist developmental pathway are cause for concern. Recently developed National Institutes of Health-funded national networks for physician-scientist training and development-such as the Advanced Research Institute in Geriatric Mental Health and the Pediatric Scientist Development Program-offer valuable approaches to supporting and retaining these trainees.

  10. Implementation of a primary care physician network obesity management program. (United States)

    Bowerman, S; Bellman, M; Saltsman, P; Garvey, D; Pimstone, K; Skootsky, S; Wang, H J; Elashoff, R; Heber, D


    Most primary care physicians do not treat obesity, citing lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers. To address this need, a 10-minute intervention delivered by the primary care physician was coupled with individual dietary counseling sessions delivered by a registered dietitian via telephone with an automated calling system (House-Calls, Mobile, AL). Patients were seen for follow-up by their physician at weeks 4, 12, 24, 36 and 52. A total of 252 patients (202 women and 50 men) were referred by 18 primary care physicians to the program. The comorbid conditions reported for all patients at baseline included low back pain, 29% (n = 72); hypertension, 45% (n = 113); hypercholesterolemia, 41% (n = 104); type 2 diabetes, 10% (n = 26); and sleep apnea, 5% (n = 12). When offered a choice of meal plans based on foods or meal replacements, two-thirds of patients (n = 166) chose to use meal replacements (Ultra Slim-Fast; Slim-Fast Foods Co., West Palm Beach, FL) at least once daily. Baseline weights of subjects averaged 200 +/- 46 lb for women (n = 202) and 237 +/- 45 lb for men (n = 50). Patients completing 6 months in the program lost an average of 19.0 +/- 4.0 lb for women (n = 94) and 15.5 +/- 8.2 lb for men (n = 26). Physicians reported a high degree of satisfaction with the program, suggesting that a brief, effective physician-directed program with nutritionist support by telephone can be implemented in a busy primary care office.

  11. The clinical characteristics of brown recluse spider bites treated by family physicians: an OKPRN Study. Oklahoma Physicians Research Network. (United States)

    Cacy, J; Mold, J W


    The brown recluse spider (Loxosceles reclusa) has been recognized as a cause of necrotizing bites since at least 1957, but most of the literature consists of laboratory studies using animals, human sera, or case reports of more dramatic examples of bite reactions. Our goal was to develop a more comprehensive clinical description of the brown recluse spider bites treated by family physicians. Two preprinted, postage-paid cards were given to physician members of the Oklahoma Physicians Research Network. One card was used for recording examination and treatment data, and the other was for tracking the progress of the bite until it was completely healed. For comparison, similar information was collected from the local poison control center. From April 1996 to August 1998, the physicians recorded 149 bites. Most of the victims were women aged 18 to 65 years, and most sought treatment within 3 days. Pain was common but not universal. Most bites were located on the extremities. Erythema was always present, but necrosis was present in only 40% of the bites. Some systemic signs or symptoms were common. The most frequent forms of treatment were systemic antibiotics (66% of cases) and conservative wound management (56%). Only 1 hospitalization occurred; 43% of the bites healed within 2 weeks; and only 13% resulted in scarring. The brown recluse spider bite is a relatively common problem treated by family physicians in Oklahoma. Most bites are not serious. More research at the practice level is needed to develop diagnostic criteria and to explore the effectiveness of various treatment options.

  12. Analysis of social networks among physicians employed at a medical school. (United States)

    Yuce, Yilmaz Kemal; Zayim, Nese; Oguz, Basak; Bozkurt, Selen; Isleyen, Filiz; Gulkesen, K Hakan


    Social network analysis is a well-known method for discovering the social complexities of relationships. In this paper, we present the results of its application in a healthcare environment, i.e. a state university hospital. The sociometric method was adopted to collect social network data. The analysis was performed using Pajek. The medical practice/academic and technological networks among physicians of a state university hospital were explored. Monomorphic and polymorphic opinion leaders (OLs) within the networks were identified using the in-degree measure. Cohesiveness were investigated based on network density and average degree. In addition, it was checked if the mentor system may present impact on the formation of social networks among physicians.

  13. Professionalism and social networking: can patients, physicians, nurses, and supervisors all be "friends?". (United States)

    Peluchette, Joy; Karl, Katherine; Coustasse, Alberto; Emmett, Dennis


    The purpose of this study was to examine the use of social networking (Facebook) among nurse anesthetists. We examined whether they would have concerns about their supervisor, patients, or physicians seeing their Facebook profile. We also examined their attitudes related to maintaining professional boundaries with regard to the initiation or receipt of Facebook "friend" requests from their supervisor, patients, or physicians they work with. Our respondents consisted of 103 nurses currently enrolled in a graduate-level nurse anesthetist program. All respondents had a minimum of 2 years of work experience in critical care nursing. Most respondents were found to be neutral about physicians and supervisors viewing their Facebook profiles but expressed concerns about patients seeing such information. A vast majority indicated they would accept a friend request from their supervisor and a physician but not a patient. Surprisingly, about 40% had initiated a friend request to their supervisor or physician they work with. Implications for health care managers are discussed.

  14. Physician behaviors to promote informed decisions for prostate cancer screening: a National Research Network study. (United States)

    Linder, Suzanne K; Kallen, Michael A; Mullen, Patricia Dolan; Galliher, James M; Swank, Paul R; Chan, Evelyn C Y; Volk, Robert J


    Clinical guidelines for prostate cancer screening (PCS) advise physicians to discuss the potential harms and benefits of screening. However, there is a lack of training programs for informed decision-making (IDM), and it is unknown which IDM behaviors physicians have the most difficulty performing. Identifying difficult behaviors can help tailor training programs. In the context of developing a physician-IDM program for PCS, we aimed to describe physicians' use of nine key IDM behaviors for the PCS discussion and to examine the relation between the behaviors and physician characteristics. A cross-sectional sample of The American Academy of Family Physicians National Research Network completed surveys about their behavior regarding PCS (N = 246; response rate = 58%). The surveys included nine physician key IDM behaviors for PCS and a single-item question describing their general practice style for PCS. The most common IDM behavior was to invite men to ask questions. The two least common reported behaviors concerned patients uncertain about screening (i.e., arrange follow-up and provide additional information for undecided men). Physicians reported difficulty with these two behaviors regardless whether they reported to discuss or not to discuss PCS with patients. Reported use of key IDM behaviors was associated with a general practice style for PCS and being affiliated with a residency-training program. Physician training programs for IDM should include physician skills to address the needs of patients uncertain about screening. Future research should determine if actual behavior is associated with self-reported behavior for the PCS discussion.

  15. Traffic Engineering of Peer-Assisted Content Delivery Network with Content-Oriented Incentive Mechanism

    National Research Council Canada - National Science Library

    MAKI, Naoya; NISHIO, Takayuki; SHINKUMA, Ryoichi; MORI, Tatsuya; KAMIYAMA, Noriaki; KAWAHARA, Ryoichi; TAKAHASHI, Tatsuro


    In content services where people purchase and download large-volume contents, minimizing network traffic is crucial for the service provider and the network operator since they want to lower the cost...

  16. Urban Mobility and Location-Based Social Networks: Social, Economic and Environmental Incentives (United States)

    Zhang, Ke


    Location-based social networks (LBSNs) have recently attracted the interest of millions of users who can now not only connect and interact with their friends--as it also happens in traditional online social networks--but can also voluntarily share their whereabouts in real time. A location database is the backbone of a location-based social…

  17. Effect of physician collaboration network on hospitalization cost and readmission rate. (United States)

    Uddin, Shahadat; Hossain, Liaquat; Kelaher, Margaret


    Previous studies have documented the effect of collaboration among physicians on the effectiveness in delivering health services and in producing better patient outcomes. However, there is no systematic empirical study suggesting the underlying relationship between the collaboration network of physicians and its effect on hospitalization cost and readmission rate. In this study, we explore the effect of different attributes (i.e. degree centrality, betweenness centrality, network density and network distance) of physician collaboration network (PCN) on hospitalization cost and readmission rate. We analyse health insurance claim data set of total hip replacement (THR) patients to construct PCN and to test the effect of its network attributes on hospitalization cost and readmission rate. We consider patient age as moderating factor, which could affect the relation of the PCN attributes with hospitalization cost and readmission rate. We find that degree centrality (i.e. level of involvement) and network density (i.e. level of connectedness) of PCN are negatively correlated with hospitalization cost and readmission rate. In contrast, betweenness centrality (i.e. capacity to control the flow of information) is found positively correlated with hospitalization cost and readmission rate. Distance (i.e. embeddedness of actors in a network) is found positively correlated with hospitalization cost but negatively correlated with readmission rate. We do not notice any significant impact of patient age on the relation of PCN attributes with hospitalization cost and readmission rate. The results show that the structure of PCNs is related to indicators of hospital costs and quality (readmission). In their respective hospitals, health-care managers or administrators may follow our research findings to reduce cost and improve quality.

  18. Detection and Prevention of Denial of Service (DoS Attacks in Mobile Ad Hoc Networks using Reputation-based Incentive Schemes

    Directory of Open Access Journals (Sweden)

    Mieso, K Denko


    Full Text Available Mobile ad hoc networks (MANETs are dynamic mobile networks that can be formed in the absence of any pre-existing communication infrastructure. In addition to node mobility, a MANET is characterized by limited resources such as bandwidth, battery power, and storage space. The underlying assumption in MANETs is that the intermediate nodes cooperate in forwarding packets. However, this assumption does not hold in commercial and emerging civilian applications. MANETs are vulnerable to Denial of Service (DoS due to their salient characteristics. There is a need to provide an incentive mechanism that can provide cooperation among nodes in the network and improve overall network performance by reducing DoS attacks. In this paper, we propose a reputation-based incentive mechanism for detecting and preventing DoS attacks. DoS attacks committed by selfish and malicious nodes were investigated. Our scheme motivates nodes to cooperate and excludes them from the network only if they fail to do so. We evaluated the performance of our scheme using the packet delivery ratio, the routing and communication overhead, and misbehaving node detection in a discrete event-simulation environment. The results indicate that a reputation-based incentive mechanism can significantly reduce the effect of DoS attacks and improve performance in MANETs.

  19. [Infant bronchiolitis point of care by physicians in the Ile-de-France bronchiolitis network]. (United States)

    Sebban, S; Grimprel, E; Bray, J


    The Ile-de-France bronchiolitis network assessment gave us the opportunity to carry out a survey regarding the customary handling of acute bronchiolitis by physicians involved in this network. The aim of this study was to retrieve results relating to season 2003-2004 and to compare them with the September 2000 French consensus conference recommendations. The practitioners engaged using a special form subsequently transmitted to network joint committee collected the clinical and therapeutic data of the patients included in the Network. We analysed 342 exploitable forms. Analysis of the physicians medications for patients classified as bronchiolitis showed that their behavior was on the whole keeping with the official recommendations. The nearly systematic prescription of specific respiratory physiotherapy (increase in expiratory flow) satisfies the expectations of the French consensus conference. Likewise, treatments such as bronchodilator or corticoids that are not recommended were prescribed only in approximately 1/4 of cases. Abstention from all medical treatment was found in only 41% of cases classified as bronchiolitis. However, in considering only the first episode of acute bronchiolitis, this rate increased to 54,3%. Short-acting bronchodilator usage may appear legitimate as a therapeutic test of reversibility. In our study, 1/3 of patients with bronchiolitis treated by bronchodilator underwent a second episode and 80% of them were older than 6 months. Analysis of the practices of physicians participating in the Bronchiolite Ile-de-France Network proves very positive in light of the comparison with studies prior and subsequent to the consensus conference. In recognition of this, it is necessary to consider the importance of the network's training programs. Beyond the need to go on with the diffusion of the recommendations, it seems desirable to extend them to clinical situations not yet considered, especially recurrent bronchiolitis and infant asthma. Finally

  20. Peace Incentives

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.


    How does economic assistance influence the success or failure of peace processes in Africa? Can economic assistance act as an incentive to facilitate an end to conflict? The literature largely ignores aid as a factor supporting peace processes. In addressing this topic, the current study tries...... to assess the impact of donor economic aid on recent African peace processes. This research points to the conclusion that international assistance can be a positive incentive for lasting peace....

  1. Using Incentives (United States)

    Seymour, Kathryn


    This article explores the ethical implications of using incentives to encourage and recognise youth participation in research. While the complexity of research projects and the diversity of research subjects necessarily preclude simple solutions, the author argues that social research can successfully and ethically use a mix of extrinsic and…

  2. iPad use in Iowa Research Network family physician offices. (United States)

    Daly, Jeanette M; Xu, Yinghui; Levy, Barcey T


    Through a cancer research infrastructure building grant, iPads were given to health care providers in family physician offices. The purpose of this study was to determine the use and application of iPads in the Iowa Research Network. A Qualtrics survey was sent to 81 iPad recipients after institutional review board approval. Fifty-nine percent responded and 85% reported they have used the iPad. The main reason for use of the iPad was browsing the World Wide Web for health care information. Open-ended comments supported use of the iPad for photographic documentation of wound and other skin lesions for insertion into the medical record and it helped improve clinic flow by making it easier to put orders in the system through the iPad. Tablet uses are variable in physician offices with provider's gathering health care information from the Internet and securing education material for patients as the frequent usages. © The Author(s) 2014.

  3. Incentives for health. (United States)

    Anderson, Peter; Harrison, Oliver; Cooper, Cary; Jané-Llopis, Eva


    This article discusses incentives to help make healthy choices the easy choices for individuals, operating at the levels of the individual, producers and service providers, and governments. Whereas paying individuals directly to be healthier seems to have a limited effect, offering financial incentives through health insurance improves health. Changing the environment to make healthier choices more accessible acts as an incentive to improve health. Employers can provide incentives to improve the health of their employees. Producers and service providers can take voluntary action to make their products less harmful, and they can be nudged into marketing healthier products within a regulatory environment. International agreements and monitoring systems can incentivize governments to do more for health. Lessons from climate change adaptation suggest that multilevel governance and policy integration are greater obstacles to policy change and implementation than knowing what has to be done. Policy change and implementation are triggered by many drivers, many of which are side effects of other policy pressures rather than of the direct policy goal itself. Effective action to reduce noncommunicable diseases will require leveraging social networks into a new ways of thinking about health; making better health prestigious and aspirational, and giving health and wellness a brand that encourages positive behavior change.

  4. Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network. (United States)

    Smith, Marie; Cannon-Breland, Michelle L; Spiggle, Susan


    Health care reform initiatives are examining new care delivery models and payment reform alternatives such as medical homes, health homes, community-based care transitions teams, medical neighborhoods and accountable care organizations (ACOs). Of particular interest is the extent to which pharmacists are integrated in team-based health care reform initiatives and the related perspectives of consumers, physicians, and payers. To assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care medication management services in a shared resource network; determine factors that will facilitate/limit consumer interest in having pharmacists as a member of a community-based "health care team;" determine factors that will facilitate/limit physician utilization of pharmacists for medication management services; and determine factors that will facilitate/limit payer reimbursement models for medication management services using a shared resource pharmacist network model. This project used qualitative research methods to assess the perceptions of consumers, primary care physicians, and payers on pharmacist-provided medication management services using a shared resource network of pharmacists. Focus groups were conducted with primary care physicians and consumers, while semi-structured discussions were conducted with a public and private payer. Most consumers viewed pharmacists in traditional dispensing roles and were unaware of the direct patient care responsibilities of pharmacists as part of community-based health teams. Physicians noted several chronic disease states where clinically-trained pharmacists could collaborate as health care team members yet had uncertainties about integrating pharmacists into their practice workflow and payment sources for pharmacist services. Payers were interested in having credentialed pharmacists provide medication management services if the services improved quality of patient

  5. Longitudinal trends in networks of university-industry-government relations in South Korea: the role of programmatic incentives

    NARCIS (Netherlands)

    Park, H.; Leydesdorff, L.


    This study examines the longitudinal trend of systemness in networked research relations in South Korea using a triple helix (TH) indicator of university-industry-government (UIG) relations. The data were harvested from the Science Citation Index (SCI) and its counterparts in the social sciences

  6. Aligning Ambition and Incentives

    DEFF Research Database (Denmark)

    Koch, Alexander; Peyrache, Eloïc

    Labor turnover creates longer term career concerns incentives that motivate employees in addition to the short term monetary incentives provided by the current employer. We analyze how these incentives interact and derive implications for the design of incentive contracts and organizational choice....... The main insights stem from a trade-off between ‘good monetary incentives' and ‘good reputational incentives'. We show that the principal optimally designs contracts to create ambiguity about agents' abilities. This may make it optimal to contract on relative performance measures, even though the extant...

  7. Mapping physician Twitter networks: describing how they work as a first step in understanding connectivity, information flow, and message diffusion. (United States)

    Mishori, Ranit; Singh, Lisa Oberoi; Levy, Brendan; Newport, Calvin


    Twitter is becoming an important tool in medicine, but there is little information on Twitter metrics. In order to recommend best practices for information dissemination and diffusion, it is important to first study and analyze the networks. This study describes the characteristics of four medical networks, analyzes their theoretical dissemination potential, their actual dissemination, and the propagation and distribution of tweets. Open Twitter data was used to characterize four networks: the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the American College of Physicians (ACP). Data were collected between July 2012 and September 2012. Visualization was used to understand the follower overlap between the groups. Actual flow of the tweets for each group was assessed. Tweets were examined using Topsy, a Twitter data aggregator. The theoretical information dissemination potential for the groups is large. A collective community is emerging, where large percentages of individuals are following more than one of the groups. The overlap across groups is small, indicating a limited amount of community cohesion and cross-fertilization. The AMA followers' network is not as active as the other networks. The AMA posted the largest number of tweets while the AAP posted the fewest. The number of retweets for each organization was low indicating dissemination that is far below its potential. To increase the dissemination potential, medical groups should develop a more cohesive community of shared followers. Tweet content must be engaging to provide a hook for retweeting and reaching potential audience. Next steps call for content analysis, assessment of the behavior and actions of the messengers and the recipients, and a larger-scale study that considers other medical groups using Twitter.

  8. Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. (United States)

    Takian, Amirhossein; Doshmangir, Leila; Rashidian, Arash


    The primary health care (PHC) network contributed considerably to improving health outcomes in rural Iran. However, the health system suffers from inadequate responses to ever-increasing demands. In 2005, a reform comprised of a family physician (FP) programme and universal health insurance was implemented in all rural areas and cities with a population of <20 000. We explored the role of the pre-existing PHC network on the implementation of FP programme in rural Iran. We conducted a qualitative study involving 71 semi-structured interviews at national, provincial and local levels, and three focus group discussions at local level, plus a purposeful content analysis of documents of various types. We used a mixed inductive/deductive framework approach for data analysis. We identified seven main aspects related to the existing primary health network, which contributed to the implementation of FP programme: 'a respected and functioning PHC network', 'accessibility and geographical coverage', 'efficient hierarchy', 'the only possible host', 'a remedy for chronic challenges in the rural PHC', 'FP as the gatekeeper?' and 'the role of the private sector'. The existence of a functioning PHC was pivotal in driving policy makers' decision to implement FP programme. Implementing a new policy depends on its hosting context. In regards to FP programme and rural insurance in Iran, the existing PHC network proved to be a fundamental asset in facilitating the implementation of FP programme in rural areas.

  9. A Novel Network for Mentoring Family Physicians on Mental Health Issues Using E-Mail (United States)

    Hunter, Jon J.; Rockman, Patricia; Gingrich, Nadine; Silveira, Jose; Salach, Lena


    Objective: Family practitioners are significant providers of mental health care and routinely report difficulty acquiring timely support in this area. The Collaborative Mental Health Care Network assembled groups of family practitioners and provided them with mental health practitioner mentors. This article addresses communication in the Network,…

  10. Incentive and Architecture of Multi-Band Enabled Small Cell and UE for Up-/Down-Link and Control-/User-Plane Splitting for 5G Mobile Networks (United States)

    Saha, Rony Kumer; Aswakul, Chaodit


    In this paper, a multi-band enabled femtocell base station (FCBS) and user equipment (UE) architecture is proposed in a multi-tier network that consists of small cells, including femtocells and picocells deployed over the coverage of a macrocell for splitting uplink and downlink (UL/DL) as well as control-plane and user-plane (C-/U-plane) for 5G mobile networks. Since splitting is performed at the same FCBS, we define this architecture as the same base station based split architecture (SBSA). For multiple bands, we consider co-channel (CC) microwave and different frequency (DF) 60 GHz millimeter wave (mmWave) bands for FCBSs and UEs with respect to the microwave band used by their over-laid macrocell base station. All femtocells are assumed to be deployed in a 3-dimensional multi-storage building. For CC microwave band, cross-tier CC interference of femtocells with macrocell is avoided using almost blank subframe based enhanced inter-cell interference coordination techniques. The co-existence of CC microwave and DF mmWave bands for SBSA on the same FCBS and UE is first studied to show their performance disparities in terms of system capacity and spectral efficiency in order to provide incentives for employing multiple bands at the same FCBS and UE and identify a suitable band for routing decoupled UL/DL or C-/U-plane traffic. We then present a number of disruptive architectural design alternatives of multi-band enabled SBSA for 5G mobile networks for UL/DL and C-/U-plane splitting, including a disruptive and complete splitting of UL/DL and C-/U-plane as well as a combined UL/DL and C-/U-plane splitting, by exploiting dual connectivity on CC microwave and DF mmWave bands. The outperformances of SBSA in terms of system level capacity, average spectral efficiency, energy efficiency, and control-plane overhead traffic capacity in comparison with different base stations based split architecture (DBSA) are shown. Finally, a number of technical and business perspectives

  11. Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study. (United States)

    Petry, Nancy M; Peirce, Jessica M; Stitzer, Maxine L; Blaine, Jack; Roll, John M; Cohen, Allan; Obert, Jeanne; Killeen, Therese; Saladin, Michael E; Cowell, Mark; Kirby, Kimberly C; Sterling, Robert; Royer-Malvestuto, Charlotte; Hamilton, John; Booth, Robert E; Macdonald, Marilyn; Liebert, Marc; Rader, Linda; Burns, Raynetta; DiMaria, Joan; Copersino, Marc; Stabile, Patricia Quinn; Kolodner, Ken; Li, Rui


    Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings. To evaluate the efficacy of an abstinence-based contingency management intervention as an addition to usual care in community treatment settings. Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks. Eight community-based outpatient psychosocial drug abuse treatment programs. A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment. All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent. Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant- and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence. Participants assigned to the abstinence-based incentive condition remained in treatment for a mean +/- SD of 8.0 +/- 4.2 weeks and attended a mean +/- SD of 19.2 +/- 16.8 counseling sessions compared with 6.9 +/- 4.4 weeks and 15.7 +/- 14.4 sessions for those assigned to the usual care condition (P<.02 for all). Participants in the abstinence-based incentive condition also submitted significantly more stimulant- and alcohol-free samples (P<.001). The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively. However, the percentage of positive samples submitted was low overall and did not differ between conditions. The abstinence-based incentive procedure, which provided a mean of 203 dollars in prizes per participant, was

  12. Prescribing patterns in dementia: a multicentre observational study in a German network of CAM physicians

    Directory of Open Access Journals (Sweden)

    Vollmar Horst C


    Full Text Available Abstract Background Dementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM by analysing prescribing patterns and comparing them to current treatment guidelines in Germany. Methods Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba. Results During the 5-year study period (2004-2008, 577 patients with dementia were included (median age: 81 years (IQR: 74-87; 69% female. Dementia was classified as unspecified dementia (57.2%, vascular dementia (25.1%, dementia in Alzheimer's disease (10.4%, and dementia in Parkinson's disease (7.3%. The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all followed by cholinesterase inhibitors (17.6%. The adjusted odds ratio (AOR for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47, the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50, neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88, co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90, and heart failure (AOR = 4.85; CI: 3.42-6.88. The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95 and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86. The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89, patient age (AOR = 1

  13. Innovation in Workforce Incentives (United States)


    Secretary of Defense and Service Secretaries should implement clearer, more tangible recognition, incentives , and enhanced promotion ...May 13, 2015 Innovation in Workforce Incentives Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection...Innovation in Workforce Incentives 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER

  14. Aligning ambition and incentives

    DEFF Research Database (Denmark)

    Koch, Alexander; Peyrache, Eloïc


    Labor turnover creates longer term career concerns incentives that motivate employees in addition to the short term monetary incentives provided by the current employer. We analyze how these incentives interact, and derive implications for the design of incentive contracts and organizational choice....... The main insights stem from a trade-off between ‘good monetary incentives’ and ‘good reputational incentives’. We show that the principal optimally designs contracts to create ambiguity about agents’ abilities. This may make it optimal to contract on relative performance measures, even though the extant...

  15. Incentives from Curriculum Tracking (United States)

    Koerselman, Kristian


    Curriculum tracking creates incentives in the years before its start, and we should therefore expect test scores to be higher during those years. I find robust evidence for incentive effects of tracking in the UK based on the UK comprehensive school reform. Results from the Swedish comprehensive school reform are inconclusive. Internationally, I…

  16. Incentives and Earnings Growth

    DEFF Research Database (Denmark)

    Frederiksen, Anders


    by investigating the effects that explicit short-run incentives and implicit incentives have on earnings growth. The model’s predictions are tested using personnel records from a large bank and are found to be consistent with the observed earnings growth during the first half of the employees’ careers....

  17. Effect of provider and patient reminders, deployment of nurse practitioners, and financial incentives on cervical and breast cancer screening rates. (United States)

    Kaczorowski, Janusz; Hearps, Stephen J C; Lohfeld, Lynne; Goeree, Ron; Donald, Faith; Burgess, Ken; Sebaldt, Rolf J


    To evaluate the effect of the Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools (P-PROMPT) reminder and recall system and pay-for-performance incentives on the delivery rates of cervical and breast cancer screening in primary care practices in Ontario, with or without deployment of nurse practitioners (NPs). Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP-augmented strategies of the P-PROMPT reminder and recall system. Southwestern Ontario. A total of 232 physicians from 24 primary care network or family health network groups across 110 different sites eligible for pay-for-performance incentives. The P-PROMPT project combined pay-for-performance incentives with provider and patient reminders and deployment of NPs to enhance the delivery of preventive care services. The mean delivery rates at the practice level of time-appropriate mammograms and Papanicolaou tests completed within the previous 30 months. Before-and-after comparisons of time-appropriate delivery rates (performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario.

  18. Handover Incentives for Self-Interested WLANs with Overlapping Coverage

    DEFF Research Database (Denmark)

    Fafoutis, Xenofon; Siris, Vasilios A.


    We consider an environment where self-interested IEEE 802.11 Wireless Local Area Networks (WLANs) have overlapping coverage, and investigate the incentives that can trigger handovers between the WLANs. Our focus is on the incentives for supporting handovers due solely to the improved performance ...

  19. Expansion of transmission networks considering incentives the addition of distributed generation; Expansao de redes de transmissao considerando incentivos a adicao de geracao distribuida

    Energy Technology Data Exchange (ETDEWEB)

    Lotero, Roberto Cayetano; Rocha, Carlos Roberto Mendonca da [Universidade Estadual do Oeste do Parana (UNIOESTE), Parana (Brazil)], emails:,


    This paper presents a model that allows to evaluate the impact of distributed generation (DG) in the expansion of high voltage transmission grid. By applying the model it is possible to determine the size and location of small range generation that can grow incrementally, avoiding or delaying large investments in transmission lines. Whereas the cost of distributed generation for the system is associated with the cost of the incentives offered for that installation, it is also possible to determine the maximum value of this incentive to stimulate the installation of some quantity of DG that postponing the expansion of the transmission grid. The results show the need to consider explicitly the introduction of DG in the expansion planning since the impact it can have on the formation of tariffs for using the transmission system is meaningful. (author)

  20. Small practices' experience with EHR, quality measurement, and incentives. (United States)

    Begum, Rohima; Smith Ryan, Mandy; Winther, Chloe H; Wang, Jason J; Bardach, Naomi S; Parsons, Amanda H; Shih, Sarah C; Dudley, R Adams


    To assess clinician attitudes and experiences in Health eHearts, a quality recognition and financial incentive program using health information technology. Survey of physicians. A survey was administered to 140 lead clinicians at each participating practice. Survey domains included clinicians' experiences and attitudes toward the selected clinical quality measures focused on cardiovascular care, use of electronic health records (EHRs), technical assistance visits, quality measurement reports, and incentive payments. Responses were compared across groups of practices receiving financial incentives with those in the control (no financial rewards). Survey response rate was 74%. The majority of respondents reported receiving and reviewing the quality reports (89%), agreed with the prioritization of measures (89%), and understood the information given in the quality reports (95%). Over half of the respondents had a quality improvement visit (56%), with incentive clinicians more likely to have had a visit compared with the control group (68% vs 43%, P = .01). The incentive group respondents (92%) were more likely to report using clinical decision support system alerts than control group respondents (82%, P = .11). Clinicians in both incentive and control groups reported positive experiences with the program. No differences were detected between groups regarding agreement with selected clinical measures or their relevance to the patient population. However, clinicians in the incentive group were more likely to review quarterly performance reports and access quality improvement visits. Incentives may be used to further engage clinicians operating in small independently owned practices to participate in quality improvement activities.

  1. Physician compensation: rewarding productivity of the knowledge worker. (United States)

    Walker, D L


    Designing a physician incentive compensation plan that aligns the demands of managed care with the perceived fairness of income distribution is a key challenge for medical practices today. Rather than focus on traditional productivity measures, managed care requires physicians to demonstrate efficient practice of medicine. Physicians still need to be highly productive; however, they are now required to demonstrate efficiency related to clinical resource management, patient access and service, and evidence-based outcomes. Approaches to the development of physician incentive compensation plans and case examples are offered to assist practices that are transitioning physician compensation from volume-based to efficiency-based indicators.

  2. Innumeracy and incentives

    Directory of Open Access Journals (Sweden)

    Donald Dale


    Full Text Available The Ratio-Bias phenomenon, observed by psychologist Seymour Epstein and colleagues, is a systematic manifestation of irrationality. When offered a choice between two lotteries, individuals consistently choose the lottery with the greater number of potential successes, even when it offers a smaller probability of success. In the current study, we conduct experiments to confirm this phenomenon and test for the existence of Bias as distinct from general irrationality. Moreover, we examine the effect of introducing a monetary incentive of varying size (depending on the treatment on the extent of irrational choices within this framework. We confirm the existence of the Bias. Moreover, the existence of an incentive significantly reduces the extent of irrationality exhibited, and that this effect is roughly linear in response to changes in the size of the incentive within the magnitudes investigated.

  3. Cost incentives for doctors

    DEFF Research Database (Denmark)

    Schottmüller, Christoph


    If doctors take the costs of treatment into account when prescribing medication, their objectives differ from their patients' objectives because the patients are insured. This misalignment of interests hampers communication between patient and doctor. Giving cost incentives to doctors increases...... welfare if (i) the doctor's examination technology is sufficiently good or (ii) (marginal) costs of treatment are high enough. If the planner can costlessly choose the extent to which doctors take costs into account, he will opt for less than 100%. Optimal health care systems should implement different...... degrees of cost incentives depending on type of disease and/or doctor....

  4. Physician leadership in changing times. (United States)

    Cochran, Jack; Kaplan, Gary S; Nesse, Robert E


    Today, hospitals and physicians are reorganizing themselves in novel ways to take advantage of payment incentives that reward shared accountability for the total health care experience. These delivery system changes will take place with our without physician leadership. To optimize change on behalf of patients, physicians must play a conscious role in shaping future health care delivery organizations. As physician leaders of three of the nation׳s largest integrated health care delivery systems - Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System - we call on physicians to view leadership and the development of leaders as key aspects of their role as patient advocates. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Incentive Funding Meets Incentive-Based Budgeting: Can They Coexist? (United States)

    Lang, Daniel W.


    Two major developments in the financial management of higher education have occurred more or less contemporaneously: incentive or performance funding on the part of government and incentive-based budgeting on the part of institutions. Both are based on fiscal incentives. Despite their several inherent and interconnected similarities, incentive…

  6. Taking incentive regulation into account in assessing the yield of electricity and gas networks; Beruecksichtigung der Anreizregulierung bei der Ertragsbewertung von Strom- und Gasnetzen

    Energy Technology Data Exchange (ETDEWEB)

    Zander, W.; Steinbach, P.; Hintze, D. [BET Buero fuer Energiewirtschaft und Technische Planung GmbH, Aachen (Germany)


    The most common motive for network assessments is when a network is to change owners due to the expiry of a concession contract between a town or municipality as licensing authority and a network operator as licensee. At the contract's expiry, which in most cases is after a term of 20 years, the municipality has a number of options at its disposal. Besides renewing the contract it can grant the license to a new partner or participate in the takeover by founding a company of its own. In the latter case various corporate constellations are conceivable, each of which has its own opportunities and risks. In today's liberalised market network operators must meet far higher requirements than they used to. Therefore the best solution usually is to enter into a cooperation with a third party that is already operating in proximity to the network area in question.

  7. Physician Compare (United States)

    U.S. Department of Health & Human Services — Physician Compare, which meets Affordable Care Act of 2010 requirements, helps you search for and select physicians and other healthcare professionals enrolled in...

  8. Psychology, economics and incentives.


    Biel, P. R.


    This PhD. Thesis deals with the effects that psychological phenomena may have on the incentives of agents participating in economic interaction. In particular, I focus on how individuals' preference for certain distributions of welfare among others may affect their effort and other strategic decisions in a variety of contexts. The thesis consists of five chapters. The first one introduces the study. The next two chapters are theoretical and study the effects that aversion to inequity may have...

  9. Incentives and Prosocial Behavior


    Bénabou, Roland; Tirole, Jean


    We develop a theory of prosocial behavior that combines heterogeneity in individual altruism and greed with concerns for social reputation or self-respect. Rewards or punishments (whether material or image-related) create doubt about the true motive for which good deeds are performed, and this ?overjustification effect? can induce a partial or even net crowding out of prosocial behavior by extrinsic incentives. We also identify the settings that are conducive to multiple social norms and, mor...

  10. Using social media to create a professional network between physician-trainees and the American Society of Nephrology. (United States)

    Shariff, Afreen I; Fang, Xiangming; Desai, Tejas


    Twitter is the fastest growing social media network. It offers participants the ability to network with other individuals. Medical societies are interested in helping individuals network to boost recruitment, encourage collaboration, and assist in job placement. We hypothesized that the American Society of Nephrology (ASN) successfully used Twitter to create a network between participants and itself to stay connected with its members. Tweets from 3 Twitter networking sessions during Kidney Week 2011 were analyzed for content. These messages were used to create a network between all participants of the networking sessions. The network was analyzed for strength and influence by calculating clustering coefficients (CC) and eigenvector centrality (EC) scores, respectively. Eight moderators and 9 trainees authored 376 Twitter messages. Most tweets by trainees (64%) and moderators (61%) discussed 1 of 3 themes: networking, education, or navigating Kidney Week 2011. A total of 25 online network connections were established during the 3 sessions; 20% were bidirectional. The CC for the network was 0.300. All moderators formed at least 1 connection, but 7 of the 9 trainees failed to make any connections. ASN made 5 unidirectional and 0 bidirectional connections with a low EC of 0.108. ASN was unable to form powerful connections with trainees through Twitter, but medical societies should not be discouraged by the results reported in this investigation. As societies become more familiar with Twitter and understand the mechanisms to develop connections, these societies will have a greater influence within increasingly stronger networks. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  11. Incentives, health promotion and equality. (United States)

    Voigt, Kristin


    The use of incentives to encourage individuals to adopt 'healthier' behaviours is an increasingly popular instrument in health policy. Much of the literature has been critical of 'negative' incentives, often due to concerns about equality; 'positive' incentives, however, have largely been welcomed as an instrument for the improvement of population health and possibly the reduction of health inequalities. The aim of this paper is to provide a more systematic assessment of the use of incentives from the perspective of equality. The paper begins with an overview of existing and proposed incentive schemes. I then suggest that the distinction between 'positive' and 'negative' incentives - or 'carrots' and 'sticks' - is of limited use in distinguishing those incentive schemes that raise concerns of equality from those that do not. The paper assesses incentive schemes with respect to two important considerations of equality: equality of access and equality of outcomes. While our assessment of incentive schemes will, ultimately, depend on various empirical facts, the paper aims to advance the debate by identifying some of the empirical questions we need to ask. The paper concludes by considering a number of trade-offs and caveats relevant to the assessment of incentive schemes.

  12. Offering Incentives from the Outside

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.


    Incentives offer a good deal of underexplored opportunities to help manage conflict by encouraging political bargaining. This study has two primary objectives. First, it furthers the discussion of how external third parties can help manage conflicts. Second, it offers a typology of the available...... incentive strategies, classifying them along noncoercive and coercive lines. Thus, the article outlines the possibilities offered by an incentives approach, focusing on examples drawn from recent African cases....

  13. Social media: physicians-to-physicians education and communication. (United States)

    Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K


    Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.

  14. Incentives for smoking cessation. (United States)

    Cahill, Kate; Hartmann-Boyce, Jamie; Perera, Rafael


    Material or financial incentives are widely used in an attempt to precipitate or reinforce behaviour change, including smoking cessation. They operate in workplaces, in clinics and hospitals, and to a lesser extent within community programmes. In this third update of our review we now include trials conducted in pregnant women, to reflect the increasing activity and resources now targeting this high-risk group of smokers. To determine whether incentives and contingency management programmes lead to higher long-term quit rates. We searched the Cochrane Tobacco Addiction Group Specialised Register, with additional searches of MEDLINE, EMBASE, CINAHL and PsycINFO. The most recent searches were in December 2014, although we also include two trials published in 2015. We considered randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. We include studies in a mixed-population setting (e.g. community-, work-, institution-based), and also, for this update, trials in pregnant smokers. One author (KC) extracted data and a second (JH-B) checked them. We contacted study authors for additional data where necessary. The main outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up, and at least six months from the start of the intervention. In the trials of pregnant smokers abstinence was measured at the longest follow-up, and at least to the end of the pregnancy. Twenty-one mixed-population studies met our inclusion criteria, covering more than 8400 participants. Ten studies were set in clinics or health centres, one in Thai villages served by community health workers, two in academic institutions, and the rest in worksites. All but six of the trials were run in the USA. The incentives included lottery tickets or prize draws, cash payments, vouchers for goods and

  15. Financial incentives and weight control. (United States)

    Jeffery, Robert W


    This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of behavioral theories pertaining to incentives and describes empirical studies evaluating specific aspects of incentives. Research on financial incentives and weight control has a history spanning more than 30 years. Early studies were guided by operant learning concepts from Psychology, while more recent studies have relied on economic theory. Both theoretical orientations argue that providing financial rewards for losing weight should motivate people to engage in behaviors that produce weight loss. Empirical research has strongly supported this idea. However, results vary widely due to differences in incentive size and schedule, as well as contextual factors. Thus, many important questions about the use of incentives have not yet been clearly answered. Weight-maintenance studies using financial incentives are particularly sparse, so that their long-term efficacy and thus, value in addressing the public health problem of obesity is unclear. Major obstacles to sustained applications of incentive in weight control are funding sources and acceptance by those who might benefit. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Separating Real Incentives and Accountability

    NARCIS (Netherlands)

    F.M. Vieider (Ferdinand)


    textabstractIn experimental investigations of the effect of real incentives, accountability—the implicit or explicit expectation of a decision maker that she may have to justify her decisions in front of somebody else—is often confounded with the incentives themselves. This confounding of

  17. Incentives and moral hazard

    DEFF Research Database (Denmark)

    Wendimu, Mengistu Assefa; Henningsen, Arne; Czekaj, Tomasz Gerard


    system and thus, the incentives to the workers. We compare the productivity of these two production schemes using a cross-sectional plot-level data set. As sugarcane production depends on various exogenous factors that are measured as categorical variables (e.g., soil type, cane variety, etc.), we......We investigate the unique contractual arrangement between a large Ethiopian sugar factory and its adjacent outgrower associations. The only significant difference between the sugarcane production on the factory-operated sugarcane plantation and on the outgrower-operated plots is the remuneration...... estimate the production function by a nonparametric kernel regression method that takes into account both continuous and categorical explanatory variables without assuming a functional form and without imposing restrictions on interactions between the explanatory variables. Our results show that outgrower...

  18. Challenges in recruiting minority-serving private practice primary care physicians to a quality improvement project. (United States)

    Meehan, Thomas P; Van Hoof, Thomas J; Galusha, Deron; Barr, Judith K; Curry, Maureen; Kelvey-Albert, Michele; Meehan, Thomas P


    The objectives of this study were the following: (1) describe one organization's experience with recruiting minority-serving private practice primary care physicians to an ambulatory quality improvement (QI) project; (2) compare and contrast physicians who agreed to participate with those who declined; and (3) list incentives and barriers to participation. The authors identified eligible physicians by analyzing Medicare Part B claims data, a publicly available physician database, and office staff responses to telephone inquiries. The recruitment team had difficulty identifying, contacting, and recruiting eligible physicians. Solo practitioners and physicians who had lower scores on certain quality measures were more likely to participate. Barriers to participation were similar in all practices and included concerns about extra work, difficulty of change, and impact on office work flow. Commonly used incentives were offered but were not universally embraced. Additional work is required to refine the process of physician recruitment and to find more compelling incentives for QI.

  19. The influence of provider characteristics and market forces on response to financial incentives. (United States)

    O'Neil, Brock; Tyson, Mark; Graves, Amy J; Barocas, Daniel A; Chang, Sam S; Penson, David F; Resnick, Matthew J


    Alternative payment models, such as accountable care organizations, use financial incentives as levers for change to facilitate the transition from volume to value. However, implementation raises concerns about adverse changes in market competition and the resultant physician response. We sought to identify physician characteristics and market-level factors associated with variation in response to financial incentives for cancer care that may ultimately be leveraged in risk-shared payment models. Retrospective cohort study of physicians providing minimally invasive bladder cancer procedures to fee-for-service Medicare beneficiaries. We examined the relationship of between-group differences in market-level factors (competition [Herfindahl-Hirschman Index (HHI)] and provider density) and physician-level factors (use of unique billing codes, number of billing codes per patient, and competing financial interest) to responsiveness to financial incentives. Incentive-responsive providers had increased odds (odds ratio [OR], 1.19; 95% CI, 1.04-1.35) of practicing in markets with the highest quartile of provider density but not HHI (OR, 0.96; 95% CI, 0.87-1.05). Incentive-responsive providers were more likely to bill in the highest quartile for unique codes (OR, 1.49; 95% CI, 1.32-1.69) and codes per patient (OR, 1.18; 95% CI, 1.11-1.25) and less likely to have a competing financial interest (OR, 0.76; 95% CI, 0.72-0.81). Responsiveness to financial incentives in cancer care is associated with high market provider density, profit-maximizing billing behavior, and lack of competing financial ownership interests. Identifying physicians and markets responsive to financial incentives may ultimately promote the successful implementation of alternative payment models in cancer care.

  20. Incentives and Big E Engagement. (United States)

    Terry, Paul E


    The kind of engagement industrial psychologists have shown can produce optimal performance relates more to a state of mind than to increasing participation in programs or motivating a workforce with financial incentives. In the context of quality improvement methodologies, the health promotion profession has yet to discover when, where and how large financial incentives should be and how they best fit in our processes. That is, there is no "standard work" for the use of extrinsic motivators. Yet, to argue against incentives given evidence to date has more to do with polemics than science.

  1. Premier Hospital Quality Incentive Demonstration (United States)

    U.S. Department of Health & Human Services — CMS is pursuing a vision to improve the quality of health care by expanding the information available about quality of care and through direct incentives to reward...

  2. Increasing Army Retention Through Incentives

    National Research Council Canada - National Science Library

    Beerman, Kevin


    .... This study examines current retention issues and the Army Incentive Model. The model appears to offer a range of benefits that may retain a segment of what demographers have labeled as the Millennium Generation...

  3. Motivating employees through incentive programs.


    Lai, Calista.


    Motivated employees are the cornerstone of any successful organization. The objectives of this research are to explore the motivational factors and the effectiveness of these incentive programs pertaining to work motivation. The thesis consists of two main components: theoretical and research. The first part is the theoretical framework, which examines the various motivation theories and the different categories of incentives. Information for the theoretical background was collected from publ...

  4. On Manufacturing/Marketing Incentives


    Evan L. Porteus; Seungjin Whang


    Stereotypically, marketing is mainly concerned about satisfying customers and manufacturing is mainly interested in factory efficiency. Using the principal-agent (agency) paradigm, which assumes that the marketing and manufacturing managers of the firm will act in their self-interest, we seek incentive plans that will induce those managers to act so that the owner of the firm can attain as much as possible of the residual returns. One optimal incentive plan can be interpreted as follows: The ...

  5. Long Term Incentives for Residential Customers Using Dynamic Tariff

    DEFF Research Database (Denmark)

    Huang, Shaojun; Wu, Qiuwei; Nielsen, Arne Hejde


    This paper reviews several grid tariff schemes, including flat tariff, time-of-use, time-varying tariff, demand charge and dynamic tariff (DT), from the perspective of the long term incentives. The long term incentives can motivate the owners of flexible demands to change their energy consumption...... behavior in such a way that the power system operation issues, such as system balance and congestion, can be alleviated. From the comparison study, including analysis and case study, the DT scheme outperforms the other tariff schemes in terms of cost saving and network operation condition improving....

  6. Improving clinical productivity in the academic setting: a novel incentive plan based on utility theory. (United States)

    Wilson, Madeline S; Joiner, Keith A; Inzucchi, Silvio E; Mulligan, Gary J; Mechem, Mary F; Gross, Cary P; Coleman, David L


    Academic internal medicine practices face growing challenges to financial viability due to high overhead, competing institutional missions, and suboptimal physician productivity. The authors describe the development of a clinical incentive plan for a group of academic subspecialty physicians at the Dana Clinic, an outpatient setting at Yale School of Medicine, and report on results of the first year's experience under the plan. Utility theory was used to assess the risk profile of clinic faculty and identify incentive payments that would optimize faculty benefit or "utility" while minimizing departmental costs. Under the plan, physicians who reached a productivity target based on work Relative Value Units (wRVUs) between October 2003 and November 2004 had overhead costs covered and received a fixed payment to support salary; additional incentive payments were available for those exceeding the target. Physicians failing to reach the target were responsible for their own overhead costs and received no fixed payment. Physician productivity as measured by wRVU per full-time equivalent (FTE) was compared for the year prior to, and the year following, incentive plan introduction. Forty-seven members of eight academic sections were included in the analysis. Median productivity improved by 34%, with 42 of 47 physicians showing improvement. Significant improvements were also noted in collections (62%) and visit volume (23%), and shifts were observed in coding patterns. The unique threshold-based structure of the incentive plan, as determined through utility theory modeling, as well as permitting physicians to choose how to achieve the wRVU target were key features of its success, resulting in improved productivity without increasing practice resources or faculty salaries.

  7. Cost-Effectiveness of Rural Incentive Packages for Graduating Medical Students in Lao PDR

    Directory of Open Access Journals (Sweden)

    Eric Keuffel


    Full Text Available Background The dearth of health workers in rural settings in Lao People’s Democratic Republic (PDR and other developing countries limits healthcare access and outcomes. In evaluating non-wage financial incentive packages as a potential policy option to attract health workers to rural settings, understanding the expected costs and effects of the various programs ex antecan assist policy-makers in selecting the optimal incentive package. Methods We use discrete choice experiments (DCEs, costing analyses and recent empirical results linking health worker density and health outcomes to estimate the future location decisions of physicians and determine the costeffectiveness of 15 voluntary incentives packages for new physicians in Lao PDR. Our data sources include a DCE survey completed by medical students (n = 329 in May 2011 and secondary cost, economic and health data. Mixed logit regressions provide the basis for estimating how each incentive package influences rural versus urban location choice over time. We estimate the expected rural density of physicians and the cost-effectiveness of 15 separate incentive packages from a societal perspective. In order to generate the cost-effectiveness ratios we relied on the rural uptake probabilities inferred from the DCEs, the costing data and prior World Health Organization (WHO estimates that relate health outcomes to health worker density. Results Relative to no program, the optimal voluntary incentive package would increase rural physician density by 15% by 2016 and 65% by 2041. After incorporating anticipated health effects, seven (three of the 15 incentive packages have anticipated average cost-effectiveness ratio less than the WHO threshold (three times gross domestic product [GDP] per capita over a 5-year (30 year period. The optimal package’s incremental cost-effectiveness ratio is $1454/QALY (quality-adjusted life year over 5 years and $2380/QALY over 30 years. Capital intensive components

  8. Cost-Effectiveness of Rural Incentive Packages for Graduating Medical Students in Lao PDR. (United States)

    Keuffell, Eric; Jaskiewicz, Wanda; Theppanya, Khampasong; Tulenko, Kate


    The dearth of health workers in rural settings in Lao People's Democratic Republic (PDR) and other developing countries limits healthcare access and outcomes. In evaluating non-wage financial incentive packages as a potential policy option to attract health workers to rural settings, understanding the expected costs and effects of the various programs ex ante can assist policy-makers in selecting the optimal incentive package. We use discrete choice experiments (DCEs), costing analyses and recent empirical results linking health worker density and health outcomes to estimate the future location decisions of physicians and determine the cost-effectiveness of 15 voluntary incentives packages for new physicians in Lao PDR. Our data sources include a DCE survey completed by medical students (n = 329) in May 2011 and secondary cost, economic and health data. Mixed logit regressions provide the basis for estimating how each incentive package influences rural versus urban location choice over time. We estimate the expected rural density of physicians and the cost-effectiveness of 15 separate incentive packages from a societal perspective. In order to generate the cost-effectiveness ratios we relied on the rural uptake probabilities inferred from the DCEs, the costing data and prior World Health Organization (WHO) estimates that relate health outcomes to health worker density. Relative to no program, the optimal voluntary incentive package would increase rural physician density by 15% by 2016 and 65% by 2041. After incorporating anticipated health effects, seven (three) of the 15 incentive packages have anticipated average cost-effectiveness ratio less than the WHO threshold (three times gross domestic product [GDP] per capita) over a 5-year (30 year) period. The optimal package's incremental cost-effectiveness ratio is $1454/QALY (quality-adjusted life year) over 5 years and $2380/QALY over 30 years. Capital intensive components, such as housing or facility improvement

  9. The effect of performance-based financial incentives on improving patient care experiences: a statewide evaluation. (United States)

    Rodriguez, Hector P; von Glahn, Ted; Elliott, Marc N; Rogers, William H; Safran, Dana Gelb


    Patient experience measures are central to many pay-for-performance (P4P) programs nationally, but the effect of performance-based financial incentives on improving patient care experiences has not been assessed. The study uses Clinician & Group CAHPS data from commercially insured adult patients (n = 124,021) who had visits with 1,444 primary care physicians from 25 California medical groups between 2003 and 2006. Medical directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the patient experience improvement activities adopted by groups. Multilevel regression models were used to assess the relationship between performance change on patient care experience measures and medical group characteristics, financial incentives, and performance improvement activities. Over the course of the study period, physicians improved performance on the physician-patient communication (0.62 point annual increase, p performance on patient experience measures experienced larger improvements (p performance on the physician communication (p performance-based financial incentives, patient care experiences significantly improved. In order to promote patient-centered care in pay for performance and public reporting programs, the mechanisms by which program features influence performance improvement should be clarified.

  10. Negative incentive steering in a policy network

    NARCIS (Netherlands)

    van Vught, Franciscus A.


    In this article the process of developing a policy for the recent comprehensive retrenchment operation in the Dutch university system is analysed from a theoretical point of view on decisionmaking. The article especially addresses the question whether some empirical evidence can be found for the

  11. Organizational commitment of military physicians. (United States)

    Demir, Cesim; Sahin, Bayram; Teke, Kadir; Ucar, Muharrem; Kursun, Olcay


    An individual's loyalty or bond to his or her employing organization, referred to as organizational commitment, influences various organizational outcomes such as employee motivation, job satisfaction, performance, accomplishment of organizational goals, employee turnover, and absenteeism. Therefore, as in other sectors, employee commitment is crucial also in the healthcare market. This study investigates the effects of organizational factors and personal characteristics on organizational commitment of military physicians using structural equation modeling (SEM) on a self-report, cross-sectional survey that consisted of 635 physicians working in the 2 biggest military hospitals in Turkey. The results of this study indicate that professional commitment and organizational incentives contribute positively to organizational commitment, whereas conflict with organizational goals makes a significantly negative contribution to it. These results might help develop strategies to increase employee commitment, especially in healthcare organizations, because job-related factors have been found to possess greater impact on organizational commitment than personal characteristics.

  12. An incentive-based architecture for social recommendations

    KAUST Repository

    Bhattacharjee, Rajat


    We present an incentive-based architecture for providing recommendations in a social network. We maintain a distinct reputation system for each individual and we rely on users to identify appropriate correlations and rate the items using a system-provided recommendation language. The key idea is to design an incentive structure and a ranking system such that any inaccuracy in the recommendations implies the existence of a profitable arbitrage opportunity, hence making the system resistant to malicious spam and presentation bias. We also show that, under mild assumptions, our architecture provides users with incentive to minimize the Kullback-Leibler divergence between the ratings and the actual item qualities, quickly driving the system to an equilibrium state with accurate recommendations. Copyright 2009 ACM.

  13. Discordant American College of Physicians and international rheumatology guidelines for gout management: consensus statement of the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN). (United States)

    Dalbeth, Nicola; Bardin, Thomas; Doherty, Michael; Lioté, Frédéric; Richette, Pascal; Saag, Kenneth G; So, Alexander K; Stamp, Lisa K; Choi, Hyon K; Terkeltaub, Robert


    In November 2016, the American College of Physicians (ACP) published a clinical practice guideline on the management of acute and recurrent gout. This guideline differs substantially from the latest guidelines generated by the American College of Rheumatology (ACR), European League Against Rheumatism (EULAR) and 3e (Evidence, Expertise, Exchange) Initiative, despite reviewing largely the same body of evidence. The Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) convened an expert panel to review the methodology and conclusions of these four sets of guidelines and examine possible reasons for discordance between them. The G-CAN position, presented here, is that the fundamental pathophysiological knowledge underlying gout care, and evidence from clinical experience and clinical trials, supports a treat-to-target approach for gout aimed at lowering serum urate levels to below the saturation threshold at which monosodium urate crystals form. This practice, which is truly evidence-based and promotes the steady reduction in tissue urate crystal deposits, is promoted by the ACR, EULAR and 3e Initiative recommendations. By contrast, the ACP does not provide a clear recommendation for urate-lowering therapy (ULT) for patients with frequent, recurrent flares or those with tophi, nor does it recommend monitoring serum urate levels of patients prescribed ULT. Results from emerging clinical trials that have gout symptoms as the primary end point are expected to resolve this debate for all clinicians in the near term future.

  14. The Effect of External Incentives on Profits and Firm-Provided Incentives Strategy


    Ofer H. Azar


    The article examines the firm's choice of incentives when workers face additional incentives (“external incentives”) to those provided by the firm, such as building reputation that improves the workers' prospects with other employers, or satisfaction from working well. Surprisingly, the firm might find it optimal to increase the incentives it provides following an increase in external incentives. Even if the firm reduces its incentives, however, total incentives unambiguously increase, leadin...

  15. The effect of a monetary incentive for administrative assistants on the survey response rate: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Arnav Agarwal


    Full Text Available Abstract Background There is sufficient evidence that monetary incentives are effective in increasing survey response rates in the general population as well as with physicians. The objective of this study was to assess the impact of a monetary incentive intended for administrative assistants on the survey response rate of physicians in leadership positions. Methods This was an ancillary study to a national survey of chairs of academic Departments of Medicine in the United States about measuring faculty productivity. We randomized survey participants to receive or not receive a $5 gift card enclosed in the survey package. The cover letter explained that the gift card was intended for the administrative assistants as a “thank you for their time.” We compared the response rates between the 2 study arms using the Chi-square test. Results Out of 152 participants to whom survey packages were mailed to, a total of 78 responses were received (51 % response rate. The response rates were 59 % in the incentive arm and 46 % in the no incentive arm. The relative effect of the incentive compared to no monetary incentive was borderline statistically significant (relative risk (RR = 1.36, 95 % confidence interval (CI 0.99 to 1.87; p = 0.055. Conclusion Monetary incentives intended for administrative assistants likely increase the response rate of physicians in leadership positions.

  16. Modeling regulated water utility investment incentives (United States)

    Padula, S.; Harou, J. J.


    This work attempts to model the infrastructure investment choices of privatized water utilities subject to rate of return and price cap regulation. The goal is to understand how regulation influences water companies' investment decisions such as their desire to engage in transfers with neighbouring companies. We formulate a profit maximization capacity expansion model that finds the schedule of new supply, demand management and transfer schemes that maintain the annual supply-demand balance and maximize a companies' profit under the 2010-15 price control process in England. Regulatory incentives for costs savings are also represented in the model. These include: the CIS scheme for the capital expenditure (capex) and incentive allowance schemes for the operating expenditure (opex) . The profit-maximizing investment program (what to build, when and what size) is compared with the least cost program (social optimum). We apply this formulation to several water companies in South East England to model performance and sensitivity to water network particulars. Results show that if companies' are able to outperform the regulatory assumption on the cost of capital, a capital bias can be generated, due to the fact that the capital expenditure, contrarily to opex, can be remunerated through the companies' regulatory capital value (RCV). The occurrence of the 'capital bias' or its entity depends on the extent to which a company can finance its investments at a rate below the allowed cost of capital. The bias can be reduced by the regulatory penalties for underperformances on the capital expenditure (CIS scheme); Sensitivity analysis can be applied by varying the CIS penalty to see how and to which extent this impacts the capital bias effect. We show how regulatory changes could potentially be devised to partially remove the 'capital bias' effect. Solutions potentially include allowing for incentives on total expenditure rather than separately for capex and opex and allowing

  17. Unintended consequences of incentive provision for behaviour change and maintenance around childbirth.

    Directory of Open Access Journals (Sweden)

    Gill Thomson

    Full Text Available Financial (positive or negative and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497 including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing

  18. Optimal incentives for collective intelligence. (United States)

    Mann, Richard P; Helbing, Dirk


    Collective intelligence is the ability of a group to perform more effectively than any individual alone. Diversity among group members is a key condition for the emergence of collective intelligence, but maintaining diversity is challenging in the face of social pressure to imitate one's peers. Through an evolutionary game-theoretic model of collective prediction, we investigate the role that incentives may play in maintaining useful diversity. We show that market-based incentive systems produce herding effects, reduce information available to the group, and restrain collective intelligence. Therefore, we propose an incentive scheme that rewards accurate minority predictions and show that this produces optimal diversity and collective predictive accuracy. We conclude that real world systems should reward those who have shown accuracy when the majority opinion has been in error.

  19. The Original Management Incentive Schemes


    Richard T. Holden


    During the 1990s, the structure of pay for top corporate executives shifted markedly as the use of stock options greatly expanded. By the early 2000s, as the dot-com boom ended and the Nasdaq stock index melted down, these modern executive incentive schemes were being sharply questioned on many grounds—for encouraging excessive risk-taking and a short-run orientation, for being an overly costly and inefficient method of providing incentives, and even for tempting managers of firms like Enron,...

  20. Do not trash the incentive! Monetary incentives and waste sorting

    NARCIS (Netherlands)

    Bucciol, A.; Montinari, N.; Piovesan, M.


    This paper examines whether monetary incentives are an effective tool for increasing domestic waste sorting. We exploit the exogenous variation in the pricing systems experienced during the 1999-2008 decade by the 95 municipalities in the district of Treviso (Italy). We estimate with a panel

  1. Physicians and Insider Trading. (United States)

    Kesselheim, Aaron S; Sinha, Michael S; Joffe, Steven


    Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information.

  2. Reports of unintended consequences of financial incentives to improve management of hypertension.

    Directory of Open Access Journals (Sweden)

    Sylvia J Hysong

    Full Text Available Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT of financial incentives.We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis.Sixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site.Emergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems rather than financial incentives.Many unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended Identifier: NCT

  3. Reports of unintended consequences of financial incentives to improve management of hypertension. (United States)

    Hysong, Sylvia J; SoRelle, Richard; Broussard Smitham, Kristen; Petersen, Laura A


    Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives. We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis. Sixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site. Emergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems) rather than financial incentives. Many unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended consequences. Identifier: NCT00302718.

  4. Variation in Incentive Effects across Neighbourhoods

    Directory of Open Access Journals (Sweden)

    Mark J Hanly


    Full Text Available Small monetary incentives increase survey cooperation rates, however evidence suggests that the appeal of incentives may vary across sample subgroups. Fieldwork budgets can be most effectively distributed by targeting those subgroups where incentives will have the strongest appeal. We examine data from a randomised experiment implemented in the pilot phase of the Irish Longitudinal Study of Ageing, which randomly assigned households to receive a higher (€25 or lower (€10 incentive amount. Using a random effects logistic regression model, we observe a variable effect of the higher incentive across geographic neighbourhoods. The higher incentive has the largest impact in neighbourhoods where baseline cooperation is low, as predicted by Leverage-Saliency theory. Auxiliary neighbourhood-level variables are linked to the sample frame to explore this variation further, however none of these moderate the incentive effect, suggesting that richer information is needed to identify sample subgroups where incentive budgets should be directed.

  5. An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Forberg Jakob L


    Full Text Available Abstract Background Pre-hospital electrocardiogram (ECG transmission to an expert for interpretation and triage reduces time to acute percutaneous coronary intervention (PCI in patients with ST elevation Myocardial Infarction (STEMI. In order to detect all STEMI patients, the ECG should be transmitted in all cases of suspected acute cardiac ischemia. The aim of this study was to examine the ability of an artificial neural network (ANN to safely reduce the number of ECGs transmitted by identifying patients without STEMI and patients not needing acute PCI. Methods Five hundred and sixty ambulance ECGs transmitted to the coronary care unit (CCU in routine care were prospectively collected. The ECG interpretation by the ANN was compared with the diagnosis (STEMI or not and the need for an acute PCI (or not as determined from the Swedish coronary angiography and angioplasty register. The CCU physician's real time ECG interpretation (STEMI or not and triage decision (acute PCI or not were registered for comparison. Results The ANN sensitivity, specificity, positive and negative predictive values for STEMI was 95%, 68%, 18% and 99%, respectively, and for a need of acute PCI it was 97%, 68%, 17% and 100%. The area under the ANN's receiver operating characteristics curve for STEMI detection was 0.93 (95% CI 0.89-0.96 and for predicting the need of acute PCI 0.94 (95% CI 0.90-0.97. If ECGs where the ANN did not identify a STEMI or a need of acute PCI were theoretically to be withheld from transmission, the number of ECGs sent to the CCU could have been reduced by 64% without missing any case with STEMI or a need of immediate PCI. Conclusions Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds.

  6. Incentive Contracts and Cost Growth (United States)


    Jack Livingston. Also see draft of DOI acd NASA Incentive Contracting Guide, Jan. 467.) Industry might not set up an infrastructure to implement...cmiuurcial ve tures is fusided through DOD business. I Can an Wicentive based on profit maximization function effectively in the above- environment? It is

  7. Incentives and regulation in banking

    NARCIS (Netherlands)

    Martynova, N.


    The financial crisis of 2007-2008 has unveiled the hidden flaws in the regulatory framework of the financial sector. The rules of the game established by regulators were not stringent enough and provided bankers with wrong incentives to gamble with depositors’ money. There are two major challenges

  8. Incentive Ratios of Fisher Markets

    DEFF Research Database (Denmark)

    Chen, Ning; Deng, Xuaitue; Zhang, Hongyang


    by misreporting their private information, we show that the percentage of improvement by a unilateral strategic play, called incentive ratio, is rather limited—it is less than 2 for linear markets and at most $e^{1/e}\\thickapprox 1.445$ for Cobb-Douglas markets. We further prove that both ratios are tight....

  9. Incentives in Supply Function Equilibrium

    DEFF Research Database (Denmark)

    Vetter, Henrik


    The author analyses delegation in homogenous duopoly under the assumption that the firm-managers compete in supply functions. In supply function equilibrium, managers’ decisions are strategic complements. This reverses earlier findings in that the author finds that owners give managers incentives...

  10. Incentives in Supply Function Equilibrium

    DEFF Research Database (Denmark)

    Vetter, Henrik


    The author analyses delegation in homogenous duopoly under the assumption that firm-managers compete in supply functions. He reverses earlier findings in that owners give managers incentives to act in an accommodating way. That is, optimal delegation reduces per-firm output and increases profits...

  11. The Effect of Incentives and Meta-incentives on the Evolution of Cooperation.

    Directory of Open Access Journals (Sweden)

    Isamu Okada


    Full Text Available Although positive incentives for cooperators and/or negative incentives for free-riders in social dilemmas play an important role in maintaining cooperation, there is still the outstanding issue of who should pay the cost of incentives. The second-order free-rider problem, in which players who do not provide the incentives dominate in a game, is a well-known academic challenge. In order to meet this challenge, we devise and analyze a meta-incentive game that integrates positive incentives (rewards and negative incentives (punishments with second-order incentives, which are incentives for other players' incentives. The critical assumption of our model is that players who tend to provide incentives to other players for their cooperative or non-cooperative behavior also tend to provide incentives to their incentive behaviors. In this paper, we solve the replicator dynamics for a simple version of the game and analytically categorize the game types into four groups. We find that the second-order free-rider problem is completely resolved without any third-order or higher (meta incentive under the assumption. To do so, a second-order costly incentive, which is given individually (peer-to-peer after playing donation games, is needed. The paper concludes that (1 second-order incentives for first-order reward are necessary for cooperative regimes, (2 a system without first-order rewards cannot maintain a cooperative regime, (3 a system with first-order rewards and no incentives for rewards is the worst because it never reaches cooperation, and (4 a system with rewards for incentives is more likely to be a cooperative regime than a system with punishments for incentives when the cost-effect ratio of incentives is sufficiently large. This solution is general and strong in the sense that the game does not need any centralized institution or proactive system for incentives.

  12. The Effect of Incentives and Meta-incentives on the Evolution of Cooperation. (United States)

    Okada, Isamu; Yamamoto, Hitoshi; Toriumi, Fujio; Sasaki, Tatsuya


    Although positive incentives for cooperators and/or negative incentives for free-riders in social dilemmas play an important role in maintaining cooperation, there is still the outstanding issue of who should pay the cost of incentives. The second-order free-rider problem, in which players who do not provide the incentives dominate in a game, is a well-known academic challenge. In order to meet this challenge, we devise and analyze a meta-incentive game that integrates positive incentives (rewards) and negative incentives (punishments) with second-order incentives, which are incentives for other players' incentives. The critical assumption of our model is that players who tend to provide incentives to other players for their cooperative or non-cooperative behavior also tend to provide incentives to their incentive behaviors. In this paper, we solve the replicator dynamics for a simple version of the game and analytically categorize the game types into four groups. We find that the second-order free-rider problem is completely resolved without any third-order or higher (meta) incentive under the assumption. To do so, a second-order costly incentive, which is given individually (peer-to-peer) after playing donation games, is needed. The paper concludes that (1) second-order incentives for first-order reward are necessary for cooperative regimes, (2) a system without first-order rewards cannot maintain a cooperative regime, (3) a system with first-order rewards and no incentives for rewards is the worst because it never reaches cooperation, and (4) a system with rewards for incentives is more likely to be a cooperative regime than a system with punishments for incentives when the cost-effect ratio of incentives is sufficiently large. This solution is general and strong in the sense that the game does not need any centralized institution or proactive system for incentives.

  13. Patient–physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study (United States)

    Tucker, Joseph D; Cheng, Yu; Wong, Bonnie; Gong, Ni; Nie, Jing-Bao; Zhu, Wei; McLaughlin, Megan M; Xie, Ruishi; Deng, Yinghui; Huang, Meijin; Wong, William C W; Lan, Ping; Liu, Huanliang; Miao, Wei; Kleinman, Arthur


    Objective To better understand the origins, manifestations and current policy responses to patient–physician mistrust in China. Design Qualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust. Setting Guangdong Province, China. Participants One hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient–physician relationships. Results One of the most prominent forces driving patient–physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient–physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient–physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient–physician trust. Conclusions The blind pursuit of financial profits at a systems level has eroded patient–physician trust in China. Restructuring incentives

  14. 20 CFR 638.519 - Incentives system. (United States)


    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Incentives system. 638.519 Section 638.519... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.519 Incentives system. The center operator shall establish and maintain its own incentives system for students in accordance with procedures...

  15. Incentive Systems for Education Personnel. Final Report. (United States)

    Guttenberg, Richard

    Herein are discussed the question of what is an incentive; the use of incentives in industry; the current patterns of reward and punishment in the schools; policy implications of the patterns of reward and punishment currently found in the schools; from an historical view, the incentive systems that the schools have tried out in the past,…

  16. Merger incentives and the failing firm defense

    NARCIS (Netherlands)

    Bouckaert, J.M.C.; Kort, P.M.


    The merger incentives between profitable firms differ fundamentally from the incentives of a profitable firm to merge with a failing firm. We investigate these incentives under different modes of price competition and Cournot behavior. Our main finding is that firms strictly prefer exit of the

  17. 28 CFR 544.43 - Incentives. (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Incentives. 544.43 Section 544.43... Mandatory English-as-a-Second Language Program (ESL) § 544.43 Incentives. The Warden or designee shall establish a system of incentives to encourage an inmate to meet the mandatory ESL program requirements. ...

  18. 12 CFR 708a.12 - Voting incentives. (United States)


    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Voting incentives. 708a.12 Section 708a.12... INSURED CREDIT UNIONS TO MUTUAL SAVINGS BANKS § 708a.12 Voting incentives. If a converting credit union offers an incentive to encourage members to participate in the vote, including a prize raffle, every...

  19. 7 CFR 3560.656 - Incentives offers. (United States)


    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Incentives offers. 3560.656 Section 3560.656... AGRICULTURE DIRECT MULTI-FAMILY HOUSING LOANS AND GRANTS Housing Preservation § 3560.656 Incentives offers. (a....653(d), incentives to agree to the restrictive-use period in § 3560.662 if the following conditions...

  20. 28 CFR 544.72 - Incentives. (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Incentives. 544.72 Section 544.72 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT EDUCATION Literacy Program § 544.72 Incentives. The Warden shall establish a system of incentives to encourage an...

  1. Start-up incentives the Netherlands

    NARCIS (Netherlands)

    Bekker, S.; van den Eijnden, J.


    Generally, there are three different types of start-up incentive for unemployed and inactive people in the Netherlands. The first is a set of incentives for potential entrepreneurs receiving Unemployment Benefits (UB) (Werloosheidwet - WW). Such incentives have existed since 2006 and were adjusted

  2. Earnings progression, human capital and incentives

    DEFF Research Database (Denmark)

    Frederiksen, Anders

    progression by investigating the effects of on-the-job human capital acquisition, explicit short-run incentives and career concern incentives on earnings progression. The model leads to predictions about the incentive structure and the progression in both cross-sectional and individual earnings which...

  3. Neurobiology of the structure of personality: dopamine, facilitation of incentive motivation, and extraversion. (United States)

    Depue, R A; Collins, P F


    Extraversion has two central characteristics: (1) interpersonal engagement, which consists of affiliation (enjoying and valuing close interpersonal bonds, being warm and affectionate) and agency (being socially dominant, enjoying leadership roles, being assertive, being exhibitionistic, and having a sense of potency in accomplishing goals) and (2) impulsivity, which emerges from the interaction of extraversion and a second, independent trait (constraint). Agency is a more general motivational disposition that includes dominance, ambition, mastery, efficacy, and achievement. Positive affect (a combination of positive feelings and motivation) is closely associated with extraversion. Extraversion is accordingly based on positive incentive motivation. Parallels between extraversion (particularly its agency component) and a mammalian behavioral approach system based on positive incentive motivation implicate a neuroanatomical network and modulatory neurotransmitters in the processing of incentive motivation. A corticolimbic-striatal-thalamic network (1) integrates the salient incentive context in the medial orbital cortex, amygdala, and hippocampus; (2) encodes the intensity of incentive stimuli in a motive circuit composed of the nucleus accumbens, ventral pallidum, and ventral tegmental area dopamine projection system; and (3) creates an incentive motivational state that can be transmitted to the motor system. Individual differences in the functioning of this network arise from functional variation in the ventral tegmental area dopamine projections, which are directly involved in coding the intensity of incentive motivation. The animal evidence suggests that there are three neurodevelopmental sources of individual differences in dopamine: genetic, "experience-expectant," and "experience-dependent." Individual differences in dopamine promote variation in the heterosynaptic plasticity that enhances the connection between incentive context and incentive motivation and

  4. Logistic Incentive Structures Reflected in Irregular Logistic Procedures (United States)


    34 Washington Head- quarters Services, Directorate for Information Operations and Reports, 14 November. Festinger , Leon . (1950) Social Pressures in...Group Norms and Responsibility for Property A-22 3.3 Communication Networks and Irregular Logistic Procedures A-23 4.0 The Psychological Dimension A-25...Irregular Logistic Procedures A-31 4.2 Motivational Psychology Perspective A-32 4.2.1 Job-Related Incentives and Irregular Logistic Procedures A-33

  5. Incentive systems in multi-level markets for virtual goods


    Schmidt, A.U.


    As an alternative to rigid DRM measures, ways of marketing virtual goods through multi-level or networked marketing have raised some interest. This report is a first approach to multi-level markets for virtual goods from the viewpoint of theoretical economy. A generic, kinematic model for the monetary flow in multi-level markets, which quantitatively describes the incentives that buyers receive through resales revenues, is devised. Building on it, the competition of goods is examined in a dyn...

  6. Internet access and investment incentives for broadband service providers


    Baranes, Edmond; Poudou, Jean-Christophe


    This paper studies a model of the Internet broadband market as a platform in order to show how di¤erent pricing schemes from the so-called "net neutrality " can increase economic e¢ ciency by allowing more investment of access providers and enhancing consumers surplus and social welfare. We show that departing from the "net neutrality", where at rates are used, introducing termination fees can increase incentives to invest for the ISP and enhance social surplus. Keywords : Network neutrality,...

  7. Private versus social incentives for pharmaceutical innovation. (United States)

    González, Paula; Macho-Stadler, Inés; Pérez-Castrillo, David


    We provide a theoretical framework to contribute to the current debate regarding the tendency of pharmaceutical companies to direct their R&D toward marketing products that are "follow-on" drugs of already existing drugs, rather than toward the development of breakthrough drugs. We construct a model with a population of patients who can be treated with drugs that are horizontally and vertically differentiated. In addition to a pioneering drug, a new drug can be marketed as the result of an innovative process. We analyze physician prescription choices and the optimal pricing decision of an innovative firm. We also characterize the incentives of the innovative firm to conduct R&D activities, disentangling the quest for breakthrough drugs from the firm effort to develop follow-on drugs. Our results offer theoretical support for the conventional wisdom that pharmaceutical firms devote too many resources to conducting R&D activities that lead to incremental innovations. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. College Diversity and Investment Incentives


    Gall, Thomas; LEGROS, Patrick; Newman, Andrew


    This paper studies the aggregate economic effects of diversity policies such as affirmative action in college admission. If agents are constrained in the side payments they can make, the free market allocation displays excessive segregation relative to the first-best. Affirmative action policies can restore diversity within colleges but also affect incentives to invest in pre-college scholastic achievement. Affirmative action policies that are achievement-based can increase aggregate investme...

  9. Performance Measurement and Incentive Intensity


    Bayo-Moriones, Alberto; Galdon-Sanchez, Jose Enrique; Martinez-de-Morentin, Sara


    This study addresses the factors that determine the intensity of pay for performance schemes. The results indicate that the use of individual and group incentives boost intensity, whereas plant or firm pay for performance do not seem to affect the variable of interest. In addition, the adoption of measures of results, such as productivity or quality, has a significant positive effect on intensity. On the contrary, measures of human resource management outcomes, subjective measures and financi...

  10. Extrinsic incentives and tax compliance


    Sour, Laura; Gutiérrez Andrade, Miguel Ángel


    This paper models the impact of extrinsic incentives in a tax compliance model. It also provides experimental evidence that confirms the existence of a positive relationship between rewards and tax compliance. If individuals are audited, rewards for honest taxpayers are effective in increasing the level of tax compliance. These results are particularly relevant in countries where there is little respect for tax law since rewards can contribute to crowding in the intrinsic motivation to comply.

  11. Risk Sharing under Incentive Constraints.


    Wagner, W.B.


    In addressing the matter, this thesis covers issues such as the welfare gains from international risk sharing, the impact of international risk sharing on national economic policies and production efficiency, the welfare effects of international risk sharing in the presence of tax competition, and risk sharing among entrepreneurs that face financing constraints. The thesis outlines the implications of incentive constraints for the efficiency of the actual extent and pattern of risk sharing am...

  12. Incentives for reporting disease outbreaks.

    Directory of Open Access Journals (Sweden)

    Ramanan Laxminarayan

    Full Text Available BACKGROUND: Countries face conflicting incentives to report infectious disease outbreaks. Reports of outbreaks can prompt other countries to impose trade and travel restrictions, which has the potential to discourage reporting. However, reports can also bring medical assistance to contain the outbreak, including access to vaccines. METHODS: We compiled data on reports of meningococcal meningitis to the World Health Organization (WHO from 54 African countries between 1966 and 2002, a period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak. We used fixed-effects regression modeling to statistically estimate the effect of external forcing events on the number of countries reporting cases of meningitis to WHO. FINDINGS: We find that the Hajj vaccination requirements started in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased. INTERPRETATION: These results indicate that countries may respond to changing incentives to report outbreaks when they can do so. In the long term, these incentives are likely to be more important than surveillance assistance in prompt reporting of outbreaks.

  13. a mathematical framework for analyzing incentives in peer-to-peer ...

    African Journals Online (AJOL)

    Incentives for Sharing in Peer-to-Peer Networks," Electronic Commerce,,. Gupta, R. and Somani, A. K. (2005) “Game theory as a tool to strategize as well as predict nodes behavior in peer-to-peer networks," in. Proceedings of the 11th International Conference on Parallel and. Distributed Systems - Volume 01, ser. ICPADS ...

  14. A Study of the Factors Influencing Career Motivation Among Physicians and Dentists. (United States)

    Braunstein, Claude

    The study was designed to assess the factors influencing the career motivation of Navy physicians and dentists and to evaluate differential career incentives. A structured multiple-choice mail questionnaire was administered in March 1973. Twenty-six job factors were found to be related to job satisfaction among physicians and dentists. The…

  15. Should we pay the student? A randomised trial of financial incentives in medical education. (United States)

    Raupach, Tobias; Brown, Jamie; Wieland, Anna; Anders, Sven; Harendza, Sigrid


    Financial incentives are effective in moderating physician and patient behaviour, but they have not been studied in the context of medical education. This study assessed whether financial incentives can motivate students to acquire electrocardiogram (ECG) interpretation skills. Students enrolled for a cardio-respiratory teaching module (n = 121) were randomised to an intervention (financial incentive) or a control (book voucher raffle) condition. All students took three validated exams of ECG interpretation skills (at module entry, module exit and seven weeks later). Only the exit exam was financially incentivised in the intervention group. The primary outcome was the proportion of students who correctly identified ≥60% of clinically important diagnoses in the exit exam. Financial incentives more than doubled the odds of correctly identifying ≥60% of diagnoses in the exit exam (adjusted odds ratio 2.44, 95% confidence interval 1.05-5.67) and significantly increased student learning time. However, there was no significant effect on performance levels in the retention exam. Financial incentives increase reported learning time and examination results in the short-term. The lack of a sustained effect on performance suggests that financial incentives may foster a superficial or strategic rather than a deep approach to learning.

  16. Exploring the impact of different multi-level measures of physician communities in patient-centric care networks on healthcare outcomes: A multi-level regression approach

    National Research Council Canada - National Science Library

    Uddin, Shahadat


    .... In order to assess the impact different multi-level attributes of patient-centric care networks on healthcare outcomes, this study first captured patient-centric care networks for 85 hospitals using...

  17. Economic incentive in community nursing: attraction, rejection or indifference?

    Directory of Open Access Journals (Sweden)

    Kingma Mireille


    Full Text Available Abstract Background It is hard to imagine any period in time when economic issues were more visible in health sector decision-making. The search for measures that maximize available resources has never been greater than within the present decade. A staff payroll represents 60%-70% of budgeted health service funds. The cost-effective use of human resources is thus an objective of paramount importance. Using incentives and disincentives to direct individuals' energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas. Conclusion Understanding the value system of community nurses and how they respond to economic incentives/disincentives facilitates the development of reward systems more likely to be relevant and strategic. If nurse rewards are to become more effective organizational tools, the data suggest that future initiatives should: • Improve nurses' salary/income relativities (e.g. comparable pay/rates; • Provide just compensation for job-related expenses (e.g. petrol, clothing; • Introduce promotional opportunities within the clinical area, rewarding skill and competence development; • Make available a range of financed rewards. - Direct (e.g. subsidized education, additional leave, insurance benefits; - Indirect (e.g. better working conditions, access to professional support network, greater participation in decision-making bodies.

  18. Economic incentive in community nursing: attraction, rejection or indifference? (United States)

    Kingma, Mireille


    BACKGROUND: It is hard to imagine any period in time when economic issues were more visible in health sector decision-making. The search for measures that maximize available resources has never been greater than within the present decade. A staff payroll represents 60%-70% of budgeted health service funds. The cost-effective use of human resources is thus an objective of paramount importance.Using incentives and disincentives to direct individuals' energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas. CONCLUSION: Understanding the value system of community nurses and how they respond to economic incentives/disincentives facilitates the development of reward systems more likely to be relevant and strategic. If nurse rewards are to become more effective organizational tools, the data suggest that future initiatives should:bullet; Improve nurses' salary/income relativities (e.g. comparable pay/rates);bullet; Provide just compensation for job-related expenses (e.g. petrol, clothing);bullet; Introduce promotional opportunities within the clinical area, rewarding skill and competence development;bullet; Make available a range of financed rewards.- Direct (e.g. subsidized education, additional leave, insurance benefits);- Indirect (e.g. better working conditions, access to professional support network, greater participation in decision-making bodies).

  19. German physicians "on strike"--shedding light on the roots of physician dissatisfaction. (United States)

    Janus, Katharina; Amelung, Volker Eric; Gaitanides, Michael; Schwartz, Friedrich Wilhelm


    Over the past few years, students in Germany have been dropping out of medical school at increasing rates, and the number of physicians choosing to work abroad or in non-medical professions has been growing. A recent study (the "Ramboll Study") commissioned by the Health Ministry concluded that German physicians' dissatisfaction with existing monetary and non-monetary incentive systems during training and subsequent practice was the main reason for these trends. Among those physicians who have remained in the workforce, there is a similar dissatisfaction, reflected in part by a general strike in 2006 by German physicians in favour of higher wages and better working conditions. To better understand the decision-making process of physicians which is highly determined by the satisfaction they experience in their work life and to extract the factors that contribute to their satisfaction. We surveyed all physicians who spent more than 50% of their time in patient care (and less than 50% in research) at the teaching hospital of the Hannover Medical School (839, after exclusion of pre-test participants). Based on existing satisfaction studies, we designed a self-administered questionnaire that contained 28 items, including items measuring several dimensions of physician job satisfaction; the monetary and non-monetary incentives the physicians experienced in the recent past; other job-related potential confounding factors and socio-demographic questions. Respondents were asked to rate each job satisfaction item on five-point Likert scales regarding both satisfaction with and importance of the item. Data were analysed using descriptive statistics, factor and correlation analyses. Our data suggest that non-monetary factors are important determinants of physician job satisfaction, perhaps more important than monetary incentives that may augment or reduce physicians' base incomes. Factor analysis revealed seven principal factors of which decision-making and recognition

  20. Water Conservation and Economic Incentives (United States)

    Narayanan, M.


    Water has played a vital role in the progress of human civilization throughout history. Both agriculture based economics as well as industry based economics totally rely upon water for survival and prosperity. Water could be a limiting factor in dictating day-to-day human activities and as such one should learn to live within the limits of available natural resources. Most of the water on this earth is either salty or undrinkable. Only one percent of world's water is available for all the needs of human civilization. This includes human personal household needs, community activities, agriculture, industry, plant and animal life sustenance. The supply of usable fresh water is finite and the per capita consumption of fresh water needs to be reduced in particularly in some selected regions of this world. The United States consumes about 450 billion gallons of water every day. The U.S. daily average of water pumped by public water supply systems is 185 gallons per person. The biggest water gobbler in a household is the lawn. Typically, at least 50% of water consumed by households is used outdoors. Even inside a house, bathroom facilities claim nearly 75% of the water used. Here is a short list of economic Incentives that may help water conservation. (1) Providing rebates, refunds or other economic incentives to those consumers that are willing to change to modern technological methods. Examples include, but not limited to energy efficient washing machines, low-flush toilets and improved shower head designs. (2) Communities should provide economic incentives to limit the type and size of landscaping. (3) Need, necessity and nature of outdoor water use could be restricted whenever possible. (4) Sprinkler ban may be deemed appropriate in extreme cases. (5) Set up hotlines that can help penalize those that ignore water conservation guidelines. (6) Incorporating water conservation monitors. References:

  1. Individual Teacher Incentives And Student Performance


    David N. Figlio; Lawrence Kenny


    This paper is the first to systematically document the relationship between individual teacher performance incentives and student achievement using United States data. We combine data from the National Education Longitudinal Survey on schools, students, and their families with our own survey conducted in 2000 regarding the use of teacher incentives. This survey on teacher incentives has unique data on frequency and magnitude of merit raises and bonuses, teacher evaluation, and teacher termina...

  2. On the Effectiveness of Incentive Pay

    DEFF Research Database (Denmark)

    Friis, Ivar; Hansen, Allan; Vámosi, Tamás S.


    Extant research already emphasises that complementarities and substitution involving incentive pay and other elements of an organisation's management control system play an important role in terms of explaining the effectiveness of incentive systems. Despite this awareness calls continue for more...... and insight into how incentive pay features in complementary and substitutional relationships in an individual organisational setting. Greater insight can help illustrate how complementary and substitutional relationships unfold in even more complex ways than current research indicates, as well as how...

  3. Are Delegation and Incentives Complementary Instruments ?

    DEFF Research Database (Denmark)

    Lando, Henrik


    It is natural to suppose that delegation and incentives are complementaryboth in the sense that when more decisions are delegated toa lower level of an organizational hierarchy, more use should be madeof incentives at that level, and in the sense that more use of incentivesshould be accompanied...... thisframework it is shown that delegation and incentives are not necessarilycomplementary instruments; some decisions should be centralized whenincentives are introduced....

  4. Factors influencing physicians' choice of workplace: systematic review of drivers of attrition and policy interventions to address them. (United States)

    El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E


    The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians' choice of workplace, and policy interventions for retaining physicians in the public sector. Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Nineteen articles met the inclusion criteria. Six major themes that affected physicians' choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. While factors affecting physicians' choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross-country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector.

  5. Incentive Driven Distributed Generation Planning with Renewable Energy Resources

    Directory of Open Access Journals (Sweden)

    KAUR, S.


    Full Text Available Renewable DGs may not be economically viable due to the stochastic generation and huge capital investment, but are an inevitable choice for sustainable energy development and future planning. An appropriate incentive scheme for clean Distributed Generation (DG technologies is able to address this issue in an economical manner and is considered in proposed distributed generation planning model. The proposed model minimizes the annualized cost with Emission Offset Incentive (EOI and the penalty for Green-house Gas (GHG emissions. A meta-heuristic approach with dynamic tuning of control parameters is adopted to improve the success and the convergence rate of optimal solutions. The algorithm provides the optimal solution in terms of type, size, and location of DG. The proposed technique is implemented on IEEE 33-bus system. Proposed model helps the Distribution Network Operators (DNOs to decide the proper DG technology from an economic prospective for eco-friendly energy planning.

  6. Incentive-based management for nonprofit organizations. (United States)

    Nelsen, W C


    Nonprofit organizations should consider using incentive-based management programs so long as such programs are studied thoughtfully, implemented carefully, and closely tied to other important management practices. The article describes the experiences of one nonprofit organization, Citizens' Scholarship Foundation of America (CSFA), in successfully conducting a staff incentive program during the past several years. The author also reports briefly on the results of a recent survey among CSFA staff involved in the incentive plan, outlining the benefits of such a program in helping the organization to reach its objectives. Finally, the author addresses potential pitfalls to avoid in implementing an effective staff incentive program.

  7. Incentive-based approaches to sustainable fisheries

    National Research Council Canada - National Science Library

    Grafton, R Q; Arnason, Ragnar; Bjorndal, Trond; Campbell, David; Campbell, Harry F; Clark, Colin W; Connor, Robin; Dupont, Diane P; Hannesson, Rognvaldur; Hilborn, Ray; Kirkley, James E; Kompas, Tom; Lane, Daniel E; Munro, Gordon R; Pascoe, Sean; Squires, Dale; Steinshamn, Stein I.v.a.r; Turris, Bruce R; Weninger, Quinn


    ...: inappropriate incentives bearing on fishers and the ineffective governance that frequently exists in commercial, developed fisheries managed primarily by total-harvest limits and input controls...

  8. Incentives and intrinsic motivation in healthcare

    Directory of Open Access Journals (Sweden)

    Mikel Berdud


    Conclusions: The conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated.

  9. Physicians' potential use and preferences related to health information exchange. (United States)

    Patel, Vaishali; Abramson, Erika L; Edwards, Alison; Malhotra, Sameer; Kaushal, Rainu


    To characterize physician attitudes and preferences towards health information exchange (HIE), which is the ability to transmit health information electronically across institutions, and identify factors that influence physicians' interest in using HIE for their clinical work. A survey was conducted of physicians affiliated with institutions that are stakeholders of a regional health information organization in the United States (U.S.). Surveys were administered between May and October, 2009 at educational conferences and on site at physician practices. Of the 328 physicians asked to participate, 44% (n=144) completed the survey. Sixty-eight percent (n=88) of physicians expressed interest in using HIE for their clinical work. Most physicians expected HIE to improve provider communication (89%), coordination and continuity of care (87%) and efficiency (87%). Potential barriers to adopting or using HIE included start-up costs (57%) and resources to select and implement a system (38%). A majority reported that technical assistance (70%) and financial incentives to use (65%) or purchase (54%) health IT systems would positively influence their adoption and use of HIE. Physicians who believe that financial incentives would be helpful, that HIE would be easy to use, or who prefer viewing patient health information electronically were found to be at least three times more likely to indicate they would adopt and use HIE. These findings suggest that providers largely consider HIE as potentially valuable and a majority would be willing to use HIE. Recent U.S. federal health IT policies that provide financial incentives as well as technical assistance may address potential barriers to adoption and usage of HIE. Published by Elsevier Ireland Ltd.

  10. 48 CFR 16.402-1 - Cost incentives. (United States)


    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost incentives. 16.402-1... AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-1 Cost incentives. (a) Most incentive contracts include only cost incentives, which take the form of a profit or fee adjustment formula and are...

  11. 5 CFR 575.109 - Payment of recruitment incentives. (United States)


    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Payment of recruitment incentives. 575... RECRUITMENT, RELOCATION, AND RETENTION INCENTIVES; SUPERVISORY DIFFERENTIALS; AND EXTENDED ASSIGNMENT INCENTIVES Recruitment Incentives § 575.109 Payment of recruitment incentives. (a) An authorized agency...

  12. A review of case studies evaluating economic incentives to promote occupational safety and health. (United States)

    Elsler, Dietmar; Treutlein, Daniela; Rydlewska, Iza; Frusteri, Liliana; Krüger, Henning; Veerman, Theo; Eeckelaert, Lieven; Roskams, Nele; Van Den Broek, Karla; Taylor, Terry N


    In many European countries, external economic incentives are discussed as a policy instrument to promote occupational safety and health (OSH) in enterprises. This narrative case study review aims to support policy-makers in organizations providing such incentives by supplying information about different incentive schemes and their main characteristics such as effectiveness, efficiency, and feasibility. The focal point and topic centre network of the European Agency for Safety and Health at Work were used to collect case studies about incentive schemes aimed at supporting the prevention of occupational accidents and diseases in enterprises. Such incentives are rarely described in the scientific literature. To be considered for this review, studies had to focus on external financial benefits that could be provided as part of an insurance-related incentive or a governmental subsidy scheme. In total, 14 cases were included in the review: 6 insurance premium- and 8 subsidy-based schemes. Of these, 13 contained an evaluation of the incentive scheme, of which 7 use quantitative criteria. Three cases provided sufficient data to conduct a cost-benefit analysis. Most qualitative evaluations related to the successful management of the program and the effectiveness of the promoted measures in the workplace. Regarding the latter, quantitative criteria covered accident rates, sick leave, and general improvement in working conditions. The cost-benefit analyses all resulted in a positive payout ratio, ranging from 1.01-4.81 euros return for every 1 euro invested. Generally, we found economic incentive schemes to be feasible and reasonably effective. However, analysis regarding the efficiency of such schemes is scarce and our evaluation of the cost-benefit analysis had to rely on few cases that, nevertheless, delivered positive results for large samples. Besides this finding, our study also revealed deficits in the quality of evaluations. In order to enable policy-makers to make

  13. [Job satisfaction among primary care physicians at the IMSS]. (United States)

    Valderrama-Martínez, José Arturo; Dávalos-Díaz, Guillermina


    To know factors related to job satisfaction among primary care Physicians from the Mexican Social Security Institute. Cross-sectional survey applied to physicians of outpatient visit areas in four Family Medicine Units in Leon, Guanajuato, from February to May 2007. The survey explored six areas. We used 95% confidence intervals and One-Way ANOVA to compare means among clinics and Chi square and OR'95% confidence intervals to compare proportions. One hundred sixty physicians participated (response rate 88.9%), three were excluded. Most physicians were satisfied with their work (86%). Half of the doctors feel satisfied with their economic benefits (48%), non-economic benefits (52%), and those from the collective bargaining agreement (53%), as well as with the labor union (46%) and their actual insurances (45%). Only one third or less of participants refer to receive incentives (31%) or recognitions for their work (33%), were satisfied with the opportunities for training (31%), the economic incentives (29%), or the salary (24%). The satisfaction's means of work, benefits, insurances, labor union and collective bargaining agreement were significantly higher than the means of salary and economic incentives. Satisfaction means were significantly higher in Clinic #53 than in Clinic #51 for job satisfaction and opportunities for training, as well as percentages of response in institutional support, incentives and recognitions for their work, were higher in Clinic 53 compared to all other clinics; however, it's the smallest clinic in this study. Family doctors find satisfaction in their practice, and factors such as institutional support, recognition and incentives may improve their general job satisfaction.

  14. Behavioural economics: Cash incentives avert deforestation (United States)

    Cárdenas, Juan Camilo


    There is tension in developing countries between financial incentives to clear forests and climate regulation benefits of preserving trees. Now research shows that paying private forest owners in Uganda reduced deforestation, adding to the debate on the use of monetary incentives in forest conservation.

  15. Estimating Acceptability of Financial Health Incentives (United States)

    Bigsby, Elisabeth; Seitz, Holli H.; Halpern, Scott D.; Volpp, Kevin; Cappella, Joseph N.


    A growing body of evidence suggests that financial incentives can influence health behavior change, but research on the public acceptability of these programs and factors that predict public support have been limited. A representative sample of U.S. adults (N = 526) were randomly assigned to receive an incentive program description in which the…

  16. Physician beliefs about the impact of meaningful use of the EHR: a cross-sectional study. (United States)

    Emani, S; Ting, D Y; Healey, M; Lipsitz, S R; Karson, A S; Einbinder, J S; Leinen, L; Suric, V; Bates, D W


    As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs. Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care. A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program. Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items. Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.

  17. The Impact of Lottery Incentives on Student Survey Response Rates. (United States)

    Porter, Stephen R.; Whitcomb, Michael E.


    A controlled experiment tested the effects of lottery incentives using a prospective college applicant Web survey, with emails sent to more than 9,000 high school students. Found minimal effect of postpaid incentives for increasing levels of incentive. (EV)

  18. 48 CFR 1816.402-2 - Performance incentives. (United States)


    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Performance incentives... ADMINISTRATION CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 1816.402-2 Performance incentives. ...

  19. Incentive contracts for development projects (United States)

    Finley, David T.; Smith, Byron; DeGroff, B.


    Finding a contract vehicle that balances the concerns of the customer and the contractor in a development project can be difficult. The customer wants a low price and an early delivery, with as few surprises as possible as the project progresses. The contractor wants sufficient cost and schedule to cover risk. Both want to clearly define what each party will provide. Many program offices do not want to award cost plus contracts because their funding sources will not allow it, their boards do not want an open ended commitment, and they feel like they lose financial control of the project. A fixed price incentive contract, with a mutually agreed upon target cost, provides the owner with visibility into the project and input into the execution of the project, encourages both parties to save costs, and stimulates a collaborative atmosphere by aligning the respective interests of customers and contractors.

  20. Substantial Physician Turnover And Beneficiary 'Churn' In A Large Medicare Pioneer ACO. (United States)

    Hsu, John; Vogeli, Christine; Price, Mary; Brand, Richard; Chernew, Michael E; Mohta, Namita; Chaguturu, Sreekanth K; Weil, Eric; Ferris, Timothy G


    Alternative payment models, such as accountable care organizations (ACOs), attempt to stimulate improvements in care delivery by better alignment of payer and provider incentives. However, limited attention has been paid to the physicians who actually deliver the care. In a large Medicare Pioneer ACO, we found that the number of beneficiaries per physician was low (median of seventy beneficiaries per physician, or less than 5 percent of a typical panel). We also found substantial physician turnover: More than half of physicians either joined (41 percent) or left (18 percent) the ACO during the 2012-14 contract period studied. When physicians left the ACO, most of their attributed beneficiaries also left the ACO. Conversely, about half of the growth in the beneficiary population was because of new physicians affiliating with the ACO; the remainder joined after switching physicians. These findings may help explain the muted financial impact ACOs have had overall, and they raise the possibility of future gaming on the part of ACOs to artificially control spending. Policy refinements include coordinated and standardized risk-sharing parameters across payers to prevent any dilution of the payment incentives or confusion from a cacophony of incentives across payers. Project HOPE—The People-to-People Health Foundation, Inc.

  1. Physician Quality Reporting System (United States)

    U.S. Department of Health & Human Services — PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible...

  2. Financial incentives, quality improvement programs, and the adoption of clinical information technology. (United States)

    Robinson, James C; Casalino, Lawrence P; Gillies, Robin R; Rittenhouse, Diane R; Shortell, Stephen S; Fernandes-Taylor, Sara


    Physician use of clinical information technology (CIT) is important for the management of chronic illness, but has lagged behind expectations. We studied the role of health insurers' financial incentives (including pay-for-performance) and quality improvement initiatives in accelerating adoption of CIT in large physician practices. National survey of all medical groups and independent practice association (IPA) physician organizations with 20 or more physicians in the United States in 2006 to 2007. The response rate was 60.3%. Use of 19 CIT capabilities was measured. Multivariate statistical analysis of financial and organizational factors associated with adoption and use of CIT. Use of information technology varied across physician organizations, including electronic access to laboratory test results (medical groups, 49.3%; IPAs, 19.6%), alerts for potential drug interactions (medical groups, 33.9%; IPAs, 9.5%), electronic drug prescribing (medical groups, 41.9%; IPAs, 25.1%), and physician use of e-mail with patients (medical groups, 34.2%; IPAs, 29.1%). Adoption of CIT was stronger for physician organizations evaluated by external entities for pay-for-performance and public reporting purposes (P = 0.042) and for those participating in quality improvement initiatives (P quality improvement initiatives are associated with greater use of CIT by large physician practices.

  3. Health policy basics: physician quality reporting system. (United States)

    Koltov, Michelle K; Damle, Nitin S


    The U.S. health care system is in the midst of transforming from a fee-for-service system to a value-based system that delivers high-quality and cost-effective care. Quality reporting programs and increasing transparency of performance are meant to encourage physicians and hospitals to invest in improving the delivery of care. In 2006, the Centers for Medicare & Medicaid Services implemented the Physician Quality Reporting System (PQRS). The PQRS is an incentive and penalty payment program for eligible professionals who report data on quality measures for covered professional services furnished to Medicare beneficiaries. The program gives eligible professionals the opportunity to assess the quality of care they are providing to their patients and compare their performance on a given measure with that of their peers. This article discusses the history of PQRS, the 2014 PQRS, and how it affects other quality programs.

  4. 75 FR 73169 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B... (United States)


    ... period addresses changes to the physician fee schedule and other Medicare Part B payment policies to... Providers Act of 2008 (MIPPA). In addition, this final rule with comment period discusses payments under the... Authority b. Incentive Payments for the 2011 Physician Quality Reporting System c. 2011 Reporting Periods...

  5. A Neural Computational Model of Incentive Salience (United States)

    Zhang, Jun; Berridge, Kent C.; Tindell, Amy J.; Smith, Kyle S.; Aldridge, J. Wayne


    Incentive salience is a motivational property with ‘magnet-like’ qualities. When attributed to reward-predicting stimuli (cues), incentive salience triggers a pulse of ‘wanting’ and an individual is pulled toward the cues and reward. A key computational question is how incentive salience is generated during a cue re-encounter, which combines both learning and the state of limbic brain mechanisms. Learning processes, such as temporal-difference models, provide one way for stimuli to acquire cached predictive values of rewards. However, empirical data show that subsequent incentive values are also modulated on the fly by dynamic fluctuation in physiological states, altering cached values in ways requiring additional motivation mechanisms. Dynamic modulation of incentive salience for a Pavlovian conditioned stimulus (CS or cue) occurs during certain states, without necessarily requiring (re)learning about the cue. In some cases, dynamic modulation of cue value occurs during states that are quite novel, never having been experienced before, and even prior to experience of the associated unconditioned reward in the new state. Such cases can include novel drug-induced mesolimbic activation and addictive incentive-sensitization, as well as natural appetite states such as salt appetite. Dynamic enhancement specifically raises the incentive salience of an appropriate CS, without necessarily changing that of other CSs. Here we suggest a new computational model that modulates incentive salience by integrating changing physiological states with prior learning. We support the model with behavioral and neurobiological data from empirical tests that demonstrate dynamic elevations in cue-triggered motivation (involving natural salt appetite, and drug-induced intoxication and sensitization). Our data call for a dynamic model of incentive salience, such as presented here. Computational models can adequately capture fluctuations in cue-triggered ‘wanting’ only by


    DEFF Research Database (Denmark)

    Lippert-Rasmussen, Kasper


    ABSTRACT This article defends three claims: (1) even if Rawls' difference principle permits incentives to induce talented people to be more productive, it does not follow that it permits inequalities; (2) the difference principle, when adequately specified, may in some circumstances permit...... incentives and allow that the worst off are not made as well off as they could be; and (3) an argument for incentives might pass Cohen's interpersonal test even if it is unsound and might not pass it even if it is sound. 1...

  7. Incentives of Health Care Expenditure

    Directory of Open Access Journals (Sweden)

    Eero Siljander


    Full Text Available The incentives of health care expenditure (HCE have been a topic of discussion in the USA (Obama reforms and in Europe (adjustment to debt crisis. There are competing views of institutional versus GDP (unit income elasticity and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of

  8. Evaluation of prescribing patterns in a German network of CAM physicians for the treatment of patients with hypertension: a prospective observational study

    Directory of Open Access Journals (Sweden)

    Witt Claudia M


    Full Text Available Abstract Background The management of hypertension is a key challenge in modern health systems. This study aimed to investigate hypertension treatment strategies among physicians specialized in complementary and alternative medicine (CAM in Germany by analysing prescribing patterns and comparing these to the current treatment guidelines issued by the German Hypertension Society. Methods In this prospective, multicentre observational study, which included 25 primary care physicians specialized in CAM treatment, prescriptions and diagnoses were analysed for each consecutive hypertensive patient using routine electronic data. Data analysis was performed using univariate statistical tests (Chi square test, Cochran-Armitage trend test. Multiple logistic regression was used to determine factors associated with antihypertensive medication. Results In the year 2005, 1320 patients with 3278 prescriptions were included (mean age = 64.2 years (SD = 14.5, 63.5% women. Most patients were treated with conventional antihypertensive monotherapies (n = 838, 63.5%. Beta-blockers were the most commonly prescribed monotherapy (30.7%, followed by ACE inhibitors (24.0%. Combination treatment usually consisted of two antihypertensive drugs administered either as separate agents or as a coformulation. The most common combination was a diuretic plus an ACE inhibitor (31.2% of dual therapies. Patient gender, age, and comorbidities significantly influenced which treatment was prescribed. 187 patients (14.2% received one or more CAM remedies, most of which were administered in addition to classic monotherapies (n = 104. Men (OR = 0.66; 95% CI: 0.54-0.80 and patients with diabetes (OR = 0.55; 95% CI: 0.42-0.0.73, hypercholesterolaemia (OR = 0.59; 95% CI: 0.47-0.75, obesity (OR = 0.74; 95% CI: 0.57-0.97, stroke (OR = 0.54; 95% CI: 0.40-0.74, or prior myocardial infarction (OR = 0.37; 95% CI: 0.17-0.81 were less likely to receive CAM treatment. Conclusions The large majority

  9. Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis. (United States)

    Lavergne, M Ruth; Law, Michael R; Peterson, Sandra; Garrison, Scott; Hurley, Jeremiah; Cheng, Lucy; McGrail, Kimberlyn


    We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods. We observed no increases in primary care visits or continuity of care after incentives were introduced. Rates of ACR testing and antihypertensive dispensing increased among patients with hypertension, but none of the other modest increases in laboratory testing or prescriptions dispensed reached statistical significance. Rates of hospitalizations for stroke and heart failure among patients with hypertension fell relative to pre-intervention patterns, while hospitalizations for COPD increased. Total hospitalizations and hospitalizations via the emergency department did not change. Health care spending increased for patients with hypertension. This large-scale incentive scheme for primary care physicians showed some positive effects for patients with hypertension, but we observe no similar changes in patient management, reductions in hospitalizations, or changes in spending for patients with diabetes and COPD. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  10. EHR Incentive Programs - Data and Reports (United States)

    U.S. Department of Health & Human Services — As of March 2013, more than 259,000 health care providers received payment for participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive...

  11. Wetland related livelihoods, institutions and incentives for ...

    African Journals Online (AJOL)

    Balanced utilization of wetland ecosystems can be achieved if wetland related livelihoods, institutions and incentives for their management are well planned, in place ... These include connectors, whistle blowers, enforcement, information exchange, management, education and capacity building, lobbying, entrepreneurs,

  12. Behavioral Therapy, Incentives Enhance Addiction Treatment (United States)

    ... Research News From NIH Behavioral Therapy, Incentives Enhance Addiction Treatment Past Issues / Summer 2006 Table of Contents ... that people who are trying to end their addiction to marijuana can benefit from a treatment program ...

  13. Physician Fee Schedule Search (United States)

    U.S. Department of Health & Human Services — This website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services,...

  14. Physician Appraisals: Key Challenges

    Directory of Open Access Journals (Sweden)

    Klich Jacek


    Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.

  15. Altruism, Conformism, and Incentives in the Workplace


    Tichem, Jan


    markdownabstractPerformance pay can motivate employees, but money is not the only motivation in the workplace. Altruism, which means that someone enjoys the well-being of someone else, can also provide a powerful motivation. The first part of this thesis studies theoretically how altruism between an employee and his superior affects the optimal use of monetary incentives. Among others, the analysis reveals how altruism influences the credibility of monetary incentive schemes, and how altruist...

  16. Incentive Effects of Peer Pressure in Organizations


    Kohei Daido


    This paper studies the effects of peer pressure on incentives. We assume that, in addition to the material payoff, each agent's utility includes the psychological payoff from peer pressure generated by a comparison of effort costs. We show that the optimal incentive schemes depend mainly on the degree of peer pressure and of the heterogeneity of agents. Furthermore, we examine the optimal organizational forms in terms of the principal''s intention to make use of the effects of peer pressure.

  17. Tax incentive regimes: models and research methods


    Sokolovska, Olena; Dmytro SOKOLOVSKYI


    Paper deals with problem of effectiveness of tax incentive regimes. Support of priority industries remains currently important for transition economies. At once, such countries more often than developed ones face the imperfection of tax incentive mechanisms. Notably, such problems are common to Ukrainian and Moldavian economies, where the legislative support or its implementation in the area of preferential taxation of innovative enterprises which contribute essentially to sustainable develop...

  18. 24 CFR 902.71 - Incentives for high performers. (United States)


    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Incentives for high performers. 902... DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM PHAS Incentives and Remedies § 902.71 Incentives for high performers. (a) Incentives for high performer PHAs. A PHA that is designated a high performer will be...

  19. 48 CFR 16.402-2 - Performance incentives. (United States)


    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Performance incentives. 16... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-2 Performance incentives. (a) Performance incentives may be considered in connection with specific product characteristics (e.g...

  20. 48 CFR 16.402-3 - Delivery incentives. (United States)


    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Delivery incentives. 16... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-3 Delivery incentives. (a) Delivery incentives should be considered when improvement from a required delivery schedule is a...

  1. 48 CFR 1516.401-70 - Award term incentives. (United States)


    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Award term incentives. 1516... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 1516.401-70 Award term incentives. (a) Award term incentives enable a contractor to become eligible for additional periods of...

  2. 45 CFR 305.34 - Payment of incentives. (United States)


    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Payment of incentives. 305.34 Section 305.34... PROGRAM PERFORMANCE MEASURES, STANDARDS, FINANCIAL INCENTIVES, AND PENALTIES § 305.34 Payment of incentives. (a) Each State must report one-fourth of its estimated annual incentive payment on each of its...

  3. Physicians' Job Satisfaction.

    African Journals Online (AJOL)


    Conclusion: It is urgent and necessary to improve physician working conditions and their working pattern to ... an employee's well-being Examples of job resources ... physicians. In Kuwait, some physicians quit their hospital posts and then open their own clinics or move to other hospitals with better working conditions.(8).

  4. Physician participation in clinical research and trials: issues and approaches. (United States)

    Rahman, Sayeeda; Majumder, Md Anwarul Azim; Shaban, Sami F; Rahman, Nuzhat; Ahmed, Moslehuddin; Abdulrahman, Khalid Bin; D'Souza, Urban Ja


    The rapid development of new drugs, therapies, and devices has created a dramatic increase in the number of clinical research studies that highlights the need for greater participation in research by physicians as well as patients. Furthermore, the potential of clinical research is unlikely to be reached without greater participation of physicians in research. Physicians face a variety of barriers with regard to participation in clinical research. These barriers are system-or organization-related as well as research-and physician-related. To encourage physician participation, appropriate organizational and operational infrastructures are needed in health care institutes to support research planning and management. All physicians should receive education and training in the fundamentals of research design and methodology, which need to be incorporated into undergraduate medical education and postgraduate training curricula and then reinforced through continuing medical education. Medical schools need to analyze current practices of teaching-learning and research, and reflect upon possible changes needed to develop a 'student-focused teaching-learning and research culture'. This article examines the barriers to and benefits of physician participation in clinical research as well as interventions needed to increase their participation, including the specific role of undergraduate medical education. The main challenge is the unwillingness of many physicians and patients to participate in clinical trials. Barriers to participation include lack of time, lack of resources, trial-specific issues, communication difficulties, conflicts between the role of clinician and scientist, inadequate research experience and training for physicians, lack of rewards and recognition for physicians, and sometimes a scientifically uninteresting research question, among others. Strategies to encourage physician participation in clinical research include financial and nonfinancial incentives

  5. An Incentive-Based Online Optimization Framework for Distribution Grids

    Energy Technology Data Exchange (ETDEWEB)

    Dall-Anese, Emiliano [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Zhou, Xinyang [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Chen, Lijun [University of Colorado; Simonetto, Andrea [IBM Dublin


    This paper formulates a time-varying social-welfare maximization problem for distribution grids with distributed energy resources (DERs) and develops online distributed algorithms to identify (and track) its solutions. In the considered setting, network operator and DER-owners pursue given operational and economic objectives, while concurrently ensuring that voltages are within prescribed limits. The proposed algorithm affords an online implementation to enable tracking of the solutions in the presence of time-varying operational conditions and changing optimization objectives. It involves a strategy where the network operator collects voltage measurements throughout the feeder to build incentive signals for the DER-owners in real time; DERs then adjust the generated/consumed powers in order to avoid the violation of the voltage constraints while maximizing given objectives. Stability of the proposed schemes is analytically established and numerically corroborated.

  6. The incentive sensitization theory of addiction: some current issues


    Robinson, Terry E.; Berridge, Kent C.


    We present a brief overview of the incentive sensitization theory of addiction. This posits that addiction is caused primarily by drug-induced sensitization in the brain mesocorticolimbic systems that attribute incentive salience to reward-associated stimuli. If rendered hypersensitive, these systems cause pathological incentive motivation (‘wanting’) for drugs. We address some current questions including: what is the role of learning in incentive sensitization and addiction? Does incentive s...

  7. Incentives for Quality over Time

    DEFF Research Database (Denmark)

    Claussen, Jörg; Kretschmer, Tobias; Mayrhofer, Philip

    We study the market for applications on Facebook, the dominant platform for social networking and make use of a rule change by Facebook by which high-quality applications were rewarded with further opportunities to engage users. We find that the change led to quality being a more important driver...

  8. Incentives to promote breastfeeding: a systematic review. (United States)

    Moran, Victoria Hall; Morgan, Heather; Rothnie, Kieran; MacLennan, Graeme; Stewart, Fiona; Thomson, Gillian; Crossland, Nicola; Tappin, David; Campbell, Marion; Hoddinott, Pat


    Few women in industrialized countries achieve the World Health Organization's recommendation to breastfeed exclusively for 6 months. Governments are increasingly seeking new interventions to address this problem, including the use of incentives. The goal of this study was to assess the evidence regarding the effectiveness of incentive interventions, delivered within or outside of health care settings, to individuals and/or their families seeking to increase and sustain breastfeeding in the first 6 months after birth. Searches of electronic databases, reference lists, and grey literature were conducted to identify relevant reports of published, unpublished, and ongoing studies. All study designs published in English, which met our definition of incentives and that were from a developed country, were eligible for inclusion. Abstract and full-text article review with sequential data extraction were conducted by 2 independent authors. Sixteen full reports were included in the review. The majority evaluated multicomponent interventions of varying frequency, intensity, and duration. Incentives involved providing access to breast pumps, gifts, vouchers, money, food packages, and help with household tasks, but little consensus in findings was revealed. The lack of high-quality, randomized controlled trials identified by this review and the multicomponent nature of the interventions prohibited meta-analysis. This review found that the overall effect of providing incentives for breastfeeding compared with no incentives is unclear due to study heterogeneity and the variation in study quality. Further evidence on breastfeeding incentives offered to women is required to understand the possible effects of these interventions. Copyright © 2015 by the American Academy of Pediatrics.

  9. Motivational determinants among physicians in Lahore, Pakistan

    Directory of Open Access Journals (Sweden)

    Souares Aurélia


    Full Text Available Abstract Introduction Human resource crises in developing countries have been identified as a critical aspect of poor quality and low accessibility in health care. Worker motivation is an important facet of this issue. Specifically, motivation among physicians, who are an important bridge between health systems and patients, should be considered. This study aimed to identify the determinants of job motivation among physicians, a neglected perspective, especially in developing countries. Methods A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural. Results Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians. Conclusion Motivational determinants differed

  10. Role of the Physician Anesthesiologist (United States)

    ... Team Physician Anesthesiologist Role of the Physician Anesthesiologist Role of the Physician Anesthesiologist When preparing for surgery, ... points and beyond. Physician anesthesiologists play a vital role in a patient’s medical care, making decisions to ...

  11. Factors Identified with Higher Levels of Career Satisfaction of Physicians in Andalusia, Spain. (United States)

    Peña-Sánchez, Juan Nicolás; Lepnurm, Rein; Morales-Asencio, José Miguel; Delgado, Ana; Domagała, Alicja; Górkiewicz, Maciej


    The satisfaction of physicians is a worldwide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i) measure the career satisfaction of physicians; ii) identify differences in the dimensions of career satisfaction; and iii) test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain). Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians.

  12. Factors identified with higher levels of career satisfaction of physicians in Andalusia, Spain

    Directory of Open Access Journals (Sweden)

    Juan Nicolás Peña-Sánchez


    Full Text Available The satisfaction of physicians is a world-wide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i measure the career satisfaction of physicians; ii identify differences in the dimensions of career satisfaction; and iii test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain. Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians.

  13. Incentives and intrinsic motivation in healthcare. (United States)

    Berdud, Mikel; Cabasés, Juan M; Nieto, Jorge

    It has been established in the literature that workers within public organisations are intrinsically motivated. This paper is an empirical study of the healthcare sector using methods of qualitative analysis research, which aims to answer the following hypotheses: 1) doctors are intrinsically motivated; 2) economic incentives and control policies may undermine doctors' intrinsic motivation; and 3) well-designed incentives may encourage doctors' intrinsic motivation. We conducted semi-structured interviews à-la-Bewley with 16 doctors from Navarre's Healthcare Service (Servicio Navarro de Salud-Osasunbidea), Spain. The questions were based on current theories of intrinsic motivation and incentives to test the hypotheses. Interviewees were allowed to respond openly without time constraints. Relevant information was selected, quantified and analysed by using the qualitative concepts of saturation and codification. The results seem to confirm the hypotheses. Evidence supporting hypotheses 1 and 2 was gathered from all interviewees, as well as indications of the validity of hypothesis 3 based on interviewees' proposals of incentives. The conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Dumitru ZAIȚ


    Full Text Available In order to invest there are some incentives needed, including among them, certainly, the ones discussed and analysed in the scientific literature such as: specific earning chances (expectations of each participant (wage, profit, dividend, budget revenue, etc., potential investor’s general or current state, etc.. Less visible incentives from complex areas not obviously related to the investment are, however, less considered. Among these could be incentives arising from inherited or education and culture transmitted philosophy, generally regarding earnings, business and investment. We notice these incentives in case of FDI in different shades and intensities.Investor’s decision to acquire, sell or to carry out projects in a particular area, region or country is not only due to purely economic, commercial or financial reasoning. In such operations, meeting among businessmen, managers and other professionals in the field is, first of all, meeting in specific circumstances, among more or less different cultures.Both theory and practice must be concerned in what way and to what extent these factors influence the investment intention, outcome and yield. Our study proposes a list of the most important cultural type incentives for investment (mainly FDI, based on a set of cases, through a logical and empirical research, using some of the most relevant and recent studies and several real situations to which we got access. These are early data and analysis that will allow us to draw attention to the problem and to develop further research to reach generalizable results

  15. Specification and Estimation of Network Formation and Network Interaction Models with the Exponential Probability Distribution


    Hsieh, Chih-Sheng; Lee, Lung fei


    In this paper, we model network formation and network interactions under a unified framework. The key feature of our model is to allow individuals to respond to incentives stemming from interaction benefits on certain activities when they choose friends (network links), while capturing homophily in terms of unobserved characteristic variables in network formation and activities. There are two advantages of this modeling approach: first, one can evaluate whether incentives from certain interac...

  16. Impact of Physician Community Structure on Healthcare Outcomes. (United States)

    Uddin, Shahadat; Kelaher, Margaret; Piraveenan, Mahendra


    There is a substantial variation in healthcare spending and readmission rate for individuals having admissions to different hospitals. This study assessed how the community structure of physician collaboration networks that evolve during the period of providing healthcare services to hospitalised patients contribute to this variation. A physician collaboration network is said to have a community structure if the nodes (i.e. physicians) of that network can be easily grouped into sets of nodes such that each set of nodes is densely connected internally but sparsely connected between groups. This study constructed physician collaboration networks based on patient-sharing ties among physicians who provided healthcare services to hospitalised patients. An administrative health insurance claim dataset was utilised to extract patient-sharing ties among physicians. Simple linear regression models were estimated to assess the impact of the community structure of physician collaboration networks on the healthcare outcome measures (i.e. readmission rate and hospitalisation cost). From these models, this study found that the structure of a physician community has significant impact on readmission rate and hospitalisation cost. Healthcare administrators or managers could consider this finding in developing effective and efficient healthcare environments in their respective healthcare organisations.

  17. Paperless Transaction for Publication Incentive System (United States)

    Ibrahim, Rosziati; Madon, Hamiza Diana; Nazri, Nurul Hashida Amira Mohd; Saarani, Norhafizah; Mustapha, Aida


    Within the Malaysian context, incentive system in scientific publishing rewards authors for publishing journal articles or conference papers that are indexed by Scopus. At Universiti Tun Hussein Onn Malaysia, the incentive system is going into its third year in operational. The main challenge lies in preparing the evidences as required by the application guideline. This paper presents an online module for publication incentive within the University Publication Information System (SMPU). The module was developed using the Scrum methodology based on the existing workflow of paper-based application. The module is hoped to increase the quality of the system deliverables of SMPU as well as having the ability to cope with change of university requirements in the future.

  18. Splitting motivation: unilateral effects of subliminal incentives. (United States)

    Schmidt, Liane; Palminteri, Stefano; Lafargue, Gilles; Pessiglione, Mathias


    Motivation is generally understood to denote the strength of a person's desire to attain a goal. Here we challenge this view of motivation as a person-level concept, in a study that targeted subliminal incentives to only one half of the human brain. Participants in the study squeezed a handgrip to win the greatest fraction possible of each subliminal incentive, which materialized as a coin image flashed in one visual hemifield. Motivation effects (i.e., more force exerted when the incentive was higher) were observed only for the hand controlled by the stimulated brain hemisphere. These results show that in the absence of conscious control, one brain hemisphere, and hence one side of the body, can be motivated independently of the other.

  19. Incentive relativity in middle aged rats. (United States)

    Justel, N; Mustaca, A; Boccia, M; Ruetti, E


    Response to a reinforcer is affected by prior experience with different reward values of that reward, a phenomenon known as incentive relativity. Two different procedures to study this phenomenon are the incentive downshift (ID) and the consummatory anticipatory negative contrast (cANC), the former is an emotional-cognitive protocol and the latter cognitive one. Aged rodents, as also well described in aged humans, exhibit alterations in cognitive functions. The main goal of this work was to evaluate the effect of age in the incentive' assessment using these two procedures. The results indicated that aged rats had an adequate assessment of the rewards but their performance is not completely comparable to that of young subjects. They recover faster from the ID and they had a cognitive impairment in the cANC. The results are discussed in relation to age-related changes in memory and emotion. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. How to govern physician-hospital exchanges: contractual and relational issues in Belgian hospitals. (United States)

    Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven


    Our aim was to investigate contractual mechanisms in physician-hospital exchanges. The concepts of risk-sharing and the nature of physician-hospital exchanges - transactional versus relational - were studied. Two qualitative case studies were performed in Belgium. Hospital executives and physicians were interviewed to develop an in-depth understanding of contractual and relational issues that shape physician-hospital contracting in acute care hospitals. The underlying theoretical concepts of agency theory and social exchange theory were used to analyse the data. Our study found that physician-hospital contracting is highly complex. The contract is far more than an economic instrument governing financial aspects. The effect of the contract on the nature of exchange - whether transactional or relational - also needs to be considered. While it can be argued that contractual governance methods are increasingly necessary to overcome the difficulties that arise from the fragmented payment framework by aligning incentives and sharing financial risk, they undermine the necessary relational governance. Relational qualities such as mutual trust and an integrative view on physician-hospital exchanges are threatened, and may be difficult to sustain, given the current fragmentary payment framework. Since health care policy makers are increasing the financial risk borne by health care providers, it can be argued that this also increases the need to share financial risk and to align incentives between physician and hospital. However, our study demonstrates that while economic alignment is important in determining physician-hospital contracts, the corresponding impact on working relationships should also be considered. Moreover, it is important to avoid a relationship between hospital and physician predominantly characterized by transactional exchanges thereby fostering an unhealthy us-and-them divide and mentality. Relational exchange is a valuable alternative to contractual

  1. Burnout among physicians


    Romani, Maya; Ashkar, Khalil


    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to ...

  2. Powerplant productivity improvements and regulatory incentives

    Energy Technology Data Exchange (ETDEWEB)

    Hardy, D; Brown, D


    The purpose of this study was to examine the benefits to be gained from increased powerplant productivity and to validate and demonstrate the use of incentives within the regulatory process to promote the improvement of powerplant productivity. The system-wide costs savings to be gained from given productivity improvement scenarios are estimated in both the short and long term. Numerous reports and studies exist which indicate that productivity improvements at the powerplant level are feasible and cost effective. The efforts of this study widen this focus and relate system-wide productivity improvements with system-wide cost savings. The initial thrust of the regulatory section of this study is to validate the existence of reasonable incentive procedures which would enable regulatory agencies to better motivate electric utilities to improve productivity on both the powerplant and system levels. The voluntary incentive format developed in this study was designed to facilitate the link between profit and efficiency which is typically not clear in most regulated market environments. It is concluded that at the present time, many electric utilities in this country could significantly increase the productivity of their base load units, and the adoption of an incentive program of the general type recommended in this study would add to rate of return regulation the needed financial incentives to enable utilities to make such improvements without losing long-run profit. In light of the upcoming oil import target levels and mandatory cutbacks of oil and gas as boiler fuels for electric utilities, the use of incentive programs to encourage more efficient utilization of coal and nuclear base load capacity will become far more inviting over the next two decades.

  3. Barriers to ambulatory EHR: who are 'imminent adopters' and how do they differ from other physicians?

    Directory of Open Access Journals (Sweden)

    Nir Menachemi


    Conclusion Policy and decision makers interested in promoting the adoption of EHR among physicians should focus on the needs and barriers of those most likely to adopt EHR. Given that imminent adopters differ considerably from their peers, current EHR incentive programmes that focus on financial barriers only might prove sub-optimal in achieving immediate widespread EHR adoption.

  4. Doctor-Nurse Teams, Incentives and Behavior


    Aida Isabel Tavares


    Nurses have been gaining expertise over time and it is common that they work together in a team with doctors to treat patients. Using a model based on contract theory, the aim of this article is to analyze the effects of an improvement in nurses’ productivity on the incentives paid and on the behavior of doctors and nurses, in particular when the budgets are limited. The results show that following an improvement in nurse productivity, nurses’ incentives are lower but the overall budget of in...

  5. Incentive and insurance effects of income taxation

    DEFF Research Database (Denmark)

    Andersen, Torben M.


    Tax distortions cause a trade-off between efficiency and equity. However, taxes not only affect incentives; they also provide implicit insurance, and this may critically affect the efficiency–equity relationship. For a standard labour supply problem it is shown that the insurance effect mutes...... the sensitivity of labour supply to taxes, which tends to reduce tax distortions and lower the marginal costs of public funds. The relation between incentives and insurance and thus efficiency and equity is flattened by the insurance effect and it may even be non-monotone. However, the optimal utilitarian policy...... implies that there is always a trade-off between efficiency and equity on the margin....

  6. Incentives and performance governance of research organizations

    CERN Document Server

    Wollersheim, Jutta; Ringelhan, Stefanie; Osterloh, Margit


    ​This book contributes to the current discussion in society, politics and higher education on innovation capacity and the financial and non-financial incentives for researchers. The expert contributions in the book deal with implementation of incentive systems at higher education institutions in order to foster innovation. On the other hand, the book also discusses the extent to which governance structures from economy can be transferred to universities and how scientific performance can be measured and evaluated. This book is essential for decision-makers in knowledge-intensive organizations and higher-educational institutions dealing with the topic of performance management.

  7. Differential dependence of Pavlovian incentive motivation and instrumental incentive learning processes on dopamine signaling (United States)

    Wassum, Kate M.; Ostlund, Sean B.; Balleine, Bernard W.; Maidment, Nigel T.


    Here we attempted to clarify the role of dopamine signaling in reward seeking. In Experiment 1, we assessed the effects of the dopamine D1/D2 receptor antagonist flupenthixol (0.5 mg/kg i.p.) on Pavlovian incentive motivation and found that flupenthixol blocked the ability of a conditioned stimulus to enhance both goal approach and instrumental performance (Pavlovian-to-instrumental transfer). In Experiment 2 we assessed the effects of flupenthixol on reward palatability during post-training noncontingent re-exposure to the sucrose reward in either a control 3-h or novel 23-h food-deprived state. Flupenthixol, although effective in blocking the Pavlovian goal approach, was without effect on palatability or the increase in reward palatability induced by the upshift in motivational state. This noncontingent re-exposure provided an opportunity for instrumental incentive learning, the process by which rats encode the value of a reward for use in updating reward-seeking actions. Flupenthixol administered prior to the instrumental incentive learning opportunity did not affect the increase in subsequent off-drug reward-seeking actions induced by that experience. These data suggest that although dopamine signaling is necessary for Pavlovian incentive motivation, it is not necessary for changes in reward experience, or for the instrumental incentive learning process that translates this experience into the incentive value used to drive reward-seeking actions, and provide further evidence that Pavlovian and instrumental incentive learning processes are dissociable. PMID:21693635

  8. Role of primary care physicians in treating patients with ST-segment elevation myocardial infarction located in remote areas (from the REseau Nord-Alpin des Urgences [RENAU], Network). (United States)

    Yayehd, Komlavi; Ricard, Cécile; Ageron, François-Xavier; Buscaglia, Léna; Savary, Dominique; Audema, Bernard; Lacroix, Diane; Barthes, Manuela; Joubert, Patrick; Gheno, Gaël; Belle, Loic


    European guidelines for ST-segment elevation myocardial infarction (STEMI) encourage healthcare networks to increase rates of, and decrease delays to, reperfusion. We examined the impact of training primary care physicians (PCPs) to use equipment for pre-hospital management of STEMI patients in remote areas. A network for cardiac emergencies was set up in the French Northern Alps in 2002 and a registry of STEMI patients has been kept since. In 2005, 24 local volunteer PCPs were trained and equipped with electrocardiograms, fibrinolysis kits, and automated external defibrillators to deal with cardiac emergencies in remote areas (>30-minute ambulance travelling time). In this study, when the central call dispatcher received a telephone call from a patient in a remote area reporting chest pain with a high probability of STEMI, the dispatcher sent a mobile intensive care unit (MICU) with an emergency physician on board and asked the local PCP, if available, to manage the patient while awaiting arrival of the MICU. Patients in whom the diagnosis of STEMI was confirmed were taken by MICU to an interventional cardiology hospital. We report on patients who received care from a PCP before arrival of the MICU. Between 2005 and 2010, 4,015 patients were enrolled in the registry; 180 patients were located in a remote area, of whom 140 were in an area covered by a participating PCP. Of the 62 patients attended by a PCP before MICU arrival, 27 received thrombolysis and eight patients with ventricular tachycardia/fibrillation were shocked with an automated external defibrillator by the PCP. Mean times from telephone call to thrombolysis were shorter when the patient was attended by a PCP (45.0 ± 25.5 vs 62.4 ± 23.4 min without intervention; p = 0.003). STEMI diagnosis without contraindication to thrombolysis was confirmed in 26 of 27 patients treated as such by PCPs and 1 patient was diagnosed with a Tako-Tsubo syndrome. PCP care of STEMI patients located in isolated areas

  9. The stability of exchange networks

    NARCIS (Netherlands)

    Doğan, G.; Assen, M. van; Rijt, A. van de; Buskens, V.W.


    Economic and sociological exchange theories predict divisions of exchange benefits given an assumed fixed network of exchange relations. Since network structure has been found to have a large impact on actors’ payoffs, actors have strong incentives for network change.Weanswer the question what

  10. Incentives to improve energy efficiency in EU Grids

    Energy Technology Data Exchange (ETDEWEB)

    Papaefthymiou, G.; Beestermoeller, C.; Gardiner, A.


    The Energy Efficiency Directive (2012/27/EU) includes provisions related to network tariffs and regulation. It is timely therefore to revisit the potential options for energy efficiency in grids, the treatment of energy efficiency in network tariffs and alternative policies for improving energy efficiency. This project builds on work done previously for the European Copper Institute in this area. In this paper, we concentrate on energy efficiency in electricity network design and operation. Other articles in the Directive relate to the role of the network tariffs and regulations in enabling or incentivising the provision of energy efficiency to end users. In section 2, we describe technical efficiency measures to reduce losses (improve energy efficiency) in the grid. Section 3 reviews grid tariffs in three countries to identify whether they provide incentives or disincentives for energy efficiency in the grid. Section 4 discusses and evaluates alternative regulations for energy efficiency in grids. Section 5 concludes and discusses the main components of the optimal policy framework.

  11. An incentive mechanism for electricity transmission expansion in Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Rosellon, Juan [Division de Economia, Centro de Investigacion y Docencia Economicas (CIDE), Carret. Mexico-Toluca 3655, Lomas de Santa Fe, C.P. 01210, Mexico DF (Mexico)


    This study proposes an incentive regulatory framework for expanding electricity transmission in Mexico. A two-part pricing model is implemented within a combined merchant-regulatory structure. Three cases are considered. In the first, a monopolist with ''postage stamp tariffs'' serves the whole country using uniform prices. In the second case, one firm holds a regional monopoly in each of the five electricity areas. In the third, a monopolist operates in all areas of the national electricity system and discriminates in the prices it charges in each of the regions. This approach is described and then applied to the Mexican electricity transmission network. Using real data, the study compares all three cases in terms of profits, capacity increases, and network expansion. The results are found to depend on two effects: the ''economies-of-scale effect'', in which the maximum level is reached with a single network; and the ''discriminatory effect'' that results when a firm can discriminate among types of consumers. The economies-of-scale effect produces greater capacity and network expansion, whereas the discriminatory effect increases profits. (author)

  12. Variability of Post-Cardiac Arrest Care Practices Among Cardiac Arrest Centers: United States and South Korean Dual Network Survey of Emergency Physician Research Principal Investigators. (United States)

    Coppler, Patrick J; Sawyer, Kelly N; Youn, Chun Song; Choi, Seung Pill; Park, Kyu Nam; Kim, Young-Min; Reynolds, Joshua C; Gaieski, David F; Lee, Byung Kook; Oh, Joo Suk; Kim, Won Young; Moon, Hyung Jun; Abella, Benjamin S; Elmer, Jonathan; Callaway, Clifton W; Rittenberger, Jon C


    There is little consensus regarding many post-cardiac arrest care parameters. Variability in such practices could confound the results and generalizability of post-arrest care research. We sought to characterize the variability in post-cardiac arrest care practice in Korea and the United States. A 54-question survey was sent to investigators participating in one of two research groups in South Korea (Korean Hypothermia Network [KORHN]) and the United States (National Post-Arrest Research Consortium [NPARC]). Single investigators from each site were surveyed (N = 40). Participants answered questions based on local institutional protocols and practice. We calculated descriptive statistics for all variables. Forty surveys were completed during the study period with 30 having greater than 50% of questions completed (75% response rate; 24 KORHN and 6 NPARC). Most centers target either 33°C (N = 16) or vary the target based on patient characteristics (N = 13). Both bolus and continuous infusion dosing of sedation are employed. No single indication was unanimous for cardiac catheterization. Only six investigators reported having an institutional protocol for withdrawal of life-sustaining therapy (WLST). US patients with poor neurological prognosis tended to have WLST with subsequent expiration (N = 5), whereas Korean patients are transferred to a secondary care facility (N = 19). Both electroencephalography modality and duration vary between institutions. Serum biomarkers are commonly employed by Korean, but not US centers. We found significant variability in post-cardiac arrest care practices among US and Korean medical centers. These practice variations must be taken into account in future studies of post-arrest care.

  13. Negotiation for physicians. (United States)

    Hill, Micah J; DeCherney, Alan H


    Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  14. Downsizing the physician workforce. (United States)

    McClendon, B J; Politzer, R M; Christian, E; Fernandez, E S


    OBJECTIVE: To estimate the need for downsizing the physician workforce in a changing health care environment. METHODS: First assuming that 1993 physician-to-population ratios would be maintained, the authors derived downsizing estimates by determining the annual growth in the supply of specialists necessary to maintain these ratios (sum of losses from death and retirement plus increase necessary to parallel population growth) and compared them with an estimate of the number of new physicians being produced (average annual number of board certificates issued between 1990 and 1994). Then, assuming that workforce needs would change in a system increasingly dominated by managed care, the authors estimated specialty-specific downsizing needs for a managed care dominated environment using data from several sources. RESULTS: To maintain the 1993 199.6 active physicians per 100,000 population ratio, 14,644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed annually to maintain 1993 levels. To maintain the 132.2 ratio of active non-primary care physicians per 100,000 population, the system needed to produce 9698 non-primary care physicians per year, because an average of 14,527 new non-primary care physicians entered the workforce between 1990 and 1994, downsizing by 4829, or 33%, was needed. To maintain the 66.8 active primary care physicians per 100,000 population ratio, 4946 new primary care physicians were needed per year, since primary care averaged 6128 new certifications per year, a downsizing of 1182, or 20% was indicated. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital-based specialties, including 7 of 10 internal medicine subspecialties, needed downsizing by at least 40%. Less downsizing in general was needed in the surgical specialties and in psychiatry. A

  15. Using Effective Contractual Incentives to Obtain Superior Contractor Performance

    National Research Council Canada - National Science Library

    Venable, Timothy


    The purpose of this thesis is to provide the reader with the ability to analyze the effectiveness of incentives and to document innovative approaches to incentive contracting that can be applied to Cost-Plus-Award-Fee (CPAF) contracts...

  16. Policies and incentives for promoting innovation in antibiotic research

    National Research Council Canada - National Science Library

    Mossialos, Elias


    ... and development for antibiotics with novel mechanisms of action actively promoted. This requires appropriately designed incentives for health and regulatory systems, in addition to economic incentives to attract academic interest and industry investment...

  17. Grid Computing BOINC Redesign Mindmap with incentive system (gamification)


    Kitchen, Kris


    Grid Computing BOINC Redesign Mindmap with incentive system (gamification) this is a PDF viewable of

  18. Professional norms, public service motivation and economic incentives

    DEFF Research Database (Denmark)

    Andersen, Lotte Bøgh


    The theories of professions, public service motivation, and economic incentives explain the behaviour of the producers of publicly financed services differently. They emphasize professional norms, sector, and economic incentives, respectively. The few existing attempts to integrate these theories...

  19. 78 FR 21116 - Superior Supplier Incentive Program (United States)


    ... following CPARS areas: Technical (Quality of Product). Schedule. Cost Control. Management Responsiveness. Management of Key Personnel. Utilization of Small Business. Other CPARS Factors As Appropriate. During the... performance incentives will provide contractors with the greatest motivation to achieve SSS? 3. What contract...

  20. Incentive Issues in Information Security Management (United States)

    Lee, Chul Ho


    This dissertation studies three incentive issues in information security management. The first essay studies contract issues between a firm that outsources security functions and a managed security service provider (MSSP) that provides security functions to the firm. Since MSSP and firms cannot observe each other's actions, both can suffer…

  1. Applying incentive sensitization models to behavioral addiction

    DEFF Research Database (Denmark)

    Rømer Thomsen, Kristine; Fjorback, Lone; Møller, Arne


    The incentive sensitization theory is a promising model for understanding the mechanisms underlying drug addiction, and has received support in animal and human studies. So far the theory has not been applied to the case of behavioral addictions like Gambling Disorder, despite sharing clinical...

  2. Incentives, Teachers, and Gender at Work (United States)

    Robert, Sarah A.


    Incentive pay programs have become panacea for a multitude of educational challenges. When aimed at teachers the assumption is that rewards entice them to work in particular ways or particular schools. However, the assumption is based on an economic formula that does not take into consideration the gendered nature of policy processes. This study…

  3. Financial Incentives to Promote Active Travel (United States)

    Martin, Adam; Suhrcke, Marc; Ogilvie, David


    Context Financial incentives, including taxes and subsidies, can be used to encourage behavior change. They are common in transport policy for tackling externalities associated with use of motor vehicles, and in public health for influencing alcohol consumption and smoking behaviors. Financial incentives also offer policymakers a compromise between “nudging,” which may be insufficient for changing habitual behavior, and regulations that restrict individual choice. Evidence acquisition The literature review identified studies published between January 1997 and January 2012 of financial incentives relating to any mode of travel in which the impact on active travel, physical activity, or obesity levels was reported. It encompassed macroenvironmental schemes, such as gasoline taxes, and microenvironmental schemes, such as employer-subsidized bicycles. Five relevant reviews and 20 primary studies (of which nine were not included in the reviews) were identified. Evidence synthesis The results show that more-robust evidence is required if policymakers are to maximize the health impact of fiscal policy relating to transport schemes of this kind. Conclusions Drawing on a literature review and insights from the SLOTH (sleep, leisure, occupation, transportation, and home-based activities) time-budget model, this paper argues that financial incentives may have a larger role in promoting walking and cycling than is acknowledged generally. PMID:23159264

  4. Career concerns incentives: An experimental test

    DEFF Research Database (Denmark)

    Koch, Alexander; Morgenstern, Albrecht; Raab, Philippe

    the information that individuals base their decisions on. Our laboratory experiment provides prima facie evidence: i) the signal jamming mechanism successfully creates incentives on the labor supply side; ii) decision errors take time to decrease; iii) while subjects' average beliefs are remarkably consistent...

  5. 24 CFR 901.130 - Incentives. (United States)


    ... HOUSING MANAGEMENT ASSESSMENT PROGRAM § 901.130 Incentives. (a) A PHA that is designated high performer or... the right decision that impacts long-term overall management or the quality of a PHA's housing stock... of requirements for prior HUD approval for certain types of contracts for services, it must still...

  6. Faculty Incentives to Participate in Distance Education. (United States)

    Husmann, Dann E.; Miller, Michael T.


    Explores the demographics of faculty who volunteer to teach using distance-education technologies and discusses incentives for this participation. Finds that faculty have an interest in teaching with technology as a component of student learning, and they see internal rewards as the dominant motivation for involvement. Contains 15 references. (VWC)

  7. 75 FR 30007 - Teacher Incentive Fund (United States)


    ... FY 2010 (NIA) for the Teacher Incentive Fund. This notice makes a correction to the May 21 NIA. FOR...: Correction On page 28745 of the May 21 NIA, we requested that applicants submit a short e-mail as a notice of... applicant intends to address.'' We are correcting the May 21 NIA to provide applicants with the correct...

  8. 73 FR 8815 - Incentive Award Program Delegation (United States)


    ... Department of Justice may approve incentive awards. The rule also makes minor revisions to the regulations to... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF JUSTICE Office... Justice. ACTION: Final rule. SUMMARY: This rule amends part 0 of title 28 of the Code of Federal...

  9. Economic Incentives for Stormwater Control (ISBN9781439845608) (United States)

    Addressing a huge knowledge gap from a policy perspective, this book focuses on the economic tools available for stormwater runoff control. It provides case studies demonstrating the application of various incentives, such as tradable credits, fees with rebates, and auction mecha...

  10. Targeted Business Incentives and Local Labor Markets (United States)

    Freedman, Matthew


    This paper uses a regression discontinuity design to examine the effects of geographically targeted business incentives on local labor markets. Unlike elsewhere in the United States, enterprise zone (EZ) designations in Texas are determined in part by a cutoff rule based on census block group poverty rates. Exploiting this discontinuity as a…

  11. Non Communicable Diseases: Local incentive spirometry improves ...

    African Journals Online (AJOL)


    The non-SCA participants were recruited from the Bayero University, Kano community. Ethical approval for this study was obtained from the Ethical Committee on Research of the Aminu Kano Teaching Hospital, Kano. Locally designed incentive spirometry. An unused sterile surgical glove firmly tied with rubber band to the ...

  12. Targeting incentives to reduce habitat fragmentation (United States)

    David Lewis; Andrew Plantinga; Junjie Wu


    This article develops a theoretical model to analyze the spatial targeting of incentives for the restoration of forested landscapes when wildlife habitat can be enhanced by reducing fragmentation. The key theoretical result is that the marginal net benefits of increasing forest can be convex, in which case corner solutions--converting either none or all of the...

  13. Essays on incentives in regulation and innovation

    NARCIS (Netherlands)

    Jansen, J.A.


    The thesis contains three essays on incentives in regulation and innovation. The first essay analyzes a problem of optimal regulatory design. Key feature of the problem is that there exists asymmetric information between the regulator and the industry concerning the costs of producing complementary

  14. Incentives through Consumer Learning about Tastes

    DEFF Research Database (Denmark)

    Schumacher, Heiner


    no equilibrium in which the firm always exerts high effort. However, when consumers learn about their own tastes, such an equilibrium can exist. Consumer learning about tastes therefore is an alternative to reputational concerns that produces stable incentives. We discuss the implications of this mechanism...

  15. The Cornell Staff Retirement Incentive Program (United States)

    Whelan, Kenneth T.; Ehrenberg, Ronald G.; Hallock, Kevin F.; Seeber, Ronald L.


    We evaluate potential determinants of enrollment in an early retirement incentive program for non-tenure-track employees at a large university. Using administrative records on the eligible, population of employees not covered by collective bargaining agreements, historical employee count and layoff data by budget units, and public information on…

  16. Health, Financial Incentives and Retirement in Spain

    NARCIS (Netherlands)

    E. Erdogan-Ciftci (Esen); E.K.A. van Doorslaer (Eddy); A. Lopez-Nicolas (Angel)


    textabstractWe estimate the impact of health and financial incentives on the retirement transitions of older workers in Spain. Individual measures of pension wealth, peak and accrual values are constructed using labor market histories and health shocks are derived as changes in a composite health

  17. Examining the Incentives in Educational Research (United States)

    Brewer, Dominic J.; Goldhaber, Dan D.


    In their best seller, "Freakonomics", University of Chicago economist Steven Levitt and "New York Times" writer Stephen Dubner show in an amusing and often provocative manner how an economic way of thinking can be useful in explaining all sorts of real-world phenomena. Their central insight is very simple: incentives are the cornerstone of modern…

  18. Incentives and Social Relations in the Workplace

    NARCIS (Netherlands)

    J. Sol (Joeri)


    textabstractIn this thesis, I study how organizations can incentivize a group of individuals, both in theory and by conducting …eld experiments. The …eld experiments introduce short-term team incentives in a randomly selected sample of stores that belong to a single Dutch retail chain of 128

  19. Dynamic activity-related incentives for physical activity


    Schüler, Julia; Brunner, Sibylle


    The present studies adopted the theoretical framework of activity- and purpose-related incentives (Rheinberg, 2008) to explain the maintenance of physical activity. We hypothesized that activity-related incentives (e.g., “fun”) increase more than purpose-related incentives (e.g., “health”) between the initiation and maintenance phase of physical activity. Additionally, change in activity-related incentives was hypothesized to be a better predictor of maintenance of physical activity than chan...

  20. Organizational and market influences on physician performance on patient experience measures. (United States)

    Rodriguez, Hector P; von Glahn, Ted; Rogers, William H; Safran, Dana Gelb


    To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p=.007) and care coordination ( p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p=.04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p=.04) and care coordination ( pintegrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high

  1. 42 CFR 495.102 - Incentive payments to EPs. (United States)


    ... 42 Public Health 5 2010-10-01 2010-10-01 false Incentive payments to EPs. 495.102 Section 495.102... PROGRAM Requirements Specific to the Medicare Program § 495.102 Incentive payments to EPs. (a) General...) Increase in incentive payment limit for EPs who predominantly furnish services in a geographic HPSA. In the...

  2. 48 CFR 52.219-10 - Incentive Subcontracting Program. (United States)


    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Incentive Subcontracting....219-10 Incentive Subcontracting Program. As prescribed in 19.708(c)(1), insert the following clause: Incentive Subcontracting Program (OCT 2001) (a) Of the total dollars it plans to spend under subcontracts...

  3. 28 CFR 91.4 - Truth in Sentencing Incentive Grants. (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Truth in Sentencing Incentive Grants. 91... FACILITIES General § 91.4 Truth in Sentencing Incentive Grants. (a) Half of the total amount of funds... available for Truth in Sentencing Incentive Grants. (b) Eligibility. To be eligible to receive such a grant...

  4. Economic incentives to wind systems commercialization. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Lotker, M.; Shaw, Jr, R. W.; Adolfson, W. F.; Bernardi, R. P.; Davidoff, P. H.; Eckhart, M. T.; Gunwaldsen, D. S.; Mettam, P. J.; Narayanan, P.; Sillin, J. O.


    This assessment of Economic Incentives to Wind Systems Commercialization is an analysis of the quantitative and qualitative impacts of a variety of Government funded economic incentives on Wind Energy Conversion Systems (WECS). The purpose of this study is to achieve better understanding of the relationship between implementation of specific economic incentives for WECS, and the factors surrounding WECS commercial introduction.

  5. 48 CFR 519.7004 - Incentives for prime contractors. (United States)


    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Incentives for prime... SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS GSA Mentor-Protégé Program 519.7004 Incentives for prime... appropriate incentives to prime contractors in order to encourage subcontracting opportunities for small...

  6. 48 CFR 216.402-2 - Technical performance incentives. (United States)


    ... incentives. 216.402-2 Section 216.402-2 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 216.402-2 Technical performance incentives. See PGI 216.402-2 for guidance on establishing...

  7. Faculty Incentives for Online Course Design, Delivery, and Professional Development (United States)

    Herman, Jennifer H.


    This quantitative study investigated the types and frequency of incentives for online instruction at non-profit institutions of higher education with an established teaching and learning development unit. While up to 70% of institutions offer incentives, this support is not universal and varies by incentive type and purpose.

  8. 28 CFR 550.54 - Incentives for RDAP participation. (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Incentives for RDAP participation. 550.54... DRUG PROGRAMS Drug Abuse Treatment Program § 550.54 Incentives for RDAP participation. (a) An inmate may receive incentives for his or her satisfactory participation in the RDAP. Institutions may offer...

  9. 48 CFR 1816.402-270 - NASA technical performance incentives. (United States)


    ... incentives. 1816.402-270 Section 1816.402-270 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 1816.402-270 NASA technical performance incentives. (a) Pursuant to the guidelines in 1816.402, NASA has...

  10. The Promise of Tailoring Incentives for Healthy Behaviors. (United States)

    Kullgren, Jeffrey T; Williams, Geoffrey C; Resnicow, Kenneth; An, Lawrence C; Rothberg, Amy; Volpp, Kevin G; Heisler, Michele


    To describe how tailoring financial incentives for healthy behaviors to employees' goals, values, and aspirations might improve the efficacy of incentives. We integrate insights from self-determination theory (SDT) with principles from behavioral economics in the design of financial incentives by linking how incentives could help meet an employee's life goals, values, or aspirations. Tailored financial incentives could be more effective than standard incentives in promoting autonomous motivation necessary to initiate healthy behaviors and sustain them after incentives are removed. Previous efforts to improve the design of financial incentives have tested different incentive designs that vary the size, schedule, timing, and target of incentives. Our strategy for tailoring incentives builds on strong evidence that difficult behavior changes are more successful when integrated with important life goals and values. We outline necessary research to examine the effectiveness of this approach among at-risk employees. Instead of offering simple financial rewards for engaging in healthy behaviors, existing programs could leverage incentives to promote employees' autonomous motivation for sustained health improvements. Effective application of these concepts could lead to programs more effective at improving health, potentially at lower cost. Our approach for the first time integrates key insights from SDT, behavioral economics, and tailoring to turn an extrinsic reward for behavior change into an internalized, self-sustaining motivator for long-term engagement in risk-reducing behaviors.

  11. 10 CFR 452.6 - Incentive award terms and limitations. (United States)


    ... 10 Energy 3 2010-01-01 2010-01-01 false Incentive award terms and limitations. 452.6 Section 452.6 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.6... auctions if the incentives sought will assist the addition of plant production capacity for the eligible...

  12. Physician-assisted suicide. (United States)

    Snyder, L; Sulmasy, D P


    Medical professional codes have long prohibited physician involvement in assisting a patient's suicide. However, despite ethical and legal prohibitions, calls for the liberalization of this ban have grown in recent years. The medical profession should articulate its views on the arguments for and against changes in public policy and decide whether changes are prudent. In addressing such a contentious issue, physicians, policymakers, and society must fully consider the needs of patients, the vulnerability of particular patient groups, issues of trust and professionalism, and the complexities of end-of-life health care. Physician-assisted suicide is prominent among the issues that define our professional norms and codes of ethics. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) does not support the legalization of physician-assisted suicide. The routine practice of physician-assisted suicide raises serious ethical and other concerns. Legalization would undermine the patient-physician relationship and the trust necessary to sustain it; alter the medical profession's role in society; and endanger the value our society places on life, especially on the lives of disabled, incompetent, and vulnerable individuals. The ACP-ASIM remains thoroughly committed to improving care for patients at the end of life.

  13. Electronic health record availability among advanced practice registered nurses and physicians. (United States)

    Coffman, Janet M; Spetz, Joanne; Grumbach, Kevin; Fix, Margaret; Bindman, Andrew B


    To characterize availability of electronic health records (EHRs) at the primary practice locations of certified nurse midwives (CNMs), nurse practitioners (NPs), and physicians in California prior to the implementation of the state's Medicaid EHR incentive program. Cross-sectional mail surveys of samples of CNMs, NPs, and physicians who have active California licenses and reside in California. Descriptive statistics were calculated and multivariate regression analyses were estimated to identify characteristics associated with having an EHR. The following practice characteristics were included in the multivariate model: payer mix (% Medicaid), practice setting (hospital vs outpatient), and practice size. Variables for practitioner's age, sex, and practice location were also included. For both CNMs/NPs and physicians, practice size was the strongest predictor of EHR availability. Practicing in a large or mid-sized group was associated with higher odds of having a basic EHR or an advanced EHR. Having a high percentage of Medicaid patients was associated with lower odds of having an advanced EHR. Among physicians, but not CNMs/NPs, hospital-based practice was associated with higher odds of having an advanced EHR; being over age 45 years was associated with lower odds of having any EHR. The results suggest that prior to the launch of California's Medicaid EHR incentive program, similar characteristics predicted EHR availability among both CNMs/NPs and physicians, and that availability was concentrated among large practices with fewer Medicaid patients. Future studies should assess whether Medicaid and Medicare incentive payments attenuate these relationships.

  14. Revenue Share between Layers and Investment Incentive for ISP in the Internet Market (United States)

    Unno, Masaru; Xu, Hua

    In this paper, we consider a revenue-sharing and network investment problem between an Internet service provider (ISP) and a content provider (CP) by applying the dynamic agency theory. We formulate the problem as the principal-agent problem where the ISP is the principal and the CP is the agent. The principal-agent problem is transformed to a stochastic optimal control problem in which the objectives of ISP are to find an optimal revenue-sharing strategy and a network investment strategy, and to advise an incentive compatible effort level to the CP. The sufficient conditions for the existence of the optimal revenue-sharing strategy, the optimal investment strategy and the incentive compatible effort to the CP are obtained. A numerical example is solved to show the existence of such strategies. The practical implications of the results obtained in the paper will also be discussed.

  15. Speed regulating Effects of Incentive-based Intelligent Speed Adaptation in the short and medium term

    DEFF Research Database (Denmark)

    Agerholm, Niels

    sufficient further road safety on the basis of these solutions, while additional solutions known as Intelligent Transport Systems, and more particularly Intelligent Speed Adaptation (ISA), can be seen as a central solution towards a safer road network. ISA can be informative. It informs the driver about...... developed involving an incentive-based ISA system aimed at the target groups of young drivers and commercial drivers, on a commercial basis. The trials were Pay As You Speed (PAYS) and Intelligent Speed Adaptation Commercial (ISA C). In PAYS the size of the insurance rate would depend on the driver’s amount......Speed regulating Effects of Incentive-based Intelligent Speed Adaptation in the short and medium term Despite massive improvements in vehicles’ safety equipment, more information and safer road network, inappropriate road safety is still causing that more than 250 people are killed and several...

  16. Empirical studies of regulatory restructuring and incentives (United States)

    Knittel, Christopher Roland

    This dissertation examines the actions of firms when faced with regulatory restructuring. Chapter I examines the equilibrium pricing behavior of local exchange telephone companies under a variety of market structures. In particular, the pricing behavior of three services are analyzed: residential local service, business local service, and intraLATA toll service. Beginning in 1984, a variety of market structure changes have taken place in the local telecommunications industry. I analyze differences in the method of price-setting regulation and the restrictions on entry. Specifically, the relative pricing behavior under rate of return and price cap regulation is analyzed, as well as the impact of entry in the local exchange and intraLATA toll service markets. In doing so, I estimate an empirical model that accounts for the stickiness of rates in regulated industries that is based on firm and regulator decision processes in the presence of adjustment costs. I find that, faced with competitive pressures that reduce rates in one service, incumbent firm rates increase in other services, thereby reducing the benefits from competition. In addition, the findings suggest that price cap regulation leads to higher rates relative to rate-of-return regulation. Chapter 2 analyzes the pricing and investment behavior of electricity firms. Electricity and natural gas markets have traditionally been serviced by one of two market structures. In some markets, electricity and natural gas are sold by a dual-product regulated monopolist, while in other markets, electricity and natural gas are sold by separate single-product regulated monopolies. This paper analyzes the relative pricing and investment decisions of electricity firms operating in the two market structures. The unique relationship between these two products imply that the relative incentives of single and dual-product firms are likely to differ. Namely electricity and natural gas are substitutes in consumption while natural

  17. Review. The incentive sensitization theory of addiction: some current issues. (United States)

    Robinson, Terry E; Berridge, Kent C


    We present a brief overview of the incentive sensitization theory of addiction. This posits that addiction is caused primarily by drug-induced sensitization in the brain mesocorticolimbic systems that attribute incentive salience to reward-associated stimuli. If rendered hypersensitive, these systems cause pathological incentive motivation ('wanting') for drugs. We address some current questions including: what is the role of learning in incentive sensitization and addiction? Does incentive sensitization occur in human addicts? Is the development of addiction-like behaviour in animals associated with sensitization? What is the best way to model addiction symptoms using animal models? And, finally, what are the roles of affective pleasure or withdrawal in addiction?

  18. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period. (United States)


    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

  19. Hitler's Jewish Physicians. (United States)

    Weisz, George M


    The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler.

  20. Physician Compare Data (United States)

    U.S. Department of Health & Human Services — This is the official dataset associated with the Physician Compare Website provided by the Centers for Medicare and Medicaid Services (CMS). These data...

  1. Physicians and Surgeons (United States)

    ... classrooms, taking courses such as anatomy, biochemistry, pharmacology, psychology, medical ethics, and in the laws governing medicine. ... Surgeons, All Other Preventive Medicine Physicians Psychiatrists Radiologists Sports Medicine ... <- Similar Occupations Suggested citation: ...

  2. Physician-Owned Hospitals (United States)

    U.S. Department of Health & Human Services — Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to...

  3. Physician Referral Patterns (United States)

    U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...

  4. Physician Shared Patient Patterns (United States)

    U.S. Department of Health & Human Services — The physician referral data linked below was provided as a response to a Freedom of Information Act (FOIA) request. These files represent the number of encounters a...

  5. Accountable care organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s. (United States)

    Burns, Lawton R; Pauly, Mark V


    Accountable care organizations are intended to improve the quality and lower the cost of health care through several mechanisms, such as disease management programs, care coordination, and aligning financial incentives for hospitals and physicians. Providers employed several of these mechanisms in forming the integrated delivery networks of the 1990s. The networks failed, however, because of heavy financial losses stemming from hospitals' purchase of physician practices and their inability to align incentives, garner capitated contracts, and develop the infrastructure to manage risk. Although the current mechanisms underlying accountable care organizations continue to evolve, whether and how they will have an impact on quality and costs remains open to question. Care coordination and information technology are proving more complicated and expensive to implement than anticipated, providers may lack the ability to implement these mechanisms, and primary care providers are in short supply. As in the 1990s, success depends on targeting specific populations, such as people with multiple chronic conditions who need and may benefit from coordinated care.

  6. Do generation firms in restructured electricity markets have incentives to support social-welfare-improving transmission investments?

    Energy Technology Data Exchange (ETDEWEB)

    Sauma, Enzo E. [Pontificia Universidad Catolica de Chile, Industrial and Systems Engineering Department, Avenida Vicuna Mackenna 4860, Raul Deves Hall, Piso 3, Macul, Santiago (Chile); Oren, Shmuel S. [University of California Berkeley, Industrial Engineering and Operations Research Department, 4141 Etcheverry Hall, Berkeley, CA 94720-1777 (United States)


    This paper examines the incentives that generation firms have in restructured electricity markets for supporting long-term transmission investments. In particular, we study whether generation firms, which arguably play a dominant role in the restructured electricity markets, have the incentives to fund or support incremental social-welfare-improving transmission investments. We examine this question in a two-node network and explore how such incentives are affected by the ownership of financial transmission rights (FTRs) by generation firms. In the analyzed two-node network, we show both (1) that the net exporter generation firm has the correct incentives to increase the transmission capacity incrementally up to a certain level and (2) that, although a policy that allocates FTRs to the net exporter generation firm can be desirable from a social point of view, such a policy would dilute the net-importer-generation-firm's incentives to support transmission expansion. Moreover, if all FTRs were allocated or auctioned off to the net exporter generation firm, then it is possible to increase both consumer surplus and social welfare while keeping the net exporter generation firm revenue neutral. (author)

  7. Applied economics: The use of monetary incentives to modulate behavior. (United States)

    Strang, S; Park, S Q; Strombach, T; Kenning, P


    According to standard economic theory higher monetary incentives will lead to higher performance and higher effort independent of task, context, or individual. In many contexts this standard economic advice is implemented. Monetary incentives are, for example, used to enhance performance at workplace or to increase health-related behavior. However, the fundamental positive impact of monetary incentives has been questioned by psychologists as well as behavioral economists during the last decade, arguing that monetary incentives can sometimes even backfire. In this chapter, studies from proponents as well as opponents of monetary incentives will be presented. Specifically, the impact of monetary incentives on performance, prosocial, and health behavior will be discussed. Furthermore, variables determining whether incentives have a positive or negative impact will be identified. © 2016 Elsevier B.V. All rights reserved.

  8. U.S. physicians' views on financing options to expand health insurance coverage: a national survey. (United States)

    McCormick, Danny; Woolhandler, Steffie; Bose-Kolanu, Anjali; Germann, Antonio; Bor, David H; Himmelstein, David U


    Physician opinion can influence the prospects for health care reform, yet there are few recent data on physician views on reform proposals or access to medical care in the United States. To assess physician views on financing options for expanding health care coverage and on access to health care. Nationally representative mail survey conducted between March 2007 and October 2007 of U.S. physicians engaged in direct patient care. Rated support for reform options including financial incentives to induce individuals to purchase health insurance and single-payer national health insurance; rated views of several dimensions of access to care. 1,675 of 3,300 physicians responded (50.8%). Only 9% of physicians preferred the current employer-based financing system. Forty-nine percent favored either tax incentives or penalties to encourage the purchase of medical insurance, and 42% preferred a government-run, taxpayer-financed single-payer national health insurance program. The majority of respondents believed that all Americans should receive needed medical care regardless of ability to pay (89%); 33% believed that the uninsured currently have access to needed care. Nearly one fifth of respondents (19.3%) believed that even the insured lack access to needed care. Views about access were independently associated with support for single-payer national health insurance. The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.

  9. Using structured incentives to increase value for money in an academic health sciences centre. (United States)

    Hébert, Guy J; Colasante, Connie; Ilse, Renate G; Forster, Alan J


    As healthcare continues to consume more and more of provincial government spending, there is a continuing pressure to improve efficiency and cut overall costs. In this increasingly constrained healthcare system, value for money is a growing focus of discussions around accountability and system sustainability; healthcare leaders are required to find ways of measuring, enforcing, and reporting on that value. In 2014, our organization began implementing an innovative system of structured incentives, linking distribution of Ministry of Health and Long-Term Care academic physician funding to quality and performance goals. Through a carefully planned process of benchmarking, stakeholder consultation, model improvement, and change management, we were able to move to a new value for money allocation model. The new model drives accountability by linking distribution of government payments to quality and performance outcomes. Initial results include increased stakeholder satisfaction as well as broader physician engagement in corporate and academic quality improvement initiatives.

  10. Federal Tax Incentives for Energy Storage Systems

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Katherine H [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Elgqvist, Emma M [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Settle, Donald E [National Renewable Energy Laboratory (NREL), Golden, CO (United States)


    Investments in renewable energy are more attractive due to the contribution of two key federal tax incentives. The investment tax credit (ITC) and the Modified Accelerated Cost Recovery System (MACRS) depreciation deduction may apply to energy storage systems such as batteries depending on who owns the battery and how the battery is used. The guidelines in this fact sheet apply to energy storage systems installed at the same time as the renewable energy system.

  11. Beyond Widgets -- Systems Incentive Programs for Utilities

    Energy Technology Data Exchange (ETDEWEB)

    Regnier, Cindy [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mathew, Paul [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Robinson, Alastair [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schwartz, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Walter, Travis [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)


    Utility incentive programs remain one of the most significant means of deploying commercialized, but underutilized building technologies to scale. However, these programs have been largely limited to component-based products (e.g., lamps, RTUs). While some utilities do provide ‘custom’ incentive programs with whole building and system level technical assistance, these programs require deeper levels of analysis, resulting in higher program costs. This results in custom programs being restricted to utilities with greater resources, and are typically applied mainly to large or energy-intensive facilities, leaving much of the market without cost effective access and incentives for these solutions. In addition, with increasingly stringent energy codes, cost effective component-based solutions that achieve significant savings are dwindling. Building systems (e.g., integrated façade, HVAC and/or lighting solutions) can deliver higher savings that translate into large sector-wide savings if deployed at the scale of these programs. However, systems application poses a number of challenges – baseline energy use must be defined and measured; the metrics for energy and performance must be defined and tested against; in addition, system savings must be validated under well understood conditions. This paper presents a sample of findings of a project to develop validated utility incentive program packages for three specific integrated building systems, in collaboration with Xcel Energy (CO, MN), ComEd, and a consortium of California Public Owned Utilities (CA POUs) (Northern California Power Agency(NCPA) and the Southern California Public Power Authority(SCPPA)). Furthermore, these program packages consist of system specifications, system performance, M&V protocols, streamlined assessment methods, market assessment and implementation guidance.

  12. Motivational incentives of nurses and nursing leadership


    Bakola H.; Zyga S.; Panoutsopoulos G.; Alikari V.


    Introduction: In the health sector which is characterized much more as a "labor intensive" rather than as "capital intensive" human capital is the core for improving efficiency, enhancing productivity and maximizing the quality of service. Purpose: The purpose of this paper is to highlight the need for motivating nurses, presenting a realistic framework of incentives as well as the role of nursing leadership in this. Method: Literature review was carried out based on research and ...

  13. Loss Aversion, Stochastic Compensation, and Team Incentives


    大洞, 公平; Murooka, Takeshi


    We investigate moral-hazard problems with limited liability where agents have expectation-based reference-dependent preferences. We show that stochastic compensation for low performance can be optimal. Because of loss aversion, the agents have first-order risk aversion to wage uncertainty. This causes the agents to work harder when their low performance is stochastically compensated. We also examine team incentives for credibly employing such stochastic compensation. In an optimal contract, l...

  14. Improving Acquisition Through Innovation in Workforce Incentives (United States)


    composite evaluation that considers a system’s safety, interoperability, availability, maintainability, and reliability” (OUSD[AT&L], 2014). The...incentives over punitive measures. Employing the carrot more often than the stick will make the establishment of an enduring and sustainable culture of...Motivates Us, states “ Carrots & sticks are so last century. Drive says for 21st century work, we need to upgrade to autonomy, mastery, purpose.” The

  15. Incentives for demand-side management

    Energy Technology Data Exchange (ETDEWEB)

    Reid, M.W.; Brown, J.B. (Barakat and Chamberlin, Inc., Oakland, CA (United States))


    This report is the first product of an ongoing project to monitor the efforts of states to remove regulatory barriers to, and provide financial incentives for, utility investment in demand-side management (DSM) resources. The project was commissioned by the National Association of Regulatory Utility Commissioners (NARUC) in response to growing interest among regulators for a comprehensive survey of developments in this area. Each state report beings with an overview of the state's progress toward removing regulatory barriers and providing incentives for DSM. Information is organized under five headings: status; IRP regulations and practice; current treatment of DSM, directions and trends; commission contact person. Where applicable, each overview is followed by one or more sections that report on specific incentive proposals or mechanisms within the state. Information on each proposal or mechanism is organized under eight headings. A notation on each page identifies the utility or other group associated with the proposal or mechanism. The eight headings are as follows: status; background; treatment of cost recovery; treatment of lost revenues/decoupling; treatment of profitability; other features; issues, and additional observations.

  16. Incentives for demand-side management

    Energy Technology Data Exchange (ETDEWEB)

    Reid, M.W.; Brown, J.B. [Barakat and Chamberlin, Inc., Oakland, CA (United States)


    This report is the first product of an ongoing project to monitor the efforts of states to remove regulatory barriers to, and provide financial incentives for, utility investment in demand-side management (DSM) resources. The project was commissioned by the National Association of Regulatory Utility Commissioners (NARUC) in response to growing interest among regulators for a comprehensive survey of developments in this area. Each state report beings with an overview of the state`s progress toward removing regulatory barriers and providing incentives for DSM. Information is organized under five headings: status; IRP regulations and practice; current treatment of DSM, directions and trends; commission contact person. Where applicable, each overview is followed by one or more sections that report on specific incentive proposals or mechanisms within the state. Information on each proposal or mechanism is organized under eight headings. A notation on each page identifies the utility or other group associated with the proposal or mechanism. The eight headings are as follows: status; background; treatment of cost recovery; treatment of lost revenues/decoupling; treatment of profitability; other features; issues, and additional observations.

  17. A Model for Physician Leadership Development and Succession Planning. (United States)

    Dubinsky, Isser; Feerasta, Nadia; Lash, Rick


    Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders.

  18. Physicians' attitudes towards health telematics--an empirical survey. (United States)

    Langer, B; Wetter, T


    Telemedical networks and services have received high attention in professional and scientific media in the recent past. In Germany some institutions and few physicians volunteer in experimenting with diverse telemedical service offerings. However, much is speculated but little is known about attitudes and expectations of the majority of physicians in local offices towards this new medium. Therefore we conducted an empirical survey using a random regional sample to poll the respective opinions. Encouraged by a high response rate to our paper questionnaire, we offer as conclusion: that physicians are surprisingly realistic about costs and benefits and can therefore be expected to subscribe as soon as benefits become obvious; that this trend increases with offices being taken over or newly established by younger physicians; and that the establishment of networks of comprehensive care offered by health care professionals from different disciplines is regarded as essential future advantage of telemedical networks.

  19. HIPAA for physicians in the information age. (United States)

    Kavoussi, Shaheen C; Huang, John J; Tsai, James C; Kempton, James E


    The increased prominence of electronic health records, email, mobile devices, and social media has transformed the health care environment by providing both physicians and patients with opportunities for rapid communication and knowledge exchange. However, these technological advances require increased attention to patient privacy under the Health Insurance Portability and Accountability Act (HIPAA). Instant access to large amounts of electronic protected health information (PHI) merits the highest standard of network security and HIPAA training for all staff members. Physicians are responsible for protecting PHI stored on portable devices. Personal, residential, and public wireless connections are not certified with HIPAA-compliant Business Associate Agreements and are unsuitablefor PHI. A professional and privacy-oriented approach to electronic communication, online activity, and social media is imperative to maintaining public trust in physician integrity. As new technologies are integrated into health care practice, the assurance of privacy will encourage patients to continue to seek medical care.

  20. Negative Attitudes, Network and Education

    DEFF Research Database (Denmark)

    Bennett, Patrick; la Cour, Lisbeth; Larsen, Birthe

    This paper explores potential explanations behind the educational gap between young natives and immigrants using two measures, negative attitudes towards immigrants and networking, which may influence natives and immigrants differently. The paper considers, both theoretically and empirically......, the impact of negative attitudes and networking taking into account that these parameters may influence high and uneducated workers as well as immigrants and natives differently, creating different incentives to acquire education for the two ethnic groups. Using rich Danish administrative data, this paper...... finds evidence that greater negative attitudes increase incentives for males to acquire education and that networking also increases immigrant education....

  1. Can incentives undermine intrinsic motivation to participate in epidemiologic surveys? (United States)

    Wenemark, Marika; Vernby, Asa; Norberg, Annika Lindahl


    Response rates to surveys are decreasing. The purpose of this study was to evaluate the use of lottery tickets as incentives in an epidemiologic control group. A self-administered questionnaire was sent to parents in the municipality of Stockholm, Sweden, who were to be used as a control group in a study addressing stress in parents of children with cancer. A stratified random sample of 450 parents were randomized into three incentive groups: (a) no incentive; (b) a promised incentive of one lottery ticket to be received upon reply; (c) a promised incentive of one lottery ticket to be received upon reply and an additional lottery ticket upon reply within 1 week. The overall response rate across the three groups was 65.3%. The response rate was highest in the no incentive group (69.3%) and lowest in the one plus one lottery ticket group (62.0%). In a survival analysis, the difference between the two response curves was significant by the log-rank test (P = 0.04), with the no incentive group having a shorter time to response than the incentive group. Our findings suggest that the use of lottery tickets as incentives to increase participation in a mail questionnaire among parents may be less valuable or even harmful. Incentives may undermine motivation in studies in which the intrinsic motivation of the respondents is already high.

  2. Peer influence in network markets: a theoretical and empirical analysis

    NARCIS (Netherlands)

    J. Henkel (Joachim); J.H. Block (Jörn)


    textabstractNetwork externalities spur the growth of networks and the adoption of network goods in two ways. First, they make it more attractive to join a network the larger its installed base. Second, they create incentives for network members to actively recruit new members. Despite indications

  3. Physician Incentive Management in University Hospitals: Inducing Efficient Behavior Through the Allocation of Research Facilities

    NARCIS (Netherlands)

    K.M. Glorie (Kristiaan); J.M. van Oostrum (Jeroen); A.J. Dur (Robert); G. Kazemier (Geert); A.P.M. Wagelmans (Albert)


    textabstractThe imperative to improve healthcare efficiency is now stronger than ever. Rapidly increasing healthcare demand and the prospect of healthcare cost exploding require that measures be taken to make healthcare organizations become more efficiency-aware. Alignment of organizational

  4. [Insurgent physicians and surgeons]. (United States)

    de Micheli-Serra, A


    The long way toward the Mexican Independence developed in various stages, each one characterized by the temperament of the leaders, the theater of war actions and the social instances. At the beginning of the movement, of popular and radical types, we find few physicians perhaps due to the small number of them in the cities and to their absence in the villages. The middle period shows a larger number of national and foreign physicians. They are present in a more important number during the last stage, of bourgeois and reformist characteristics. The comportment of these worthy members of the medical class, during the different stages of the national independence movement, is a clear example of the patriotism and honesty of the Mexican physicians.

  5. Burnout among physicians. (United States)

    Romani, Maya; Ashkar, Khalil


    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians' quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as the

  6. Wellness Incentives, Equity, and the 5 Groups Problem (United States)


    Wellness incentives are an increasingly popular means of encouraging participation in prevention programs, but they may not benefit all groups equally. To assist those planning, conducting, and evaluating incentive programs, I describe the impact of incentives on 5 groups: the “lucky ones,” the “yes-I-can” group, the “I'll-do-it-tomorrow” group, the “unlucky ones,” and the “leave-me-alone” group. The 5 groups problem concerns the question of when disparities in the capacity to use incentive programs constitute unfairness and how policymakers ought to respond. I outline 4 policy options: to continue to offer incentives universally, to offer them universally but with modifications, to offer targeted rather than universal programs, and to abandon incentive programs altogether. PMID:22095346

  7. Beyond likes and tweets: an in-depth look at the physician social media landscape. (United States)

    Fogelson, Nicholas S; Rubin, Zarya A; Ault, Kevin A


    Social networking sites are a popular way for physicians to communicate about clinical, professional, and social topics. These sites can be used for educational purposes, professional interaction, and for general discussion. There are many popular sites oriented toward health care professionals, each with their own functionality and style. We reviewed the top physician-oriented networking sites, as well as popular general social networking sites that can be used for physician communication. We also provide background on social media communication, as well as specific advice for online physician communication and a discussion of confidentiality.

  8. Globalisation and National Incentives for Protecting Environmental Goods


    Alkuin Kölliker


    This article tries to explain national incentives for protecting environmental goods either autonomously or collectively; it explores how globalisation has affected those incentives; and it suggests how national environmental policy might respond so as to ensure its effectiveness. The central argument is that national incentives for environmental protection may to a considerable extent be explained by a combination of the type of environmental good to be protected (in terms of public goods th...

  9. Design of economic incentive instruments in nutrition policy

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård


    • Economic incentives are instruments to improve diets and reduce the fraction of people exposed to diet-related health risks • Proper targeting and design of economic incentive instruments is important, if such instruments should be efficient and feasible policy measures in the improvement of di...... of dietary behaviour in industrialised countries • From a cost-effectiveness perspective, there are considerable potential for optimizing the targeting and design of economic incentive instruments in nutritional policy...

  10. Incentive Contracts and Efficient Unemployment Benefits in a Globalized World


    Carsten Helm; Dominique Demougin


    Several European countries have reformed their labor market institutions. Incentive effects of unemployment benefits have been an important aspect of these reforms. We analyse this issue in a principal-agent model, higher level of unemployment benefits improves the workers' position in wage bargaining, leading to stronger effort incentives and higher output. However, it also reduces incentives for labor market participation. Accordingly, there is a trade-off. We analyze how changes in the eco...

  11. Japanese human resource management from the viewpoint of incentive theory


    Itoh, Hideshi


    This essay concerns the management of human resources in the stylized large Japanese firm. The emphasis is on issues of internal incentives, how the Japanese firm provides its employees with incentives to behave in harmony with goals of the firm. By drawing freely the insights from the growing literature on the economics of organizations (incentive theory), I attempt to explain economic rationale of some of the distinct features of Japanese management practices concerning pay and promotion sy...

  12. Behavioral implications of providing real incentives in stated choice experiments

    DEFF Research Database (Denmark)

    Mørkbak, Morten Raun; Olsen, Søren Bøye; Campbell, Danny


    the scope of research to other behavioral aspects where consumers in CE are often found to deviate from homo economicus. We develop a theoretical model where not only Willingness to pay (WTP) measures but also decision processing can be affected by the introduction of an economic incentive. Specifically...... incentive, we find marked benefits in relation to a number of behavioral aspects that together would favor the use of an economic incentive regardless of hypothetical bias being present or not....

  13. Incentives to Repurpose Existing Drugs for Orphan Indications. (United States)

    Kwok, Annette K; Koenigbauer, Fabian M


    The Orphan Drug Act has been successful in providing incentives to find cures for orphan diseases. However, many orphan diseases are still without cure. Therefore, the 114th Congress has introduced the 21st Century Cures Act and the Orphan Product Extension Now Accelerating Cures and Treatment Act of 2015 to further provide incentives to innovators to repurpose existing drugs for treatment of these orphan diseases. However, these bills are currently pending and their incentives might not go far enough.

  14. Incentives to participate in clinical trials: practical and ethical considerations. (United States)

    Bernstein, Steven L; Feldman, James


    Clinical trials often offer incentives to encourage individuals to enroll and to enhance follow-up. The scope and nature of incentives used in emergency department (ED)-based trials are unknown. The objective of this study is to characterize the quantity and quality of incentives and other forms of compensation used in clinical trials of human subjects recruited in US EDs. A secondary goal is to provide an historical and ethical analysis of the use of incentives in clinical trials. We reviewed English-language randomized clinical trials conducted in US EDs from 2009 to 2013. Full text of the studies was reviewed to identify whether incentives were used, their value, and timing. Funding source was noted as well. Data are presented with descriptive statistics. Of 1151 articles identified, 76 (6.6%) fit criteria for review. Of these, 7 (9.2%) provided incentive payments. A recently published eighth trial was included as well. The total cash value of incentives offered ranged from $10 to $195. Four studies offered payment at enrollment only. Incentives included cash, debit cards, and gift cards. The use of financial incentives in ED-based trials is uncommon. Studies that use incentives are generally extramurally funded, usually by a federal agency, and include waves of follow-up that continue after discharge from the ED. Payment size is modest. Incentives may improve recruitment and retention in ED-based trials, but authoritative data are lacking. Investigators need to take care to avoid incentives that may be coercive or unduly influence research participants. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Do incentives exert undue influence on survey participation? Experimental evidence. (United States)

    Singer, Eleanor; Couper, Mick P


    MONETARY INCENTIVES ARE INCREASINGLY used to help motivate survey participation. Research Ethics Committees have begun to ask whether, and under what conditions, the use of monetary incentives to induce participation might be coercive. The article reports research from an online vignette-based study bearing on this question, concluding that at present the evidence suggests that larger incentives do not induce research participants to accept higher risks than they would be unwilling to accept with smaller ones.

  16. Applying incentive sensitization models to behavioral addiction. (United States)

    Rømer Thomsen, Kristine; Fjorback, Lone O; Møller, Arne; Lou, Hans C


    The incentive sensitization theory is a promising model for understanding the mechanisms underlying drug addiction, and has received support in animal and human studies. So far the theory has not been applied to the case of behavioral addictions like Gambling Disorder, despite sharing clinical symptoms and underlying neurobiology. We examine the relevance of this theory for Gambling Disorder and point to predictions for future studies. The theory promises a significant contribution to the understanding of behavioral addiction and opens new avenues for treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Initiating a regional laboratory network. (United States)

    Nigon, D L


    Wherever we look--on television, in national and local newspapers, or within our own institutions and communities--the biggest issue facing health-care providers is integration. The Clinton plan virtually mandates integrated services, and many individual states are moving ahead rapidly with their own programs. Mandated purchasing alliances will require network services that are focused on cost savings and broad access to the medical system. The incentive to form collaborative medical networks defies our tradition of actively competing for patients and reimbursement dollars. Hospital and physician office laboratories, along with small independent laboratories, face both their greatest challenge and their best opportunity in the changing health-care environment. Those choosing to take up the gauntlet thrown down in the Clinton Administration's commitment to reform will be uniquely positioned to survive and thrive; those who dig their heels firmly into past paradigms will be swept away by the tide of economic change. Whether mandated by law or forged into being by the heat of economic pressure, the formation of integrated care networks positioned to vie for health-care dollars seems inevitable. Some states, including Florida, Washington, and Minnesota, have already passed legislation that anticipates national reform by virtually mandating integrated health-care services. Others are contemplating similar action, and the economic impact is already apparent in a lower-than-projected increase in health-care costs. How can community laboratories position themselves to participate in this rapidly changing environment? Most experts agree that laboratory services must roll themselves into total health-care programs and operate regionally to compete with the national, for-profit conglomerates.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. The aeromedical physician assistant. (United States)

    Radi, Joshua; Brisson, Michael; Line, Michael


    The US Army aeromedical physician assistant (PA) serves aviation units in regards to crewmember medical readiness. All PAs are graduates of a 6-week flight surgeon course. They are responsible for conducting nearly 40% of the annual US Army flight physicals. This unique training and deployment illustrates the growing adaptability of PAs to assume a greater role in military medicine.

  19. Incentives and the siting of radioactive waste facilities

    Energy Technology Data Exchange (ETDEWEB)

    Carnes, S.A.; Copenhaver, E.D.; Reed, J.H.; Soderstrom, E.J.; Sorensen, J.H.; Peelle, E.; Bjornstad, D.J.


    The importance of social and institutional issues in the siting of nuclear waste facilities has been recognized in recent years. Limited evidence from a survey of rural Wisconsin residents in 1980 indicates that incentives may help achieve the twin goals of increasing local support and decreasing local opposition to hosting nuclear waste facilities. Incentives are classified according to functional categories (i.e., mitigation, compensation, and reward) and the conditions which may be prerequisites to the use of incentives are outlined (i.e., guarantee of public health and safety, some measure of local control, and a legitimation of negotiations during siting). Criteria for evaluating the utility of incentives in nuclear waste repository siting are developed. Incentive packages may be more useful than single incentives, and nonmonetary incentives, such as independent monitoring and access to credible information, may be as important in eliciting support as monetary incentives. Without careful attention to prerequisites in the siting process it is not likely that incentives will facilitate the siting process.

  20. R&D tax incentives for innovation and managerial decisions

    Directory of Open Access Journals (Sweden)

    Monika Walicka


    Full Text Available In many countries tax incentives are a popular means of realizing political, economic and social objectives. The main motive of their application is often to achieve and accelerate the selected activities in the public interest and also stimulate development of industry, and induce growth in research and investment. The key element that helps a company achieve a competitive advantage is innovation. Global competition forces the production of unique products and services. Tax incentives in science, research and development are important in stimulating innovation. The purpose of this article is to show the level of managerial awareness about R&D tax incentives, the level of R&D tax incentive usage by companies in Poland, and main obstacles that managers meet with R&D tax incentives in practice. We explore R&D tax incentives as a government instrument on R&D management and aim to find the reasons why Polish companies do not take advantage of them. We examine 275 companies using a semi-structured questi onnaire. Our findings suggest that many firms report lack of knowledge about such incentives, and firms find many obstacles to reach all of the requirements which are necessary to use the incentive. Due to our analysis we find that large firms, especially those that implement innovation, are more likely to use the tax incentives, but small and medium sized companies find more obstacle. The effect of this tax policy is significant mainly in large, high-tech sector firms.

  1. Understanding congestion in China's medical market: an incentive structure perspective

    National Research Council Canada - National Science Library

    Sun, Zesheng; Wang, Shuhong; Barnes, Stephen R


    .... Our analysis reveals that prior medical system reforms with price regulation in China have induced hospitals to establish incentives for capital-intensive investments, while ignoring human capital...

  2. The National Day for the Libyan Physician

    Directory of Open Access Journals (Sweden)

    Elmahdi A. Elkhammas


    it is time to celebrate a Libyan Physician Day (Youm attabeeb alleebi during which the Libyan physician is recognized in all health institutions at the level of the ministry, press, television, radio, as well as hospitals and rural health care units. During this day, we thank the Libyan physician for his/her hard work under diverse conditions and circumstances (1. During this day, we remind the physician of his/her duty toward humanity in general and Libyan citizens in particular. The physicians need to know that they have a moral and ethical (2 duty toward the Libyan citizen from birth to death. This duty extends to the poor and to the wealthy and it does not discriminate against colour, race, or religion of the citizen. This duty is purely humane and has no allegiance to political beliefs. We also remind the Libyan physician to extend his/her hands to colleagues in basic science, in different sectors of medical education, and the allied medical personnel. We all know that without nurses, pharmacists, physiotherapists, respiratory therapist, laboratory technicians, physicists and radiology technicians we can not perform our jobs. On this day, we inform the Libyan physicians that we love them and respect their field. The society and government should be united in providing them with decent living standards. The Libyan physicians are human and have needs and responsibilities toward their families and deserve a decent life. This acknowledgment by the society and the government gives them a moral boost. Hopefully, it would provide an incentive to work harder and to be creative to minimize the flux of the Libyan patients to the neighbouring countries for the treatment of simple ailments. I truly believe that the creation of a national day for the Libyan physician will be fruitful within few years of its initiation. It will certainly shed the light on this group of the Libyan society. It will remind physicians to give more consideration to interactions with members of the

  3. Physician Satisfaction and Physician Well-Being: Should Anyone Care?

    Directory of Open Access Journals (Sweden)

    Lawrence P. Casalino


    Full Text Available We present a model of hypothesized relationships between physician satisfaction, physician well-being and the quality of care, in addition to a review of relevant literature. The model suggests that physicians who are stressed, burned out, depressed, and/or have poor self-care are more likely to be dissatisfied, and vice-versa. Both poor physician well-being and physician dissatisfaction are hypothesized to lead to diminished physician concentration, effort, empathy, and professionalism. This results in misdiagnoses and other medical errors, a higher rate of inappropriate referrals and prescriptions, lower patient satisfaction and adherence to physician recommendations, and worse physician performance in areas not observed by others. Research to date largely supports the model, but high quality studies are few. Research should include studies that are prospective, larger, and have a stronger analytic design, ideally including difference in differences analyses comparing quality of care for patients of physicians who become dissatisfied to those who remain satisfied, and vice versa.Keywords: physician satisfaction, physician dissatisfaction, quality of care, physician well-being, physician burnout 

  4. Network Formation and Cooperation


    Felipe Balmaceda


    In this paper we adopt Granovetter's view expressed in his famous article ''Economic Action and Social Structure: The Problem of Embeddedness'' , where he argues that the concept of man in economics is extremely undersocialized because it ignores the importance of social networks. In so doing the incentives to mutual cooperation in social matching games in which the social network is endogenously determined are studied. The main result shows that in atomized societies where there is no inform...

  5. Do medical doctors respond to economic incentives? (United States)

    Andreassen, Leif; Di Tommaso, Maria Laura; Strøm, Steinar


    A longitudinal analysis of married physicians labor supply is carried out on Norwegian data from 1997 to 1999. The model utilized for estimation implies that physicians can choose among 10 different job packages which are a combination of part time/full time, hospital/primary care, private/public sector, and not working. Their current choice is influenced by past available options due to a habit persistence parameter in the utility function. In the estimation we take into account the budget constraint, including all features of the tax system. Our results imply that an overall wage increase or less progressive taxation moves married physicians toward full time job packages, in particular to full time jobs in the private sector. But the overall and aggregate labor supply elasticities in the population of employed doctors are rather low compared to previous estimates. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Birth planning propaganda, incentives and peer pressure. (United States)

    Schima, M E; Chen, P C; Oakley, D; Gille, H; Grant, J P; Oakley, D


    Family planning policies are promoted at every level of Chinese society through the 3 concepts: lateness in marriage and childbirth, spacing of children, and reduction in family size (late, long, and few). The minimum legal age for girls to marry is 18, for boys, 20, but marriage is discouraged until ages 23 and 25. The Chinese put free family planning services within the reach of every eligible couple. An equally great effort is put into the acceptance and use of the services. Propaganda is pervasive, and peer pressure at the community level is intense. Individual and group sessions effect sanctions against noncompliance. Generous paid leaves are the incentives for sterilization and abortion. Community involvement in birth control has evolved to the point where annual birth quotas are established and allotted among couples. To some visitors these methods are highly coercive, a serious invasion of privacy. The 1-child family is being publicized and promoted with a generous incentive program which pays 5 yuan a month as child-care subsidy until the child is 14 years old. Living space will be given the 1-child family on a preferential basis. When 1-child couples retire they will be entitled to a monthly pension for as long as they live. The pension amounts to 80% or higher of their monthly wage at the time of retirement. Childless couples will receive 100% of their wages.

  7. Network Regulation and Support Schemes

    DEFF Research Database (Denmark)

    Ropenus, Stephanie; Schröder, Sascha Thorsten; Jacobsen, Henrik


    -in tariffs to market-based quota systems, and network regulation approaches, comprising rate-of-return and incentive regulation. National regulation and the vertical structure of the electricity sector shape the incentives of market agents, notably of distributed generators and network operators....... This article seeks to investigate the interactions between the policy dimensions of support schemes and network regulation and how they affect the deployment of distributed generation. Firstly, a conceptual analysis examines how the incentives of the different market agents are affected. In particular......At present, there exists no explicit European policy framework on distributed generation. Various Directives encompass distributed generation; inherently, their implementation is to the discretion of the Member States. The latter have adopted different kinds of support schemes, ranging from feed...

  8. Do Monetary Incentives Increase Fitness Center Utilization? It Depends. (United States)

    Hooker, Stephanie A; Wooldridge, Jennalee S; Ross, Kaile M; Masters, Kevin S


    To examine the effects of an employer-based monetary incentive program on membership termination and usage at a fitness center. Retrospective nested case-control study examining the relationship between participation in an incentive program, visits to the fitness center, and membership termination at 1 year. University-based fitness center. Members (N = 1122) of a university-based fitness center. Members were offered either a US$25 incentive for each month they visited the fitness center at least 10 times or no incentive. Data were extracted from the membership database and included membership termination at 1 year (yes, no), length of membership (days), participation in the incentive program (yes, no), and visits to the fitness center per month. Cox proportional hazards model. Members in the incentive program visited the fitness center on average more times per month (5.3 vs 4.3; P < .0001) but were significantly more likely to terminate memberships at 1 year compared to members who did not receive the incentive (38% vs 31%; P = .013). After controlling for relevant covariates, members who received the incentive had a 24% greater hazard of terminating their memberships compared to members who did not receive the incentive (hazard ratio [HR] = 1.24; P = .041). After controlling for the number of visits per month, the incentive program was no longer significantly related to membership termination (HR = 1.21; P = .07). Being in a monetary incentive program to attend a fitness center may be initially associated with a greater fitness center utilization but may not be associated with a reduced risk of membership termination.

  9. Medical Students and Staff Physicians: The Question of Social Media. (United States)

    Noller, Michael; Mai, Johnny P; Zapanta, Philip E; Camacho, Macario


    Social media's prevalence among the professional world is rapidly increasing. Its use among medical personnel-specifically, medical students, resident physicians, and staff physicians-could compromise personal-professional boundaries. Could the acceptance or lack of acceptance of a friend request bias the medical student application process? If friend requests are accepted, then medical students, resident physicians, and staff physicians are provided access to very personal aspects of one another's lives, which may not have been the intent. The question remains whether the separation of one's personal life from work is necessary. Should medical students restrict social media relationships with residents and staff physicians to professional social media networks? The suitability and opportunities of social media among medical professionals is an ongoing issue for research that needs continued evaluation.

  10. Physicians of ancient India. (United States)

    Saini, Anu


    A survey of Indian medical historiography will reveal no dearth of work on the systems of medicine and medical literature of ancient India. However, the people who were responsible for the healing have not received much attention. This article traces the evolution of the physician as a professional in ancient India. This article reviews the secondary literature on healing and medical practice in India, specifically pertaining to the individual medical practitioner, drawing from varied sources. The healers of ancient India hailed from different castes and classes. They were well-respected and enjoyed state patronage. They were held to the highest ethical standards of the day and were bound by a strict code of conduct. They underwent rigorous training in both medicine and surgery. Most physicians were multi-skilled generalists, and expected to be skilled in elocution and debate. They were reasonably well-off financially. The paper also briefly traces the evolution of medicinal ideas in ancient India.

  11. Physicians of ancient India

    Directory of Open Access Journals (Sweden)

    Anu Saini


    Full Text Available A survey of Indian medical historiography will reveal no dearth of work on the systems of medicine and medical literature of ancient India. However, the people who were responsible for the healing have not received much attention. This article traces the evolution of the physician as a professional in ancient India. This article reviews the secondary literature on healing and medical practice in India, specifically pertaining to the individual medical practitioner, drawing from varied sources. The healers of ancient India hailed from different castes and classes. They were well-respected and enjoyed state patronage. They were held to the highest ethical standards of the day and were bound by a strict code of conduct. They underwent rigorous training in both medicine and surgery. Most physicians were multi-skilled generalists, and expected to be skilled in elocution and debate. They were reasonably well-off financially. The paper also briefly traces the evolution of medicinal ideas in ancient India.

  12. A Physician's Guide to Radon (United States)

    This booklet has been developed for physicians by the U.S. Environmental Protection Agency in consultation with the American Medical Association (AMA). Its purpose is to enlist physicians in the national effort to inform the American public about radon.

  13. Physician Assistant Genomic Competencies. (United States)

    Goldgar, Constance; Michaud, Ed; Park, Nguyen; Jenkins, Jean


    Genomic discoveries are increasingly being applied to the clinical care of patients. All physician assistants (PAs) need to acquire competency in genomics to provide the best possible care for patients within the scope of their practice. In this article, we present an updated version of PA genomic competencies and learning outcomes in a framework that is consistent with the current medical education guidelines and the collaborative nature of PAs in interprofessional health care teams.

  14. [Burnout in physicians]. (United States)

    Kurzthaler, Ilsemarie; Kemmler, Georg; Fleischhacker, W Wolfgang


    Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines. A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms. Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment. Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.

  15. Reference Group Behaviour and Economic Incentives: A Remark


    Schlicht, Ekkehart


    People tend, in many ways, to behave like the others they see around them. This note´shows that such reference group behavior tends to reinforce incentives (economic or other) that influence individuals directly only marginally. The workings or such incentives is augmented what might be called a "social multiplier."

  16. The Effect of Processes and Incentives on Acquisition Cost Growth (United States)


    demanding. Four programs are examined by Gilbreth and Hubbard (2008) to develop recommendations for effective incentive use. These recommendations...Author. Gilbreth , A. S., & Hubbard, S. (2008). How to make incentive and award fees work. Defense Acquisition Review Journal, 15(2), 132–149

  17. Sellers' hedging incentives at EPA's emission trading auction

    NARCIS (Netherlands)

    Dijkstra, B.R.; Haan, M.


    Cason (1993)argued thattheauction theEPAused in order to start the market for sulfur allowances, is not efficient. The set-up of the auction gives both buyers and sellers an incentive to understate their valuation of an allowance. In this paper, we show that the sellers’ incentives are even more

  18. 5 CFR 575.309 - Payment of retention incentives. (United States)


    ... RECRUITMENT, RELOCATION, AND RETENTION INCENTIVES; SUPERVISORY DIFFERENTIALS; AND EXTENDED ASSIGNMENT... employee's basic pay based on a critical agency need. In addition to the determination required by § 575... result of approval of a waiver of the maximum limit on the amount of a retention incentive under...

  19. Layoffs as part of an optimal incentive mix:

    DEFF Research Database (Denmark)

    Frederiksen, Anders; Takáts, Elöd

    Firms offer highly complex contracts to their employees. These contracts contain a mix of incentives, such as fixed wages, bonus payments, promotion options, and layoff threats. In general, economists understand how incentives motivate employees but not why a particular mix should be used...

  20. 42 CFR 495.310 - Medicaid provider incentive payments. (United States)


    ... hospital incentive amount is calculated as the product of the (overall EHR amount) times (the Medicaid... hospital (regardless of any source of payment): (1) For the first through 1,149th discharge, $0. (2) For... Medicaid EP or eligible hospital may receive an incentive payment from only one State in a payment year. (f...

  1. Financial Incentives for Steering Education and Training. Getting Skills Right (United States)

    OECD Publishing, 2017


    This report examines how governments use financial incentives to promote a better alignment between labour market needs, on the one hand, and the supply of skills, on the other. In doing so, it identifies: (1) innovative models that countries may be interested in learning from; (2) best practice in the design and use of financial incentives; (3)…

  2. 7 CFR 701.45 - Forestry Incentives Program (FIP) contracts. (United States)


    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Forestry Incentives Program (FIP) contracts. 701.45 Section 701.45 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY... RELATED PROGRAMS PREVIOUSLY ADMINISTERED UNDER THIS PART § 701.45 Forestry Incentives Program (FIP...

  3. Patent quality and incentives at the patent office

    NARCIS (Netherlands)

    Schuett, F.


    Patent examination is a problem of moral hazard followed by adverse selection: examiners must have incentives to exert effort, but also to truthfully reveal the evidence they find. I develop a theoretical model to study the design of incentives for examiners. The model can explain the puzzling

  4. The Impact of Faculty Incentive Grants on Teaching Effectiveness. (United States)

    Jacobsen, Rhonda Hustedt

    Data on how teaching effectiveness is affected by faculty incentive grants are presented based on a study of a faculty incentive program at Messiah College in Pennsylvania. Its "Excellence in Teaching" program offers awards of up to $5000 each annually to four faculty members based on student evaluations of teaching performance.…

  5. Equity Incentives: Aligning The Interests Of Employees And Owners ...

    African Journals Online (AJOL)

    This paper reviews how to align the interests of employees and of owners of businesses and directs attention to policy issues that are critical to the attainment of this noble objective. It demonstrates that Tax Incentives and Reforms are necessary and offers recommendations on how to promote equity incentives in Nigeria.

  6. Influence of dimensional incentives on voters' turnout in 2014 and ...

    African Journals Online (AJOL)


    Jul 31, 2016 ... monetary incentives while no known studies have been carried out on the new dimension of incentives to influence voters' turnout adopted ... behind people's voting behaviour in gubernatorial elections (2014 and 2015) in Southwestern, Nigeria using ... developmental models, the political leaders are quite.

  7. 20 CFR 637.230 - Use of incentive bonuses. (United States)


    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Use of incentive bonuses. 637.230 Section 637.230 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE V OF THE JOB TRAINING PARTNERSHIP ACT Program Planning and Operation § 637.230 Use of incentive...

  8. 20 CFR 637.210 - Incentive bonus program applications. (United States)


    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Incentive bonus program applications. 637.210 Section 637.210 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE V OF THE JOB TRAINING PARTNERSHIP ACT Program Planning and Operation § 637.210 Incentive...

  9. Incentive issues in the South African construction industry ...

    African Journals Online (AJOL)

    Incentives are regarded as motivational tools which can be used to propel construction workforces to achieve project objectives. This article contributes to the existing body of knowledge by evaluating the current practices of incentive mechanisms in the South African construction industry and identifying the challenges ...

  10. Tax incentive as a catalyst for economic development in Nigeria ...

    African Journals Online (AJOL)

    An empirical study using a well structured questionnaire survey, the work assesses the relationship that exists between tax incentive and economic development in Nigeria. This study was undertaken primarily to evaluate the effectiveness of tax incentive in developing the Nigerian economy. One hundred and twenty ...

  11. Governing by carrot and stick: A genealogy of the incentive

    NARCIS (Netherlands)

    Dix, G.


    Managers, politicians and scientists frequently use the term ‘incentive’ in their explanations of human action. At the same time, individuals in the public and private sectors are now governed with the help of incentives. In this thesis, I study the incentive from a theoretical and normative

  12. Deriving fair incentives for management of hardwood timber stands (United States)

    David A. Gansner; W. Herrick Owen; David N. Larsen; David N. Larsen


    The authors present a practical method for deriving timber-management incentive payments and demonstrate its application in forest stands of upland hardwoods. The suggested incentive payment is based on the differences between discounted costs and returns of deliberate forest management and the "harvest and let grow" option.

  13. Incentives: Getting and Keeping Workers Involved in Health Promotion Programs. (United States)

    McKenzie, James F.; And Others


    The article explores motivation as it relates to worksite health promotion participation, addressing incentive use as a motivational means of getting and keeping employees involved in health promotion programs. It suggests various incentives to help program planners, categorizing them as social or material reinforcers. (SM)

  14. 12 CFR 702.307 - Incentives for new credit unions. (United States)


    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Incentives for new credit unions. 702.307 Section 702.307 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS PROMPT CORRECTIVE ACTION Alternative Prompt Corrective Action for New Credit Unions § 702.307 Incentives...

  15. Creating Teacher Incentives for School Excellence and Equity (United States)

    Berry, Barnett; Eckert, Jon


    Ensuring that all students in America's public schools are taught by good teachers is an educational and moral imperative. Teacher incentive proposals are rarely grounded on what high-quality research indicates are the kinds of teacher incentives that lead to school excellence and equity. Few of the current approaches to creating teacher…

  16. 48 CFR 919.7006 - Incentives for DOE contractor participation. (United States)


    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Incentives for DOE contractor participation. 919.7006 Section 919.7006 Federal Acquisition Regulations System DEPARTMENT OF....7006 Incentives for DOE contractor participation. (a) Under cost-plus-award fee contracts, approved...

  17. Participation in decision-making process, incentives and training as ...

    African Journals Online (AJOL)

    This study investigates the relationships among participation in decision-making process, incentives, training and organizational commitment among some industrial workers. Measures on participation in decision-making, incentives, training and organizational commitment were employed to collect data from the workers in ...

  18. Do Firms Replenish Executives’ Incentives After Equity Sales?

    NARCIS (Netherlands)

    Ladika, T.


    After selling firm equity, executives' incentives to maximize shareholder value may decrease. How do boards respond? Theory shows boards can restore executives' incentives by shifting subsequent pay from cash toward equity. Unobservable firm-level changes that cause executives to sell equity and

  19. Fundamental Characteristics of Incentive Streams Created by Legal Systems

    NARCIS (Netherlands)

    Dari Mattiacci, G.


    The law shapes people’s behaviour by creating incentives. For example, tort law induces motorists to drive carefully by making them pay compensation for the accidents they may cause. This study analyses the way the law can create incentives in those cases in which the courts or the administrative

  20. Do Price Incentives Work in Incomplete Food Agricultural Marketing ...

    African Journals Online (AJOL)

    Presumed in strategy-choices was subsistence food producers would necessarily respond to price incentives to increase food productivity. This paper interrogates the link between price incentives and increased subsistence food productivity in rural agricultural marketing systems by examining issues in subsistence ...

  1. Recruiting More and Better Teachers--With Incentives. (United States)

    Skidmore, Max


    Describes new incentive packages employed by several states and school districts to recruit prospective teachers, including signing bonuses, housing incentives, loan forgiveness and tuition waivers, scholarships, waiver of retirement rules, and child-care services. Discusses implications and describes procedures for school districts to develop…

  2. 10 CFR 212.78 - Tertiary incentive crude oil. (United States)


    ... 10 Energy 3 2010-01-01 2010-01-01 false Tertiary incentive crude oil. 212.78 Section 212.78 Energy DEPARTMENT OF ENERGY OIL MANDATORY PETROLEUM PRICE REGULATIONS Producers of Crude Oil § 212.78 Tertiary incentive crude oil. Annual prepaid expenses report. By January 31 of each year after 1980, the project...

  3. Chronic disease management: time for consultant physicians to take more leadership in system redesign. (United States)

    Brand, C; Scott, I; Greenberg, P; Sargious, P


    There is a need for system redesign to meet the needs of individuals with chronic disease. New models of chronic disease care include team-based paradigms that focus on continuous and patient-centred care. In such models the roles of providers and patients must change. In this article we focus on new roles for consultant physicians, as well as barriers and incentives to these roles.

  4. Consumer product branding strategy and the marketing of physicians' services. (United States)

    Friedrich, H; Witt, J


    Hospitals have traditionally maintained physician referral programs as a means of attracting physicians to their network of affiliated providers. The advent of managed care and impending healthcare reform has altered the relationship of hospitals and physicians. An exploratory study of marketing approaches used by twelve healthcare organizations representing twenty-five hospitals in a large city was conducted. Strategies encountered in the study ranged from practice acquisition to practice promotion. This study suggests that healthcare providers might adopt consumer product branding strategies to secure market-share, build brand equity, and improve profitability.

  5. Physician kindness as sincere benevolence

    National Research Council Canada - National Science Library

    Buetow, Stephen A


    ... of misinterpretation as one barrier to recent calls to reconnect medicine to a culture of human kindness.1 This fear, the modern importance attached to scientific objectivity, and a risk to physicians of "compassion fatigue" can frequently overwhelm the impulse of physicians to draw closer to their patients. Although physicians spontaneously displaying emotions can ...

  6. Developing Canadian physician: the quest for leadership effectiveness. (United States)

    Comber, Scott; Wilson, Lisette; Crawford, Kyle C


    Purpose The purpose of this study is to discern the physicians' perception of leadership effectiveness in their clinical and non-clinical roles (leadership) by identifying their political skill levels. Design/methodology/approach A sample of 209 Canadian physicians was surveyed using the Political Skills Inventory (PSI) during the period 2012-2014. The PSI was chosen because it assesses leadership effectiveness on four dimensions: social astuteness, interpersonal influence, networking ability and apparent authenticity. Findings Physicians in clinical roles' PSI scores were significantly lower in all four PSI dimensions when compared to all other physicians in non-clinical roles, with the principal difference being in their networking abilities. Practical implications More emphasis is needed on educating and training physicians, specifically in the areas of political skills, in current clinical roles if they are to assume leadership roles and be effective. Originality/value Although this study is located in Canada, the study design and associated findings may have implications to other areas and countries wanting to increase physician leadership effectiveness. Further, replication of this study in other settings may provide insight into the future design of physician leadership training curriculum.

  7. Social media and physicians: Exploring the benefits and challenges. (United States)

    Panahi, Sirous; Watson, Jason; Partridge, Helen


    Healthcare professionals' use of social media platforms, such as blogs, wikis, and social networking web sites has grown considerably in recent years. However, few studies have explored the perspectives and experiences of physicians in adopting social media in healthcare. This article aims to identify the potential benefits and challenges of adopting social media by physicians and demonstrates this by presenting findings from a survey conducted with physicians. A qualitative survey design was employed to achieve the research goal. Semi-structured interviews were conducted with 24 physicians from around the world who were active users of social media. The data were analyzed using the thematic analysis approach. The study revealed six main reasons and six major challenges for physicians adopting social media. The main reasons to join social media were as follows: staying connected with colleagues, reaching out and networking with the wider community, sharing knowledge, engaging in continued medical education, benchmarking, and branding. The main challenges of adopting social media by physicians were also as follows: maintaining confidentiality, lack of active participation, finding time, lack of trust, workplace acceptance and support, and information anarchy. By revealing the main benefits as well as the challenges of adopting social media by physicians, the study provides an opportunity for healthcare professionals to better understand the scope and impact of social media in healthcare, and assists them to adopt and harness social media effectively, and maximize the benefits for the specific needs of the clinical community. © The Author(s) 2014.

  8. 75 FR 81885 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Correcting Amendment (United States)


    ... Programs; Electronic Health Record Incentive Program; Correcting Amendment AGENCY: Centers for Medicare...; Electronic Health Record Incentive Program'' that appeared in the July 28, 2010 Federal Register. DATES... 44314) the final rule entitled ``Medicare and Medicaid Programs; Electronic Health Record Incentive...

  9. Third-Party Incentive Strategies and Conflict Management in Africa

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.


    Dr. Nikolas Emmanuel's examines the use of an incentives approach in managing intrastate conflict in Africa because in many cases, risks and costs make applications of hard power alone unfeasible. Furthermore, simply ignoring episodes of civil conflict in the hope that they will "burn themselves...... out"� does not appear to be a viable alternative. That said, both noncoercive and coercive incentive strategies exist and have been deployed by third parties in a variety of conflict situations. Such incentives seek to manage conflict by encouraging political bargaining. The clear intention...... parties can help manage conflicts. Second, it offers a typology of the available incentive strategies, classifying them along noncoercive and coercive lines. Thus, the article outlines the possibilities offered by an incentives approach, focusing on examples drawn from recent African cases....

  10. The role of incentives in nurses' aspirations to management roles. (United States)

    Wong, Carol A; Spence Laschinger, Heather K; Cziraki, Karen


    The objective of this study was to describe findings from a study examining nurses' perceptions of incentives for pursuing management roles. Upcoming retirements of nurse managers and a reported lack of interest in manager roles signal concerns about a leadership shortage. However, there is limited research on nurses' career aspirations and specifically the effect of perceived incentives for pursuing manager roles. Data from a national, cross-sectional survey of Canadian nurses were analyzed (n = 1241) using multiple regression to measure the effect of incentives on nurses' career aspirations. Twenty-four percent of nurses expressed interest in pursuing management roles. Age, education, and incentives explained 43% of the variance in career aspirations. Intrinsically oriented incentives such as new challenges, autonomy, and the opportunity to influence others were the strongest predictors of aspirations to management roles. Ensuring an adequate supply of nurse managers will require proactive investment in the identification, recruitment, and development of nurses with leadership potential.

  11. Successive duopoly under moral hazard: Will incentive contracts persist?

    Directory of Open Access Journals (Sweden)

    Marta Fernández-Olmos


    Full Text Available The central purpose of this paper is to examine the incentive contract as an equilibrium phenomenon. We analyse a model of vertical differentiation in which we deal with the strategic role of the competitor’s decisions in a successive duopoly. Is it better for a processor to offer an incentive contract to an upstream producer or the spot market? We determine the equilibrium of a game in which the processors simultaneously decide whether to offer an incentive contract or to continue at the spot market to acquire their input. Our results show that under successive duopoly, offering an incentive contract constitutes the unique equilibrium solution, which highlights the incentive contract persistence.

  12. Perceived dominance in physicians: are female physicians under scrutiny? (United States)

    Schmid Mast, Marianne; Hall, Judith A; Cronauer, Christina Klöckner; Cousin, Gaëtan


    This research aims at identifying how specific physician verbal and nonverbal behaviors are related to perceived dominance of female and male physicians. Analogue patients (163 students) watched videotaped excerpts of eight physicians and indicated how dominant they perceived each physician to be. Female physicians who spoke more, talked more while doing something else, spoke with louder voices, modulated their voices more, were oriented more toward the patients, sat at a smaller interpersonal distance, were more expansive, and had a more open arm position were perceived as more dominant. These relations were significantly more pronounced in female than in male physicians. With respect to verbal behavior, not agreeing with the patient, structuring the discussion, setting the agenda, and asking questions were related to being perceived as significantly more dominant in female than in male physicians. Patients interpret verbal and nonverbal female and male physicians' cues differently. If a behavior contradicts gender stereotypes regarding women, this behavior is perceived as particularly dominant in female physicians. To provide optimal care, physicians need to be aware of the expectations their patients harbor toward them--especially expected behavior related to the gender of the physician. Copyright © 2010. Published by Elsevier Ireland Ltd.

  13. Physician assistant specialty choice: Distribution, salaries, and comparison with physicians. (United States)

    Morgan, Perri; Everett, Christine M; Humeniuk, Katherine M; Valentin, Virginia L


    To describe trends in physician assistant (PA) specialty distribution, compare these trends with physicians, and quantify the relationship of PA specialty prevalence with both PA and physician salary. PA specialty and salary data were obtained from the 2013 American Academy of PAs' Annual Survey; physician specialty and salary data from the American Medical Association Physician Masterfile and the Medical Group Management Association. Analyses included descriptive statistics and linear regression. The proportion of PAs working in primary care decreased from 50% in 1997 to 30% in 2013. Substantial growth in PA proportions occurred in surgical and medical subspecialties. Regression models showed a higher prevalence of PAs in specialties with higher PA salary, higher physician salary, and higher physician-to-PA salary ratio (P<0.05). PAs are moving toward subspecialty practice. Our study suggests that demand for PAs may be an important factor driving the trend toward specialization.


    Energy Technology Data Exchange (ETDEWEB)



    For START III level forces, strike allocations and magnitudes vary little with L, but first strike costs vary directly with L, which means that for K reflecting a preference for the survival of high value targets over their destruction and a preference for high value over military targets, the costs of action are far greater than those of inaction for a wide range of values of damage preference L. Thus, if both sides have much greater preferences for the survival of their high value targets than for military targets or destruction, they do not see a net incentive to strike, and crises are terminated by inaction. Recent decades suggest strong preferences for the survival of high value and that this has contributed to the lack of direct conflict during that period.

  15. Incentive System in Hungarian High Performance Sport

    Directory of Open Access Journals (Sweden)

    Sterbenz Tamás


    Full Text Available This study will attempt to describe the role of existing incentives which have a significant effect on Hungarian sport's performance. The aim of the paper is to understand why a large gap has emerged between successful elite sports and the popular but underperforming spectacular sport. According to the concept of dual competition, in addition to sport results, the analyzed fields also concern competition for resources, particularly for the attention of supporters and sponsors. The methodology of the analysis is fundamentally economic in nature; however, qualitative methods are also given emphasis, as the analyzed topic has specific characteristics. Based on new institutional economics, the study presumes that the behavior of organizations is determined by the decisions of bounded rational individuals, and highlights the significance of the created mechanisms and institutions.

  16. The Effect of Incentives on Sustainable Behavior

    DEFF Research Database (Denmark)

    Huber, Laura Rosendahl; Sloof, Randolph; Van Praag, Mirjam


    This study investigates how children respond to different treatments aimed to fostersustainable behavior in a productive (firm like) setting. We conduct a field experiment using teams of children (aged 11 or 12) that are participating in an entrepreneurship education program in the last grade...... of primary school in the Netherlands. Schools participating in this program are randomly assigned to one of three treatments: the first is purely financially oriented, the second promotes sustainable behavior and the third also induces sustainability by (monetary) incentives. Comparing the first twogroups we...... find that solely promoting sustainability does not lead to a change in sustainable behavior. However, once the monetary reward is linked to sustainable outcome measures, we find a significant positive effect on sustainable behavior. Inour specificsetting, the choice to behave more sustainable comes...

  17. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements. Final rule. (United States)


    This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model.

  18. Problems in sickness certification of patients: a qualitative study on views of 26 physicians in Sweden. (United States)

    von Knorring, Mia; Sundberg, Linda; Löfgren, Anna; Alexanderson, Kristina


    To identify what problems physicians experience in sickness certification of patients. Qualitative analyses of data from six focus-group discussions. Four counties in different regions of Sweden. Twenty-six physicians strategically selected to achieve variation with regard to sex, geographical location, urban/rural area, and type of clinic. The problems involved four areas: society and the social insurance system, the organization of healthcare, the performance of other actors in the system, and the physicians' working situation. In all areas the problems also involved manager issues such as overall leadership, organization of healthcare, and existing incentives and support systems for physicians' handling of patients' sickness certification. Many physicians described feelings of fatigue and a lack of pride in their work with sickness certification tasks, as they believed they contributed to unnecessary sickness absence and to medicalization of patients' non-medical problems. The problems identified have negative consequences both for patients and for the well-being of physicians. Many of the problems seem related to inadequate leadership and management of sickness certification issues. Therefore, they cannot be handled merely by training of physicians, which has so far been the main intervention in this area. They also have to be addressed on manager levels within healthcare. Further research is needed on how physicians cope with the problems identified and on managers' strategies and responsibilities in relation to these problems. If the complexity of the problems is not recognized, there is a risk that inadequate actions will be taken to solve them.

  19. Optimal distribution of incentives for public cooperation in heterogeneous interaction environments

    Directory of Open Access Journals (Sweden)

    Xiaojie eChen


    Full Text Available In the framework of evolutionary games with institutional reciprocity, limited incentives are at disposal for rewarding cooperators and punishing defectors. In the simplest case, it can be assumed that, depending on their strategies, all players receive equal incentives from the common pool. The question arises, however, what is the optimal distribution of institutional incentives? How should we best reward and punish individuals for cooperation to thrive? We study this problem for the public goods game on a scale-free network. We show that if the synergetic effects of group interactions are weak, the level of cooperation in the population can be maximized simply by adopting the simplest ''equal distribution'' scheme. If synergetic effects are strong, however, it is best to reward high-degree nodes more than low-degree nodes. These distribution schemes for institutional rewards are independent of payoff normalization. For institutional punishment, however, the same optimization problem is more complex, and its solution depends on whether absolute or degree-normalized payoffs are used. We find that degree-normalized payoffs require high-degree nodes be punished more lenient than low-degree nodes. Conversely, if absolute payoffs count, then high-degree nodes should be punished stronger than low-degree nodes.

  20. Managing margins through physician engagement. (United States)

    Sears, Nicholas J


    Hospitals should take the following steps as they seek to engage physicians in an enterprisewide effort to effectively manage margins: Consider physicians' daily professional practice requirements and demands for time in balancing patient care and administrative duties. Share detailed transactional supply data with physicians to give them a behind-the-scenes look at the cost of products used for procedures. Institute physician-led management and monitoring of protocol compliance and shifts in utilization to promote clinical support for change. Select a physician champion to provide the framework for managing initiatives with targeted, efficient communication.

  1. Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders. The University Health Network Whiplash Intervention Trial.

    NARCIS (Netherlands)

    Cote, P.; Cassidy, J.D.; Carette, S.; Boyle, E.; Shearer, H.M.; Stupar, M.; Ammendolia, C.; van der Velde, G..; Hayden, J.A.; Yang, X.; van Tulder, M.W.; Frank, J.W.


    Background: Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these

  2. Counselor Attitudes Toward Contingency Management for Substance Use Disorder: Effectiveness, Acceptability, and Endorsement of Incentives for Treatment Attendance and Abstinence. (United States)

    Aletraris, Lydia; Shelton, Jeff S; Roman, Paul M


    Despite research demonstrating its effectiveness, use of contingency management (CM) in substance use disorder treatment has been limited. Given the vital role that counselors play as arbiters in the use of therapies, examination of their attitudes can provide insight into how further use of CM might be effectively promoted. In this paper, we examine 731 counselors' attitudes toward the effectiveness and acceptability of CM in treatment, as well as their specific attitudes toward both unspecified and tangible incentives for treatment attendance and abstinence. Compared to cognitive behavioral therapy, motivational interviewing, and community reinforcement approach, counselors rated CM as the least effective and least acceptable psychosocial intervention. Exposure through the use of CM in a counselor's employing organization was positively associated with perceptions of acceptability, agreement that incentives have a positive effect on the client-counselor relationship, and endorsement of tangible incentives for abstinence. Endorsement of tangible incentives for treatment attendance was significantly greater among counselors with more years in the treatment field, and counselors who held at least a master's degree. Counselors' adaptability or openness to innovations was also positively associated with attitudes toward CM. Further, female counselors and counselors with a greater 12-step philosophy were less likely to endorse the use of incentives. A highlight of our study is that it offers the first specific assessment of the impact of "Promoting Awareness of Motivational Incentives" (PAMI), a Web-based tool based on findings of CM protocols tested within the Clinical Trials Network (CTN), on counselors employed outside the CTN. We found that 10% of counselors had accessed PAMI, and those who had accessed PAMI were more likely to report a higher degree of perceived effectiveness of CM than those who had not. This study lays the groundwork for vital research on the

  3. Physician executives straddle the digital divide. (United States)

    Coile, R C


    e-Health is here to stay and experts predict that the Internet will become the hub of health care. Rapid advancements in biotechnology and medical research, increasingly curious patients who surf the Internet for medical information, and pressures from managed care companies to contain costs and speed treatments are the central components driving e-health. Despite physician reluctance to embrace the e-revolution, many hospitals and medical groups are employing the Internet and information technology to improve their customer interface, as well as to reduce business costs. This article offers seven e-strategies for health care performance improvement: (1) Supply chain management; (2) e-transactions; (3) care management; (4) improving quality; (5) boosting revenues; (6) outsourcing; and (7) provider networks (Intranets). By helping to incorporate these key e-solutions, physician executives can position their organizations for success in the new millennium.

  4. Physician assistant dual employment. (United States)

    Jeffery, Colette; Morton-Rias, Dawn; Rittle, Mary; Cannon, James; Hooker, Roderick S


    National health workforce supply and demand models help predict requirements built on individual annual productivity assumptions. Dual employment rarely is addressed, yet in 2015, about 13.5% of certified physician assistants (PAs) reported two or more clinical positions. Of PAs working two positions, 44% reported the main reason was to supplement earnings, followed by role variety. The mean number of hours worked by all certified PAs was 40.7 per week and the average number of patients was 75. Dual-employed PAs averaged more than 51 hours and 97 patients per week. This new finding reveals an added dimension to provider productivity statistics requiring refinements to annual output calculations.

  5. Physician participation in TQM in geriatric medicine. (United States)

    Miller, D K; Coe, R M


    Quality improvement (QI) approaches such as total quality management (TQM) and continuous quality improvement (CQI) have great potential for improving the care provided to older people. Geriatricians have the necessary experience and skills to initiate and lead these QI efforts. A national sample of practicing geriatricians was surveyed in 1998 regarding involvement in, satisfaction with, and insights regarding TQM processes in four care settings. Of 537 questionnaires returned in time for analysis, 497 were included for analysis after omitting questionnaires that were undeliverable or unusable (n = 25) and those from respondents who worked fewer than 20 hours per week (n = 15). More than one-third of the respondents (37.1%) reported no TQM activity at all. For the remainder, the primary site for TQM activity was the nursing home (33.0%), the hospital (22.5%), the office (11.4%), and the patient's home (3.7%). A majority of the respondents spent two hours per week or less on TQM projects. Planning an intervention and acting to maintain it in practice after its evaluation were the two stages of the improvement cycle these respondents engaged in most frequently. More geriatricians should be encouraged to participate in TQM training and in specific projects to improve systems of care for older people. Incentives to increase participation should be made available. Rapid-cycle improvement may fit better with physicians' culture of working for outcomes that have relatively short turnaround times.

  6. Incentive mechanisms for Opportunistic Cloud Computing Services

    DEFF Research Database (Denmark)

    Kuada, Eric; Olesen, Henning


    Opportunistic Cloud Computing Service (OCCS) is a social network approach to the provisioning and management of cloud computing services for enterprises. The OCCS network may suffer from the free riding problem where members are selfish and will only want to use services on the platform without...

  7. African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

    Directory of Open Access Journals (Sweden)

    Megan M McLaughlin

    Full Text Available Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust.We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians.These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.

  8. African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust. (United States)

    McLaughlin, Megan M; Simonson, Louis; Zou, Xia; Ling, Li; Tucker, Joseph D


    Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust. We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians. These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.

  9. Financial incentives to promote health care quality: the hospital acquired conditions nonpayment policy. (United States)

    Kavanagh, Kevin T


    Over a decade ago it was estimated that in the United States 98,000 patients die each year from hospital acquired conditions (HAC). Recently it has been reported that this many patients now die annually from hospital acquired infections (HAI) alone. Currently, HAI affects 1.7 million U.S. citizens each year. Although these conditions are often called "preventable errors," some are associated with particular hospital and physician cultures, and many of these conditions, such as pressure ulcer formation and infections, may be a sign of low facility staffing levels. Protocols have been developed that have been shown to lower the incidence of many HAC, but these have been slow to be adopted. Voluntary reporting mechanisms to ensure health care quality are reported as having reduced effectiveness by the Joint Commission and U.S. Department of Health and Human Services, Office of Inspector General reports. Transparency and public education have also met with resistance, but in the case of infections now have the support of major national medical organizations. As a further initiative to promote quality, financial incentives have been implemented by the Centers for Medicare and Medicaid Services. Surgeons have lived under stringent financial incentives since the mid-1980s when they were placed under global surgical fees. Medicare currently must make expenditure reductions because it is at risk of becoming insolvent within the decade. Implementation of financial incentives should depend upon a balance between the nonpayment of providers for nonpreventable HAC verses the promotion of health care quality and patient safety, the reduction in patient morbidity and mortality, the spurring of mechanisms to further reduce HAC, and the recouping of taxpayer dollars for HAC that could have been prevented.

  10. Incentive Pass-through for Residential Solar Systems in California

    Energy Technology Data Exchange (ETDEWEB)

    Dong, C. G. [Univ. of Texas, Austin, TX (United States); Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Rai, Varun [Univ. of Texas, Austin, TX (United States)


    The deployment of solar photovoltaic (PV) systems has grown rapidly over the last decade, partly because of various government incentives. In the United States, among the largest and longest-running incentives have been those established in California. Building on past research, this report addresses the still-unanswered question: to what degree have the direct PV incentives in California been passed through from installers to consumers? This report helps address this question by carefully examining the residential PV market in California (excluding a certain class of third-party-owned PV systems) and applying both a structural-modeling approach and a reduced-form regression analysis to estimate the incentive pass-through rate. The results suggest an average pass-through rate of direct incentives of nearly 100%, though with regional differences among California counties. While these results could have multiple explanations, they suggest a relatively competitive market and well-functioning subsidy program. Further analysis is required to determine whether similar results broadly apply to other states, to other customer segments, to all third-party-owned PV systems, or to all forms of financial incentives for solar (considering not only direct state subsidies, but also utility electric bill savings and federal tax incentives).

  11. The dynamic effect of incentives on postreward task engagement. (United States)

    Goswami, Indranil; Urminsky, Oleg


    Although incentives can be a powerful motivator of behavior when they are available, an influential body of research has suggested that rewards can persistently reduce engagement after they end. This research has resulted in widespread skepticism among practitioners and academics alike about using incentives to motivate behavior change. However, recent field studies looking at the longer term effects of temporary incentives have not found such detrimental behavior. We design an experimental framework to study dynamic behavior under temporary rewards, and find that although there is a robust decrease in engagement immediately after the incentive ends, engagement returns to a postreward baseline that is equal to or exceeds the initial baseline. As a result, the net effect of temporary incentives on behavior is strongly positive. The decrease in postreward engagement is not on account of a reduction in intrinsic motivation, but is instead driven by a desire to take a "break," consistent with maintaining a balance between goals with primarily immediate and primarily delayed benefits. Further supporting this interpretation, the initial decrease in postreward engagement is reduced by contextual factors (such as less task difficulty and higher magnitude incentives) that reduce the imbalance between effort and leisure. These findings are contrary to the predictions of major established accounts and have important implications for designing effective incentive policies to motivate behavior change. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. Financial incentives to improve progression through the HIV treatment cascade. (United States)

    Bassett, Ingrid V; Wilson, David; Taaffe, Jessica; Freedberg, Kenneth A


    We reviewed recent literature on conditional and unconditional financial incentives for their impact on improving movement through the HIV care cascade and HIV prevention. Concepts from behavioral economics may help improve engagement in HIV care by addressing upstream structural risk factors for HIV, such as poverty, or providing conditional rewards for immediate, measurable outcomes related to HIV care. Incentives have been shown to increase uptake of HIV testing. Yet, few studies to date focus on linkage to care: one large USA-based randomized trial failed to show an effect of incentives; and a smaller trial showed improved linkage to care among drug users, but no difference in virologic suppression. Several small USA-based studies have shown an impact of financial incentives on antiretroviral therapy adherence, but without durability beyond the incentive period. HIV prevention has the most robust evidence for decreasing HIV risk-taking behavior among adolescents and may serve as a model for research on the care cascade. Financial incentives show promise for improving engagement in HIV testing, care, and prevention. Understanding the durability, scalability, ease of implementation, and cost-effectiveness of these different approaches will be critical for maximizing the impact of incentives in curtailing the HIV epidemic.

  13. Testing novel patient financial incentives to increase breast cancer screening. (United States)

    Merrick, Elizabeth Levy; Hodgkin, Dominic; Horgan, Constance M; Lorenz, Laura S; Panas, Lee; Ritter, Grant A; Kasuba, Paul; Poskanzer, Debra; Nefussy, Renee Altman


    To examine the effects of 3 types of low-cost financial incentives for patients, including a novel "person-centered" approach on breast cancer screening (mammogram) rates. Randomized controlled trial with 4 arms: 3 types of financial incentives ($15 gift card, entry into lottery for $250 gift card, and a person-centered incentive with choice of $15 gift card or lottery) and a control group. Sample included privately insured Tufts Health Plan members in Massachusetts who were women aged 42 to 69 years with no mammogram claim in ≥ 2.6 years. A sample of 4700 eligible members were randomized to 4 study arms. The control group received a standard reminder letter and the incentive groups received a reminder letter plus an incentive offer for obtaining a mammogram within the next 4 months. Bivariate tests and multivariate logistic regression were used to assess the incentives' impact on mammogram receipt. Data were analyzed for 4427 members (after exclusions such as undeliverable mail). The percent of members receiving a mammogram during the study was 11.7% (gift card), 12.1% (lottery), 13.4% (person-centered/choice), and 11.9% (controls). Differences were not statistically significant in bivariate or multivariate full-sample analyses. In exploratory subgroup analyses of members with a mammogram during the most recent year prior to the study-defined gap, person-centered incentives were associated with a higher likelihood of mammogram receipt. None of the low-cost incentives tested had a statistically significant effect on mammogram rates in the full sample. Exploratory findings for members who were more recently screened suggest that they may be more responsive to person-centered incentives.

  14. The aging physician and surgeon. (United States)

    Sataloff, Robert T; Hawkshaw, Mary; Kutinsky, Joshua; Maitz, Edward A


    As the population of aging physicians increases, methods of assessing physicians' cognitive function and predicting clinically significant changes in clinical performance become increasingly important. Although several approaches have been suggested, no evaluation system is accepted or utilized widely. This article reviews literature using MEDLINE, PubMed, and other sources. Articles discussing the problems of geriatric physicians are summarized, stressing publications that proposed methods of evaluation. Selected literature on evaluating aging pilots also was reviewed, and potential applications for physician evaluation are proposed. Neuropsychological cognitive test protocols were summarized, and a reduced evaluation protocol is proposed for interdisciplinary longitudinal research. Although there are several articles evaluating cognitive function in aging physicians and aging pilots, and although a few institutions have instituted cognitive evaluation, there are no longitudinal data assessing cognitive function in physicians over time or correlating them with performance. Valid, reliable testing of cognitive function of physicians is needed. In order to understand its predictive value, physicians should be tested over time starting when they are young, and results should be correlated with physician performance. Early testing is needed to determine whether cognitive deficits are age-related or long-standing. A multi-institutional study over many years is proposed. Additional assessments of other factors such as manual dexterity (perhaps using simulators) and physician frailty are recommended.

  15. Geopressured-geothermal energy development: government incentives and institutional structures

    Energy Technology Data Exchange (ETDEWEB)

    Frederick, D.O.; Prestwood, D.C.L.; Roberts, K.; Vanston, J.H. Jr.


    The following subjects are included: a geothermal resource overview, the evolution of the current Texas geopressured-geothermal institutional structure, project evaluation with uncertainty and the structure of incentives, the natural gas industry, the electric utility industry, potential governmental participants in resource development, industrial users of thermal energy, current government incentives bearing on geopressured-geothermal development, six profiles for utilization of the geopressured-geothermal resources in the mid-term, and probable impacts of new government incentives on mid-term resource utilization profiles. (MHR)

  16. Design and Implementation of a Physician Coaching Pilot to Promote Value-Based Referrals to Specialty Care. (United States)

    Tuzzio, Leah; Ludman, Evette J; Chang, Eva; Palazzo, Lorella; Abbott, Travis; Wagner, Edward H; Reid, Robert J


    Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians. To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions. The team designed the program using physician input and a synthesis of the literature on the determinants of referral. We conducted a single-arm observational pilot with eight physicians which made up four dyads, and conducted a qualitative evaluation. Primary reasons for making referrals were clinical uncertainty and patient request. Physicians perceived doctor-to-doctor dialogue enabled mutual learning and a pathway to return joy to the practice of primary care medicine. The program helped physicians become aware of their own referral data, reasons for making referrals, and new strategies to use in their practice. Time constraints caused by large workloads were cited as a barrier both to participating in the pilot and to practicing in ways that optimize referrals. Physicians reported that the program could be sustained and spread if time for mentoring conversations was provided and/or nonfinancial incentives or compensation was offered. This physician mentoring program aimed at reducing specialty referral rates is feasible and acceptable in primary care settings. Increasing the appropriateness of referrals has the potential to provide patient-centered care, reduce costs for the system, and improve physician satisfaction.

  17. Developing algorithm for the critical care physician scheduling (United States)

    Lee, Hyojun; Pah, Adam; Amaral, Luis; Northwestern Memorial Hospital Collaboration

    Understanding the social network has enabled us to quantitatively study social phenomena such as behaviors in adoption and propagation of information. However, most work has been focusing on networks of large heterogeneous communities, and little attention has been paid to how work-relevant information spreads within networks of small and homogeneous groups of highly trained individuals, such as physicians. Within the professionals, the behavior patterns and the transmission of information relevant to the job are dependent not only on the social network between the employees but also on the schedules and teams that work together. In order to systematically investigate the dependence of the spread of ideas and adoption of innovations on a work-environment network, we sought to construct a model for the interaction network of critical care physicians at Northwestern Memorial Hospital (NMH) based on their work schedules. We inferred patterns and hidden rules from past work schedules such as turnover rates. Using the characteristics of the work schedules of the physicians and their turnover rates, we were able to create multi-year synthetic work schedules for a generic intensive care unit. The algorithm for creating shift schedules can be applied to other schedule dependent networks ARO1.

  18. Inappropriate care in European ICUs: confronting views from nurses and junior and senior physicians. (United States)

    Piers, Ruth D; Azoulay, Elie; Ricou, Bara; DeKeyser Ganz, Freda; Max, Adeline; Michalsen, Andrej; Azevedo Maia, Paulo; Owczuk, Radoslaw; Rubulotta, Francesca; Meert, Anne-Pascale; Reyners, Anna K; Decruyenaere, Johan; Benoit, Dominique D


    ICU care providers often feel that the care given to a patient may be inconsistent with their professional knowledge or beliefs. This study aimed to assess differences in, and reasons for, perceived inappropriate care (PIC) across ICU care providers with varying levels of decision-making power. We present subsequent analysis from the Appropricus Study, a cross-sectional study conducted on May 11, 2010, which included 1,218 nurses and 180 junior and 227 senior physicians in 82 European adult ICUs. The study was designed to evaluate PIC. The current study focuses on differences across health-care providers regarding the reasons for PIC in real patient situations. By multivariate analysis, nurses were found to have higher PIC rates compared with senior and junior physicians. However, nurses and senior physicians were more distressed by perceived disproportionate care than were junior physicians (33%, 25%, and 9%, respectively; P = .026). A perceived mismatch between level of care and prognosis (mostly excessive care) was the most common cause of PIC. The main reasons for PIC were prognostic uncertainty among physicians, poor team and family communication, the fact that no one was taking the initiative to challenge the inappropriateness of care, and financial incentives to provide excessive care among nurses. Senior physicians, compared with nurses and junior physicians, more frequently reported pressure from the referring physician as a reason. Family-related factors were reported by similar proportions of participants in the three groups. ICU care providers agree that excessive care is a true issue in the ICU. However, they differ in the reasons for the PIC, reflecting the roles each caregiver has in the ICU. Nurses charge physicians with a lack of initiative and poor communication, whereas physicians more often ascribe prognostic uncertainty. Teaching ICU physicians to deal with prognostic uncertainty in more adequate ways and to promote ethical discussions in their

  19. The physician leader as logotherapist. (United States)

    Washburn, E R


    Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.

  20. Economic incentives and foster child adoption. (United States)

    Argys, Laura; Duncan, Brian


    Every year, a large number of children in the United States enter the foster care system. Many of them are eventually reunited with their biological parents or quickly adopted. A significant number, however, face long-term foster care, and some of these children are eventually adopted by their foster parents. The decision by foster parents to adopt their foster child carries significant economic consequences, including for feiting foster care payments while also assuming responsibility for medical, legal, and educational expenses, to name a few. Since 1980, U.S. states have begun to offer adoption subsidies to offset some of these expenses, significantly lowering the cost of adopting a child who is in the foster care system. This article presents empirical evidence of the role that these economic incentives play in foster parents' decision of when, or if, to adopt their foster child. We find that adoption subsidies increase adoptions through two distinct price mechanisms: by lowering the absolute cost of adoption, and by lowering the relative cost of adoption versus long-term foster care.


    Energy Technology Data Exchange (ETDEWEB)



    This note studies the sensitivity of strike incentives to deep offensive force reductions using exchange, cost, and game theoretic decision models derived and discussed in companion reports. As forces fall, weapon allocations shift from military to high value targets, with the shift being half complete at about 1,000 weapons. By 500 weapons, the first and second strikes are almost totally on high value. The dominant cost for striking first is that of damage to one's high value, which is near total absent other constraints, and hence proportional to preferences for survival of high value. Changes in military costs are largely offsetting, so total first strike costs change little. The resulting costs at decision nodes are well above the costs of inaction, so the preferred course is inaction for all offensive reductions studied. As the dominant cost for striking first is proportional to the preference for survival of high value. There is a wide gap between the first strike cost and that of inaction for the parameters studied here. These conclusions should be insensitive to significant reductions in the preference for survival of high value, which is the most sensitive parameter.


    Directory of Open Access Journals (Sweden)



    Full Text Available The present paper aims to be an answer for many investors with financial powers, seeking financial instruments with yields above the average interest rate on the banking market. One such tool, fairly new to the Romanian banking market, has been implemented for about 14 years, and is becoming more and more an instrument for savings, investments or an aid in the purchase of a house. Regardless of the perspective presented in the table of contents, the incentive for choosing such a banking product is the state benefit, a form through which the administration creates the conditions necessary to update and develop the housing system. In the thesis I have explored aspects of legislation which, in such a short period of time have changed 3 times the amount and the method of granting the state benefit and I have also tried a quick historical and legislative evolution of the implementation of Bauspar system throughout Europe. It is pointed out that in comparison with other countries - namely Germany, England or Austria where this system is well-known and has been implemented for over 120 years - Romania is at the beginning of its journey, a fact proved especially by the number of signed contracts in relation to the number of inhabitants.

  3. Environmental controls: Market incentives v. direct regulation

    Energy Technology Data Exchange (ETDEWEB)

    Kosobud, R.F.; Atallah, D.S. [Univ. of Illinois, Chicago, IL (United States)


    Cap-and-trade environmental markets, where the commodities are tradable pollution rights, are being introduced in several closely watched applications as a potentially more cost-effective way of cleaning up the environment than direct or command-and-control (CAC) regulation. In this study, we examine the evidence on control cost savings provided by price and transactions data from the first few years of activity in two markets designed to reduce atmospheric pollution. Some observers of both markets have argued that prices for tradable permits lower than expected, and transactions fewer than expected, are evidence that the markets are not achieving the hoped for savings. It was found, on the contrary, that observed prices point toward more flexible and improved pollution control choices and that the number of transactions has been steadily increasing as market incentives are incorporated into enterprise decisions. These new markets during their first few years are generating, according to our estimates, control cost savings in the neighborhood of one to two billion dollars annually. However, there is evidence that the markets have not yet reached their full potential. In the course of this study, several obstacles to market performance were found that are worthy of attention by policy makers. 13 refs., 4 figs., 1 tab.

  4. Market incentives, human lives, and AIDS vaccines. (United States)

    Craddock, Susan


    For many, an AIDS vaccine holds the promise of intervening in a widespread epidemic because it is not predicated on changing economic structures and social contexts underlying vulnerability to HIV for millions of individuals. Yet 20 years into the AIDS epidemic, there is still no vaccine. Based on interviews of AIDS vaccine researchers, watchdog organizations, and ethics groups from the United States, South Africa, and Kenya conducted between August and December of 2003, this paper explores possible answers to the question of why there is no vaccine, looking in particular at contradictions between a biomedical research industry increasingly driven by market incentives and a disease that primarily affects individuals living in low-income countries with little vaccine purchasing power. Producing a vaccine that could be effective in low-income regions requires new kinds of initiatives that can coordinate research nationally and globally, and circumvent current regulatory mechanisms that dictate against the development and dissemination of low-profit medical technologies. Until such initiatives are supported, however, vaccine research will continue at a devastatingly slow pace at the cost of millions of lives annually.

  5. Mitigating Inadvertent Insider Threats with Incentives (United States)

    Liu, Debin; Wang, Xiaofeng; Camp, L. Jean

    Inadvertent insiders are trusted insiders who do not have malicious intent (as with malicious insiders) but do not responsibly managing security. The result is often enabling a malicious outsider to use the privileges of the inattentive insider to implement an insider attack. This risk is as old as conversion of a weak user password into root access, but the term inadvertent insider is recently coined to identify the link between the behavior and the vulnerability. In this paper, we propose to mitigate this threat using a novel risk budget mechanism that offers incentives to an insider to behave according to the risk posture set by the organization. We propose assigning an insider a risk budget, which is a specific allocation of risk points, allowing employees to take a finite number of risk-seeking choice. In this way, the employee can complete her tasks without subverting the security system, as with absolute prohibitions. In the end, the organization penalizes the insider if she fails to accomplish her task within the budget while rewards her in the presence of a surplus. Most importantly. the risk budget requires that the user make conscious visible choices to take electronic risks. We describe the theory behind the system, including specific work on the insider threats. We evaluated this approach using human-subject experiments, which demonstrate the effectiveness of our risk budget mechanism. We also present a game theoretic analysis of the mechanism.

  6. Financial incentive schemes in primary care

    Directory of Open Access Journals (Sweden)

    Gillam S


    Full Text Available Stephen Gillam Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK Abstract: Pay-for-performance (P4P schemes have become increasingly common in primary care, and this article reviews their impact. It is based primarily on existing systematic reviews. The evidence suggests that P4P schemes can change health professionals' behavior and improve recorded disease management of those clinical processes that are incentivized. P4P may narrow inequalities in performance comparing deprived with nondeprived areas. However, such schemes have unintended consequences. Whether P4P improves the patient experience, the outcomes of care or population health is less clear. These practical uncertainties mirror the ethical concerns of many clinicians that a reductionist approach to managing markers of chronic disease runs counter to the humanitarian values of family practice. The variation in P4P schemes between countries reflects different historical and organizational contexts. With so much uncertainty regarding the effects of P4P, policy makers are well advised to proceed carefully with the implementation of such schemes until and unless clearer evidence for their cost–benefit emerges. Keywords: financial incentives, pay for performance, quality improvement, primary care

  7. Disenfranchised Grief and Physician Burnout. (United States)

    Lathrop, Deborah


    Over the span of their career, physicians experience changes to their professional role and professional identity. The process of continual adaptation in their work setting incurs losses. These losses can be ambiguous, cumulative, and may require grieving. Grief in the workplace is unsanctioned, and may contribute to physicians' experience of burnout (emotional exhaustion, depersonalization, low sense of achievement). Acknowledging loss, validating grief, and being prescient in dealing with physician burnout is essential. © 2017 Annals of Family Medicine, Inc.

  8. Shared consultant physician posts. (United States)

    Cooke, J; Molefe, C; Carew, S; Finucane, P; Clinch, D


    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1/17 of consultants described the experience as negative. 14/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17/17 GPs were satisfied with the arrangement. 1/86 nurses surveyed reported a negative experience. 1/48 patients were unhappy with the arrangement. An extra 2.2 (pposts can be broadly acceptable and cost efficient in Ireland.

  9. Fractals for physicians. (United States)

    Thamrin, Cindy; Stern, Georgette; Frey, Urs


    There is increasing interest in the study of fractals in medicine. In this review, we provide an overview of fractals, of techniques available to describe fractals in physiological data, and we propose some reasons why a physician might benefit from an understanding of fractals and fractal analysis, with an emphasis on paediatric respiratory medicine where possible. Among these reasons are the ubiquity of fractal organisation in nature and in the body, and how changes in this organisation over the lifespan provide insight into development and senescence. Fractal properties have also been shown to be altered in disease and even to predict the risk of worsening of disease. Finally, implications of a fractal organisation include robustness to errors during development, ability to adapt to surroundings, and the restoration of such organisation as targets for intervention and treatment. Copyright 2010 Elsevier Ltd. All rights reserved.

  10. An ethnographic study of the incentives and barriers to lifestyle interventions for people with severe mental illness. (United States)

    Roberts, Seren Haf; Bailey, Jois Elisabeth


    To explore incentives and barriers to an educational lifestyle intervention for people with severe mental illness. Social and lifestyle factors along with long-term antipsychotic therapy contribute to poorer physical health in people with severe mental illness. Behavioural lifestyle interventions for this clinical group have shown some benefit. Evidence relating to the incentives and barriers to interventions is limited. An ethnographic qualitative study was undertaken. Data collection was carried out through participant observations and semi-structured interviews with eight mental health service users attending, or previously attended, a group-based lifestyle intervention. Interview data were collected between September 2008-April 2009 and observation data were collected between September-December 2009. Participant observation highlighted environment, facilitator style, group ownership, group cohesion, information and learning, incentives and barriers as important. Participant interviews identified weight management, social networking, information and communication, role of healthcare professionals and perceived benefits as key themes. This study provides evidence about the incentives and barriers to lifestyle interventions from service users' perspective, which should inform developments to improve the delivery of lifestyle interventions for this group. © 2013 Blackwell Publishing Ltd.

  11. Challenges of Family Physician Program in Urban Areas: A Qualitative Research. (United States)

    Sabet Sarvestani, Raheleh; Najafi Kalyani, Majid; Alizadeh, Fariba; Askari, Alireza; Ronaghy, Hossain; Bahramali, Ehsan


    Family physicians play an essential role and act as a communicational bridge between people and the healthcare system in providing healthcare services efficiently and equitably. This study aimed at exploring the challenges of the family physician program in urban areas in Iran in 2015. This research had a descriptive exploratory design with a qualitative content analysis approach. Data were collected through semi-structured interviews between 2014 and 2015. Seventeen physicians enrolling in family physician program for at least two years were selected through purposeful sampling. Conventional content analysis was used to analyze the data. Coding and analysis of the interview data generated two categories and seven subcategories related to the challenges of the family physician program. The categories were poor infrastructure and poor incentive mechanism. Our findings captured a good picture of family physician program in urban areas to better clarify the challenges of the program and provide a foundation to plan and implement appropriate changes. Thus, our findings will give policymakers a deeper perception to confront the challenges of the family physician program in urban areas.

  12. Third-Party Incentive Strategies and Conflict Management in Africa

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.


    Dr. Nikolas Emmanuel's examines the use of an incentives approach in managing intrastate conflict in Africa because in many cases, risks and costs make applications of hard power alone unfeasible. Furthermore, simply ignoring episodes of civil conflict in the hope that they will "burn themselves...... of this approach is to shift the behavior of targeted actors away from violence and towards more peaceful interaction. Indeed, such incentives offer a good deal of underexplored opportunities to help manage discord. This research has two primary objectives. First, it furthers the discussion of how external third...... out"� does not appear to be a viable alternative. That said, both noncoercive and coercive incentive strategies exist and have been deployed by third parties in a variety of conflict situations. Such incentives seek to manage conflict by encouraging political bargaining. The clear intention...

  13. Tax incentives and Made in Nigeria goods | Somorin | Economic and ...

    African Journals Online (AJOL)

    Made in Nigeria” concept and Companies that engage in made in Nigeria goods. It will explore how tax incentives can accelerate the growth of companies engaged in manufacturing of such made in Nigeria goods. From this paper, written ...

  14. Financial incentives for healthy behavior: ethical safeguards for behavioral economics. (United States)

    Lunze, Karsten; Paasche-Orlow, Michael K


    Economic incentives to promote healthy behavior are becoming increasingly common and have been suggested as an approach to decreasing healthcare costs. Ethical concerns about programs with such incentives are that they may contribute to inequities, be coercive, interfere with therapeutic relationships, undermine personal responsibility for health, and decrease social solidarity. Additionally, they may be a source of stigma or discrimination, promote dependence, and be unfair for those already engaged in targeted health behaviors or those who cannot fulfill the incentivized behaviors. Incentive programs need to incorporate appropriate safeguards to monitor these risks and support fairness in offering economic incentives to promote healthy behavior. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Incentive Elasticity of Demand for Bike/Walk Program (United States)


    The primary objective of this research is to estimate the "incentive" (price) elasticity of demand for using non-motorized transportation (specifically walking and bicycling) to work. Results can be used directly in the formation of local policies to...

  16. Four lenses through which to develop wellness incentive policies. (United States)

    O'Donnell, Michael P


    Employers had to scramble to develop policies for their Wellness Incentives in time for their Fall, 2013 Open Enrollment deadlines, and are already refining policies for the 2014 Open Enrollment period. Employers are encouraged to consider six policy elements and to view all of them through four lenses. The policy elements are: (1) Number and Types of Behaviors and Outcomes to Target. (2) Cost-Positive, Neutral, or Savings Approach. (3) Maximum Incentive Value and Allocation of Incentives. (4) Ratio of Types of Incentive Structure for Reasonable Alternative Standards. (5) Numbers of Cycles of RASs. (6) Access and Allocations for Family Members. The lenses are: (1) What drives healthy behavior? (2) What is equitable? (3) What is sustainable? and (4) What enhances employee morale?

  17. Incentive Pay and the Promotion of Teaching Proficiencies. (United States)

    Sharpes, Donald K.


    Discusses the current single-step salary schedule used to compensate teachers in most public school systems. Presents a model for basing an incentive system for promotion and salary on a more equitable and realistic multiple-step system. (NKA)

  18. An Examination of the Effects of Voluntary Separation Incentives

    National Research Council Canada - National Science Library

    Asch, Beth


    Between January 1992 and October 1995, the Department of Defense offered a voluntary separation incentive to mid-career personnel to induce them to leave service as a means of facilitating the defense drawdown...

  19. Social Relations, Incentives, and Gender in the Workplace

    NARCIS (Netherlands)

    O.A. Onemu (Okemena)


    markdownabstract__Abstract__ Gender differences in preferences regarding social relationships and competitive environments are well documented in psychology and economics. Research also shows that social relationships and competition among co-workers are affected by the incentive schemes workers

  20. International Experiences with Economic Incentives for Protecting the Environment (2004) (United States)

    This 2001 report finds that over the last 20 years, and particularly during the past decade, economic incentives have been increasingly used to control pollution and improve environmental and health protection.

  1. High-performing physician executives. (United States)

    Brown, M; Larson, S R; McCool, B P


    Physician leadership extends beyond traditional clinical disciplines to hospital administration, group practice management, health policy making, management of managed care programs, and many business positions. What kind of person makes a good physician executive? What stands out as the most important motivations, attributes, and interests of high-performing physician executives? How does this compare with non-physician health care executives? Such questions have long been high on the agenda of executives in other industries. This article builds on existing formal assessments of leadership attributes of high-performing business, government, and educational executives and on closer examination of health care executives. Previous studies looked at the need for innovative, entrepreneurial, energetic, community-oriented leaders for positions throughout health care. Traits that distinguish excellence and leadership were described by Brown and McCool.* That study characterized successful leaders in terms of physical strengths (high energy, good health, and propensity for hard work), mental strengths (creativity, intuition, and innovation), and organizational strengths (mission orientation, vision, and entrepreneurial spirit). In this investigation, a subset of health care executives, including physician executives, was examined more closely. It was initially assumed that successful physician executives exhibit many of the same positive traits as do nonphysician executives. This assumption was tested with physician leaders in a range of administrative and managerial positions. We also set out to identify key differences between physician and nonphysician executives. Even with our limited exploration, it seems to us that physician executives probably do differ from nonphysician executives.

  2. Incentive-Compatible Interdomain Routing with Linear Utilities


    Hall, Alexander; Nikolova, Evdokia; Papadimitriou, Christos


    We revisit the problem of incentive-compatible interdomain routing, examining the quite realistic special case in which the utilities of autonomous systems (ASes) are linear functions of the traffic in the incident links and the traffic leaving each AS. We show that incentive-compatibility toward maximizing total welfare is achievable efficiently, and in the uncapacitated case, by an algorithm that can be easily implemented by the border gateway protocol (BGP), the standard ...


    DEFF Research Database (Denmark)

    Friebel, Guido; Koch, Alexander; Seabright, Paul

    This report examines the effectiveness of the current system of incentives within the European Patent Office (EPO) and considers the possible consequences of placing greater emphasis on quantitative measures of productivity in rewarding EPO staff.......This report examines the effectiveness of the current system of incentives within the European Patent Office (EPO) and considers the possible consequences of placing greater emphasis on quantitative measures of productivity in rewarding EPO staff....

  4. Earnings progression, human capital and incentives: Theory and evidence


    Frederiksen, Anders


    The career prospects of newly recruited employees differ substantially within an organization. The stars experience a considerable growth in earnings; others can hardly maintain their entry salaries. This article sheds light on the mechanisms generating the observed heterogeneity in earnings progression by investigating the effects of on-the-job human capital acquisition, explicit short-run incentives and career concern incentives on earnings progression. The model leads to predictions about ...

  5. Exit Options in Corporate Finance: Liquidity versus Incentives


    Aghion, Philippe; Bolton, Patrick; Tirole, Jean


    This paper provides a first study of the optimal design of active monitors' exit options in a problem involving a demand for liquidity and costly monitoring of the issuer. Optimal incentives to monitor the issuer may involve restricting the monitor's right to sell her claims on the firm's cash-flow early. But the monitor will then require a liquidity premium for holding such an illiquid claim. In general, therefore, there will be a trade off between incentives and liquidity. The paper highlig...

  6. Short-term incentive schemes for hospital managers

    Directory of Open Access Journals (Sweden)

    Lucas Malambe


    Full Text Available Orientation: Short-term incentives, considered to be an extrinsic motivation, are commonly used to motivate performance. This study explored hospital managers’ perceptions of short term incentives in maximising performance and retention.Research purpose: The study explored the experiences, views and perceptions of private hospital managers in South Africa regarding the use of short-term incentives to maximise performance and retention, as well as the applicability of the findings to public hospitals.Motivation for the study: Whilst there is an established link between performance reward schemes and organisational performance, there is little understanding of the effects of short term incentives on the performance and retention of hospital managers within the South African context.Research design, approach, and method: The study used a qualitative research design: interviews were conducted with a purposive sample of 19 hospital managers, and a thematic content analysis was performed.Main findings: Short-term incentives may not be the primary motivator for hospital managers, but they do play a critical role in sustaining motivation. Participants indicated that these schemes could also be applicable to public hospitals.Practical/managerial implications: Hospital managers are inclined to be more motivated by intrinsic than extrinsic factors. However, hospital managers (as middle managers also seem to be motivated by short-term incentives. A combination of intrinsic and extrinsic motivators should thus be used to maximise performance and retention.Contribution/value-add: Whilst the study sought to explore hospital managers’ perceptions of short-term incentives, it also found that an adequate balance between internal and external motivators is key to implementing an effective short-term incentive scheme.

  7. Incentives to Repurpose Existing Drugs for Orphan Indications


    Kwok, Annette K.; Koenigbauer, Fabian M.


    The Orphan Drug Act has been successful in providing incentives to find cures for orphan diseases. However, many orphan diseases are still without cure. Therefore, the 114th Congress has introduced the 21st Century Cures Act and the Orphan Product Extension Now Accelerating Cures and Treatment Act of 2015 to further provide incentives to innovators to repurpose existing drugs for treatment of these orphan diseases. However, these bills are currently pending and their ince...

  8. Reformulating the Tax Incentive Program in Jordan: Analysis and Recommendations


    Duanjie Chen


    The paper summarizes the main weaknesses of Jordan’s current incentive program. Because of these weaknesses, Jordan’s long history of investment incentives has proven not to attract significant capital investment in areas favored by government. Instead, these measures have simply eroded the base for tax revenue. The paper compares Jordan to its major competitors for foreign investment with the region, namely Egypt, Israel, Tunisia, and the United Arab Emirates (UAE)/Dubai. The paper makes fou...

  9. Promotions and Incentives: The Case of Multistage Elimination Tournaments


    Altmann, Steffen; Falk, Armin; Wibral, Matthias


    Promotions play an important role for the provision of incentives in firms. We analyze incentives in multistage elimination tournaments with controlled laboratory experiments. In our two main treatments, we compare a two-stage tournament to a one-stage tournament. Subjects in the two-stage treatment provide excess effort in the first stage, both with respect to Nash predictions and compared to the strategically equivalent one-stage tournament. Additional control treatments confirm that excess...

  10. Developments in the practice of physician-assisted dying: perceptions of physicians who had experience with complex cases. (United States)

    Snijdewind, Marianne C; van Tol, Donald G; Onwuteaka-Philipsen, Bregje D; Willems, Dick L


    Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide (EAS) with their physicians and the way physicians experience the practice of EAS. To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. We conducted a secondary analysis of in-depth interviews with 28 Dutch physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN (Support and Consultation for Euthanasia in the Netherlands) as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what (family of) patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  11. Surprising Incentive: An Instrument for Promoting Safety Performance of Construction Employees

    Directory of Open Access Journals (Sweden)

    Fakhradin Ghasemi


    Conclusion: The results of this study proved that the surprising incentive would improve the employees' safety performance just in the short term because the surprising value of the incentives dwindle over time. For this reason and to maintain the surprising value of the incentive system, the amount and types of incentives need to be evaluated and modified annually or biannually.

  12. Perceptions of patients, physicians, and Medical students on physicians' appearance. (United States)

    Yonekura, Cláudia Leiko; Certain, Lucas; Karen, Suen Ka Kee; Alcântara, Guilherme Augusto Sousa; Ribeiro, Lucas Gaspar; Rodrigues-Júnior, Antonio Luiz; Baddini-Martinez, José


    To investigate the impressions made by different styles of dress and appearance adopted by physicians on patients, medical students and other physicians in Brazil. Two hundred fifty nine patients, 119 students, and 99 physicians answered questions related to a panel of male and female physicians' pictures covering the following styles: white clothing; white coat; formal, informal, and casual garments; and surgical scrubs. They also reported their level of discomfort with a list of 20 items for professional appearance of both genders. Most of the answers of the volunteers involved using white clothes or white coat, and in many situations the percentages of preference referred for these styles were close. Physicians and students preferred physicians wearing surgical scrubs for emergency visits, and doctors with informal style for discussing psychological problems with male professionals. Patients most often chose white clothing in response to questions. Regarding male professionals, all three groups reported high degree of discomfort for the use of shorts and bermuda shorts, multiple rings, facial piercing, sandals, extravagant hair color, long hair, and earrings. For females, high levels of discomfort were reported to shorts, blouses exposing the belly, facial piercing, multiple rings, extravagant hair color, and heavy makeup. Brazilian patients, physicians, and medical students form a better initial impression of physicians using clothing traditionally associated with the profession and exhibiting more conventional appearance. The use of entirely white garments appears to be a satisfactory option in this country. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  13. Increasing physician engagement: start with what's important to physicians. (United States)

    Stark, Robert


    Physician engagement has never been more important in this environment of healthcare reform--yet few healthcare organizations can define it or identify the elements of engagement that make increasing it possible. This may explain why a recent survey of physicians on the specifics regarding engagement from their perspective found, among other things, that levels of engagement over the past three years have increased at a lukewarm pace, at best. The survey confirmed that feeling engaged was very important to physicians' job satisfaction. It delved into what was important to them--and where there are gaps between what they want and what they are currently experiencing in their organizations--at a granular level, as well as measuring their current levels of engagement with their organizations and their work. It also explored the impact that feelings of engagement have on physicians' decisions around accepting or leaving a job or practice. A companion survey with administrators pointed out areas where there were gaps between their perceptions and those of physicians. The results point to actions that healthcare organizations can take to increase engagement--and, by extension, participation and buy-in--among their physician populations to reach critical goals and achieve greater success with key initiatives at a time of increasing physician shortages and competition between health systems for top physician talent.

  14. Writing to Heal Thyself: Physician as Person & Person as Physician (United States)

    Kasman, Deborah L.


    An experienced physician-teacher shares her own experiences with loss in medicine and loss in her personal life. Through personal writings during her divorce, she exemplifies the healing effect writing can have during difficult transformations that occur in life. She shares her bias that physicians need to accept and own their emotions and can use…

  15. Salary discrepancies between practicing male and female physician assistants. (United States)

    Coplan, Bettie; Essary, Alison C; Virden, Thomas B; Cawley, James; Stoehr, James D


    Salary discrepancies between male and female physicians are well documented; however, gender-based salary differences among clinically practicing physician assistants (PAs) have not been studied since 1992 (Willis, 1992). Therefore, the objectives of the current study are to evaluate the presence of salary discrepancies between clinically practicing male and female PAs and to analyze the effect of gender on income and practice characteristics. Using data from the 2009 American Academy of Physician Assistants' (AAPA) Annual Census Survey, we evaluated the salaries of PAs across multiple specialties. Differences between men and women were compared for practice characteristics (specialty, experience, etc) and salary (total pay, base pay, on-call pay, etc) in orthopedic surgery, emergency medicine, and family practice. Men reported working more years as a PA in their current specialty, working more hours per month on-call, providing more direct care to patients, and more funding available from their employers for professional development (p income, base pay, overtime pay, administrative pay, on-call pay, and incentive pay based on productivity and performance (p income (p income (p = .011) and base pay (p = .005) in emergency medicine, and higher base pay in family practice (p salary discrepancies remain between employed male and female PAs regardless of specialty, experience, or other practice characteristics. Copyright © 2012. Published by Elsevier Inc.

  16. Factors Influencing Patient Selection of an Orthopaedic Sports Medicine Physician. (United States)

    Manning, Blaine T; Bohl, Daniel D; Saltzman, Bryan M; Cotter, Eric J; Wang, Kevin C; Epley, Chad T; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R


    The rise in consumer-centric health insurance plans has increased the importance of the patient in choosing a provider. There is a paucity of studies that examine how patients select an orthopaedic sports medicine physician. To evaluate factors that patients consider when choosing an orthopaedic sports medicine physician. Case series; Level of evidence, 4. A total of 1077 patients who sought treatment by 3 sports medicine physicians were administered an anonymous questionnaire. The questionnaire included 19 questions asking respondents to rate the importance of specific factors regarding the selection of orthopaedic sports medicine physicians on a scale of 1 (not important at all) to 10 (very important). The remaining 6 questions were multiple-choice and regarded the following criteria: preferred physician age, appointment availability, clinic waiting room times, travel distance, and medical student/resident involvement. Of the 1077 consecutive patients administered the survey, 382 (35%) responded. Of these, 59% (n = 224) were male, and 41% (n = 158) were female. In ranking the 19 criteria in terms of importance, patients rated board certification (9.12 ± 1.88), being well known for a specific area of expertise (8.27 ± 2.39), and in-network provider status (8.13 ± 2.94) as the 3 most important factors in selecting an orthopaedic sports medicine physician. Radio, television, and Internet advertisements were rated the least important. Regarding physician age, 63% of patients would consider seeking a physician who is ≤65 years old. Approximately 78% of patients would consider seeking a different physician if no appointments were available within 4 weeks. The study results suggest that board certification, being well known for a specific area of expertise, and health insurance in-network providers may be the most important factors influencing patient selection of an orthopaedic sports medicine physician. Advertisements were least important to patients. Patient

  17. Social media and you: what every physician needs to know. (United States)

    Chauhan, Bindiya; George, Ruth; Coffin, Janis


    New healthcare models have been developed to keep up with the dynamic changes of the Internet revolution through social media. Physicians are taking this new technology and enhancing their communication with patients as well among the healthcare community including distributing public health information via Twitter and Facebook. However, a physician's freedom of speech via Twitter and blogs can reach millions instantly, causing irreversible harm. U.S. licensing authorities have reported numerous violations of professionalism by physicians resulting in disciplinary actions negatively impacting their careers. Federation of State Medical Boards guidelines advise that patient privacy must be protected at all times on social networking sites. In addition, employers and residency programs are also now searching Facebook and other social networking sites before hiring applicants. There are many benefits of social media; however, professionalism, patient privacy, and boundaries need to be maintained.

  18. Analysis of Federal incentives used to stimulate energy production

    Energy Technology Data Exchange (ETDEWEB)


    Federal incentives for the development of solar energy are examined. A Federal incentive is any action that can be taken by the government to expand residential and commercial use of solar energy. The development of solar energy policy could be enhanced by identification, quantification, and analysis of Federal incentives that have been used to simulate the development of other forms of energy. The text of this report identifies, quantifies, and analyzes such incentives and relates them to current thought about solar energy. Four viewpoints used in this discussion come from 4 types of analysis: economic, political, organizational, and legal. The next chapter identifies actions (primarily domestic) that the Federal government has taken concerning energy. This analysis uses the typology of actions described in the previous chapter to identify actions, and the four viewpoints described there to determine whether an action concerns energy. Once identified, the actions are described and then quantified by an estimate of the 1976 cost of accomplishing them. Then incentives, investments, liabilities, regulations, and other factors are analyzed in detail for nuclear energy, hydroelectric power, coal, petroleum, and natural gas. Incentives of all energy sources are then discussed with respect to solar energy policy. (MCW)

  19. Neural effects of positive and negative incentives during marijuana withdrawal.

    Directory of Open Access Journals (Sweden)

    Francesca M Filbey

    Full Text Available In spite of evidence suggesting two possible mechanisms related to drug-seeking behavior, namely reward-seeking and harm avoidance, much of the addiction literature has focused largely on positive incentivization mechanisms associated with addiction. In this study, we examined the contributing neural mechanisms of avoidance of an aversive state to drug-seeking behavior during marijuana withdrawal. To that end, marijuana users were scanned while performing the monetary incentive delay task in order to assess positive and negative incentive processes. The results showed a group x incentive interaction, such that marijuana users had greater response in areas that underlie reward processes during positive incentives while controls showed greater response in the same areas, but to negative incentives. Furthermore, a negative correlation between withdrawal symptoms and response in the amygdala during negative incentives was found in the marijuana users. These findings suggest that although marijuana users have greater reward sensitivity and less harm avoidance than controls, that attenuated amygdala response, an area that underlies fear and avoidance, was present in marijuana users with greater marijuana withdrawal symptoms. This is concordant with models of drug addiction that involve multiple sources of reinforcement in substance use disorders, and suggests the importance of strategies that focus on respective mechanisms.

  20. Incentive-Rewarding Mechanism for User-position Control in Mobile Services (United States)

    Yoshino, Makoto; Sato, Kenichiro; Shinkuma, Ryoichi; Takahashi, Tatsuro

    When the number of users in a service area increases in mobile multimedia services, no individual user can obtain satisfactory radio resources such as bandwidth and signal power because the resources are limited and shared. A solution for such a problem is user-position control. In the user-position control, the operator informs users of better communication areas (or spots) and navigates them to these positions. However, because of subjective costs caused by subjects moving from their original to a new position, they do not always attempt to move. To motivate users to contribute their resources in network services that require resource contributions for users, incentive-rewarding mechanisms have been proposed. However, there are no mechanisms that distribute rewards appropriately according to various subjective factors involving users. Furthermore, since the conventional mechanisms limit how rewards are paid, they are applicable only for the network service they targeted. In this paper, we propose a novel incentive-rewarding mechanism to solve these problems, using an external evaluator and interactive learning agents. We also investigated ways of appropriately controlling rewards based on user contributions and system service quality. We applied the proposed mechanism and reward control to the user-position control, and demonstrated its validity.

  1. Web-Based Physician Ratings for California Physicians on Probation. (United States)

    Murphy, Gregory P; Awad, Mohannad A; Osterberg, E Charles; Gaither, Thomas W; Chumnarnsongkhroh, Thanabhudee; Washington, Samuel L; Breyer, Benjamin N


     Web-based physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours, and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear.  The aim of this study was to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls.  A retrospective review of data from the Medical Board of California for physicians placed on probation from December 1989 to September 2015 was performed. Violations were categorized into nine types. Nonprobation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Web-based reviews were recorded from,, and (ratings range from 1-5).  A total of 410 physicians were placed on probation for 866 violations. The mean (standard deviation [SD]) number of ratings per doctor was 5.2 (7.8) for cases and 4 (6.3) for controls (P=.003). The mean rating for physicians on probation was 3.7 (1.6) compared with 4.0 (1.0) for controls when all three rating websites were pooled (P1.0-2.2). This association was not significant in a multivariate model when we included age and gender.  Web-based physician ratings were lower for doctors on probation indicating that patients may perceive a difference. Despite these statistical findings, the absolute difference was quite small. Physician rating websites have utility but are imperfect proxies for competence. Further research on physician Web-based ratings is warranted to understand what they measure and how they are associated with quality.

  2. Seasonal Variation in Diagnoses and Visits to Family Physicians


    Pace, Wilson D.; Dickinson, L. Miriam; Staton, Elizabeth W.


    BACKGROUND Practice-based research networks (PBRNs) replicating the National Ambulatory Medical Care Survey (NAMCS) must sample more than 1 year to account for presumed seasonal variation in illnesses. This study evaluated the effects of seasonality on diagnoses within NAMCS family physician data.

  3. When information is insufficient: inspiring patients for medication adherence and the role of social support networking. (United States)

    Hennessey, Maureen; Heryer, John W


    A report presented by the RAND Corporation for the Agency for Healthcare Research and Quality recommends that patient self-management programs should include supportive coaching, and the World Health Organization has suggested that the enhancement of patient motivation and behavioral skills is crucial to increasing patient care adherence. The US healthcare reform legislation also provides incentives for evidence-based activities (eg, coaching) that promote healthy behaviors. To review the current research on evidence-based coaching methods and their impact on medication adherence, as well as offer practical applications for such coaching interventions. The authors review the role of medication adherence in reducing the burden of chronic diseases, using the definitions of coaching and Network Coaching as a starting point for interventions that can enhance providers' skills in motivating patients to improve their treatment adherence. Practical examples are included throughout the article to illustrate the benefits of these coaching methods for patients and providers. The mnemonic COPE is used to assist providers in the recall of 4 significant coaching and Network Coaching concepts-connectedness and collaboration, open-ended questions, positive attitude, and encourage support. Following COPE can reinforce physicians and pharmacists in their attempt to improve patient medication adherence. The article presents healthcare providers, including physicians and pharmacists, with a rationale for developing evidence-based coaching skills and offers suggestions for the application of key coaching concepts.

  4. Physician participation in clinical research and trials: issues and approaches

    Directory of Open Access Journals (Sweden)

    Sami F Shaban


    research culture’. This article examines the barriers to and benefits of physician participation in clinical research as well as interventions needed to increase their participation, including the specific role of undergraduate medical education. The main challenge is the unwillingness of many physicians and patients to participate in clinical trials. Barriers to participation include lack of time, lack of resources, trial-specific issues, communication difficulties, conflicts between the role of clinician and scientist, inadequate research experience and training for physicians, lack of rewards and recognition for physicians, and sometimes a scientifically uninteresting research question, among others. Strategies to encourage physician participation in clinical research include financial and nonfinancial incentives, adequate training, research questions that are in line with physician interests and have clear potential to improve patient care, and regular feedback. Finally, encouraging research culture and fostering the development of inquiry and research-based learning among medical students is now a high priority in order to develop more and better clinician-researchers.Keywords: physician, clinical research, clinical trial, medical education

  5. Pharmaceutical policies: effects of financial incentives for prescribers. (United States)

    Rashidian, Arash; Omidvari, Amir-Houshang; Vali, Yasaman; Sturm, Heidrun; Oxman, Andrew D


    The proportion of total healthcare expenditures spent on drugs has continued to grow in countries of all income categories. Policy-makers are under pressure to control pharmaceutical expenditures without adversely affecting quality of care. Financial incentives seeking to influence prescribers' behaviour include budgetary arrangements at primary care and hospital settings (pharmaceutical budget caps or targets), financial rewards for target behaviours or outcomes (pay for performance interventions) and reduced benefit margin for prescribers based on medicine sales and prescriptions (pharmaceutical reimbursement rate reduction policies). This is the first update of the original version of this review. To determine the effects of pharmaceutical policies using financial incentives to influence prescribers' practices on drug use, healthcare utilisation, health outcomes and costs (expenditures). We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (searched 29/01/2015); MEDLINE, Ovid SP (searched 29/01/2015); EMBASE, Ovid SP (searched 29/01/2015); International Network for Rational Use of Drugs (INRUD) Bibliography (searched 29/01/2015); National Health Service (NHS) Economic Evaluation Database (searched 29/01/2015); EconLit - ProQuest (searched 02/02/2015); and Science Citation Index and Social Sciences Citation Index, Institute for Scientific Information (ISI) Web of Knowledge (citation search for included studies searched 10/02/2015). We screened the reference lists of relevant reports and contacted study authors and organisations to identify additional studies. We included policies that intend to affect prescribing by means of financial incentives for prescribers. Included in this category are pharmaceutical budget caps or targets, pay for performance and drug reimbursement rate reductions and other financial policies, if they were specifically targeted at prescribing or drug utilisation. Policies in this review were defined as laws, rules

  6. Decision-making in general practice: the effect of financial incentives on the use of laboratory analyses. (United States)

    Munkerud, Siri Fauli


    This paper examines the reaction of general practitioners (GPs) to a reform in 2004 in the remuneration system for using laboratory services in general practice. The purpose of this paper is to study whether income motivation exists regarding the use of laboratory services in general practice, and if so, the degree of income motivation among general practitioners (GPs) in Norway. We argue that the degree of income motivation is stronger when the physicians are uncertain about the utility of the laboratory service in question. We have panel data from actual physician-patient encounters in general practices in the years 2001-2004 and use discrete choice analysis and random effects models. Estimation results show that an increase in the fees will lead to a small but significant increase in use. The reform led to minor changes in the use of laboratory analyses in GPs' offices, and we argue that financial incentives were diluted because they were in conflict with medical recommendations and existing medical practice. The patient's age has the most influence and the results support the hypothesis that the impact of income increases with increasing uncertainty about diagnosis and treatment. The policy implication of our results is that financial incentives alone are not an effective tool for influencing the use of laboratory services in GPs' offices.

  7. Public unawareness of physician reimbursement. (United States)

    Herrick, Nicole Lilly; Fontanesi, John; Rush, Toni; Schatz, Richard A


    To assess subjects' perception of healthcare costs and physician reimbursement. The lack of transparency in healthcare reimbursement leaves patients and physicians unaware of the distribution of health care dollars. Anonymous survey-based study by means of convenience sampling. Participants were asked to estimate the total hospital cost and physician fee for one of the six medical procedures (n = 250). On the average for all 6 procedures, patients estimated the total cost was $36,177, ∼1,540% more than the actual Medicare rate of $7,333. Similarly, patients estimated the physician fee was $7,694, 1,474% more the actual Medicare rate of $589. Patients' perception of the total cost and physician fee are significantly higher than Medicare rates for all 6 procedures. This lack of insight may have widespread negative implications on the patient-physician relationship, on political trends to reduce physician reimbursement, and on a physician's desire to continue practicing medicine. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

  8. Physician Requirements-1990. For Cardiology. (United States)

    Tracy, Octavious; Birchette-Pierce, Cheryl

    Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…

  9. Investigating financial incentives for maternal health: an introduction. (United States)

    Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge


    Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured

  10. [The changing role of physicians]. (United States)

    Siegrist, J


    Despite a very successful process of professionalisation during the past 150 years, today's physicians face several challenges urging them to adapt their traditional professional role and the patient-physician relationship inherent in this role. Among these challenges, a growing economic influence on physicians' practices, new demands from particular groups of patients (consumerism, role of the Internet etc.), and increasing inter-professional competition deserve special attention. New evidence of an association between a stressful work environment and physician's increased health risks provides additional support in favour of this notion. This contribution suggests potential directions of change of the physician's role by pointing to (a) a growing 'feminisation' of medicine, (b) an even stronger emphasis on patient needs and (c) extended teamwork and inter-professional cooperation.

  11. A randomised controlled trial to determine the effect on response of including a lottery incentive in health surveys [ISRCTN32203485 (United States)

    Roberts, LM; Wilson, S; Roalfe, A; Bridge, P


    Background Postal questionnaires are an economical and simple method of data collection for research purposes but are subject to non-response bias. Several studies have explored the effect of monetary and non-monetary incentives on response. Recent meta-analyses conclude that financial incentives are an effective way of increasing response rates. However, large surveys rarely have the resources to reward individual participants. Three previous papers report on the effectiveness of lottery incentives with contradictory results. This study aimed to determine the effect of including a lottery-style incentive on response rates to a postal health survey. Methods Randomised controlled trial. Setting: North and West Birmingham. 8,645 patients aged 18 or over randomly selected from registers of eight general practices (family physician practices). Intervention: Inclusion of a flyer and letter with a health questionnaire informing patients that returned questionnaires would be entered into a lottery-style draw for £100 of gift vouchers. Control: Health questionnaire accompanied only by standard letter of explanation. Main outcome measures: Response rate and completion rate to questionnaire. Results 5,209 individuals responded with identical rates in both groups (62.1%). Practice, patient age, sex and Townsend score (a postcode based deprivation measure) were identified as predictive of response, with higher response related to older age, being female and living in an area with a lower Townsend score (less deprived). Conclusion This RCT, using a large community based sample, found that the offer of entry into a lottery style draw for £100 of High Street vouchers has no effect on response rates to a postal health questionnaire. PMID:15533256

  12. A randomised controlled trial to determine the effect on response of including a lottery incentive in health surveys [ISRCTN32203485

    Directory of Open Access Journals (Sweden)

    Bridge P


    Full Text Available Abstract Background Postal questionnaires are an economical and simple method of data collection for research purposes but are subject to non-response bias. Several studies have explored the effect of monetary and non-monetary incentives on response. Recent meta-analyses conclude that financial incentives are an effective way of increasing response rates. However, large surveys rarely have the resources to reward individual participants. Three previous papers report on the effectiveness of lottery incentives with contradictory results. This study aimed to determine the effect of including a lottery-style incentive on response rates to a postal health survey. Methods Randomised controlled trial. Setting: North and West Birmingham. 8,645 patients aged 18 or over randomly selected from registers of eight general practices (family physician practices. Intervention: Inclusion of a flyer and letter with a health questionnaire informing patients that returned questionnaires would be entered into a lottery-style draw for £100 of gift vouchers. Control: Health questionnaire accompanied only by standard letter of explanation. Main outcome measures: Response rate and completion rate to questionnaire. Results 5,209 individuals responded with identical rates in both groups (62.1%. Practice, patient age, sex and Townsend score (a postcode based deprivation measure were identified as predictive of response, with higher response related to older age, being female and living in an area with a lower Townsend score (less deprived. Conclusion This RCT, using a large community based sample, found that the offer of entry into a lottery style draw for £100 of High Street vouchers has no effect on response rates to a postal health questionnaire.

  13. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J


    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

  14. The ties that bind: an integrative framework of physician-hospital alignment

    Directory of Open Access Journals (Sweden)

    Gemmel Paul


    Full Text Available Abstract Background Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Discussion Empirical studies and management theory (agency theory and social exchange theory are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Summary Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.

  15. Stable and emergent network topologies : A structural approach

    NARCIS (Netherlands)

    Herman Monsuur


    Economic, social and military networks have at least one thing in common: they change over time. For various reasons, nodes form and terminate links, thereby rearranging the network. In this paper, we present a structural network mechanism that formalizes a possible incentive that guides nodes in

  16. Physicians beware: revisiting the physician practice acquisition frenzy. (United States)

    Eichmiller, Judith Riley


    This commentary compares the current physician practice acquisition frenzy to that of the mid-1990s and reflects on lessons learned. The bottom line: Physicians must understand that there were no "white knights" in the 1990s, and there really aren't any today. This article delineates five main factors that both physicians and hospital executives should thoroughly explore and agree on before an alignment or acquisition. Agreement on these issues is the glue that holds the deal together after the merger. These factors eliminate both buyer and seller remorse and delve into the true cultural alignment that must take place as the healthcare industry addresses the challenges of the future.

  17. Organizational factors affecting the adoption of diabetes care management processes in physician organizations. (United States)

    Li, Rui; Simon, Jodi; Bodenheimer, Thomas; Gillies, Robin R; Casalino, Lawrence; Schmittdiel, Julie; Shortell, Stephen M


    To describe the extent of adoption of diabetes care management processes in physician organizations in the U.S. and to investigate the organizational factors that affect the adoption of diabetes care management processes. Data are derived from the National Survey of Physician Organizations and the Management of Chronic Illness, conducted in 2000-2001. A total of 1,104 of the 1,590 physician organizations identified responded to the survey. The extent of adoption of four diabetes care management processes is measured by an index consisting of the organization's use of diabetic patient registries, clinical practice guidelines, case management, and physician feedback. The ordinary least-squares model is used to determine the association of organizational characteristics with the adoption of diabetes care management processes in physician organizations. A logistic regression model is used to determine the association of organizational characteristics with the adoption of individual diabetes care management processes. Of the 987 physician organizations studied that treat patients with diabetes, 48% either do not use any or use only one of the four diabetes care management processes. A total of 20% use two care management processes, and 32% use three or four processes. External incentives to improve quality, computerized clinical information systems, and ownership by hospitals or health maintenance organizations are strongly associated with the diabetes care management index and the adoption of individual diabetes care management processes. Policies to encourage external incentives to improve quality and to facilitate the adoption of computerized clinical information technology may promote greater use of diabetes care management processes. Copyright 2004 American Diabetes Association

  18. Getting physicians to open the survey: little evidence that an envelope teaser increases response rates

    Directory of Open Access Journals (Sweden)

    Ziegenfuss Jeanette Y


    Full Text Available Abstract Background Physician surveys are an important tool to assess attitudes, beliefs and self-reported behaviors of this policy relevant group. In order for a physician to respond to a mailed survey, they must first open the envelope. While there is some evidence that package elements can impact physician response rates, the impact of an envelope teaser is unknown. Here we assess this by testing the impact of adding a brightly colored "$25 incentive" sticker to the outside of an envelope on response rates and nonresponse bias in a survey of physicians. Methods In the second mailing of a survey assessing physicians' moral beliefs and views on controversial health care topics, initial nonrespondents were randomly assigned to receive a survey in an envelope with a colored "$25 incentive" sticker (teaser group or an envelope without a sticker (control group. Response rates were compared between the teaser and control groups overall and by age, gender, region of the United States, specialty and years in practice. Nonresponse bias was assessed by comparing the demographic composition of the respondents to the nonrespondents in the experimental and control condition. Results No significant differences in response rates were observed between the experimental and control conditions overall (p = 0.38 or after stratifying by age, gender, region, or practice type. Within the teaser condition, there was some variation in response rate by years since graduation. There was no independent effect of the teaser on response when simultaneously controlling for demographic characteristics (OR = 0.875, p = 0.4112. Conclusions Neither response rates nor nonresponse bias were impacted by the use of an envelope teaser in a survey of physicians in the United States.

  19. The response of maize production in Kenya to economic incentives

    Directory of Open Access Journals (Sweden)

    Onono, P.A.,


    Full Text Available Agricultural development policy in Kenya has emphasised the use of incentives towards increased production and therefore self-sufficiency in maize which is a basic staple for most households. The channels used to provide incentives to maize farmers over the years include setting higher producer prices; subsidisation of inputs; provision of agricultural credit, research and extension services; construction and maintenance of roads, development of irrigation and water systems; legislative, institutional and macroeconomic reforms. Despite these efforts outputof maize has remained below domestic requirements in most years and the country continues to rely on imports to meet the deficits. Studies have assessed the responsiveness of maize to output price and reported inelastic responses and have recommended policies targeting non-price incentives to complement prices for the required increased production of maize. The studies, however, did not analyse the influence of the non-price incentives on the production of the crop. The findings of those studies are therefore deficient in explaining the relative importance of different non-price incentives and how they complement prices in influencing maize production in Kenya. This study investigated the response of maize production to both price and non-price incentives. The aim of this study was to ascertain the relative importance of non-price factors in influencing production of the crops as well as complementarity between price and non-price incentives. The findings show that maize production responds positively to its output price, development expenditures in agriculture, maize sales to marketing boards, growth in per capita GDP, liberalisation and governance reforms. However, maize production responds negatively to fertiliser price and unfavourable weather conditions. The response of maize output to its price is lower with rising inflation and grain market liberalisation.

  20. A systematic review of financial incentives for dietary behavior change. (United States)

    Purnell, Jason Q; Gernes, Rebecca; Stein, Rick; Sherraden, Margaret S; Knoblock-Hahn, Amy


    In light of the obesity epidemic, there is growing interest in the use of financial incentives for dietary behavior change. Previous reviews of the literature have focused on randomized controlled trials and found mixed results. The purpose of this systematic review is to update and expand on previous reviews by considering a broader range of study designs, including randomized controlled trials, quasi-experimental, observational, and simulation studies testing the use of financial incentives to change dietary behavior and to inform both dietetic practice and research. The review was guided by theoretical consideration of the type of incentive used based on the principles of operant conditioning. There was further examination of whether studies were carried out with an institutional focus. Studies published between 2006 and 2012 were selected for review, and data were extracted regarding study population, intervention design, outcome measures, study duration and follow-up, and key findings. Twelve studies meeting selection criteria were reviewed, with 11 finding a positive association between incentives and dietary behavior change in the short term. All studies pointed to more specific information on the type, timing, and magnitude of incentives needed to motivate individuals to change behavior, the types of incentives and disincentives most likely to affect the behavior of various socioeconomic groups, and promising approaches for potential policy and practice innovations. Limitations of the studies are noted, including the lack of theoretical guidance in the selection of incentive structures and the absence of basic experimental data. Future research should consider these factors, even as policy makers and practitioners continue to experiment with this potentially useful approach to addressing obesity. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  1. Analysis of federal incentives used to stimulate energy consumption

    Energy Technology Data Exchange (ETDEWEB)

    Cole, R.J.; Cone, B.W.; Emery, J.C.; Huelshoff, M.; Lenerz, D.E.; Marcus, A.; Morris, F.A.; Sheppard, W.J.; Sommers, P.


    The purpose of the analysis is to identify and quantify Federal incentives that have increased the consumption of coal, oil, natural gas, and electricity. The introductory chapter is intended as a device for presenting the policy questions about the incentives that can be used to stimulate desired levels of energy development. In the theoretical chapter federal incentives were identified for the consumption of energy as Federal government actions whose major intent or result is to stimulate energy consumption. The stimulus comes through changing values of variables included in energy demand functions, thereby inducing energy consumers to move along the function in the direction of greater quantity of energy demanded, or through inducing a shift of the function to a position where more energy will be demanded at a given price. The demand variables fall into one of six categories: price of the energy form, price of complements, price of substitutes, preferences, income, and technology. The government can provide such incentives using six different policy instruments: taxation, disbursements, requirements, nontraditional services, traditional services, and market activity. The four major energy forms were examined. Six energy-consuming sectors were examined: residential, commercial, industrial, agricultural, transportation, and public. Two types of analyses of incentive actions are presented in this volume. The generic chapter focused on actions taken in 1978 across all energy forms. The subsequent chapters traced the patterns of incentive actions, energy form by energy form, from the beginning of the 20th century, to the present. The summary chapter includes the results of the previous chapters presented by energy form, incentive type, and user group. Finally, the implications of these results for solar policy are presented in the last chapter. (MCW)

  2. What incentives influence employers to engage in workplace health interventions?

    Directory of Open Access Journals (Sweden)

    Camilla Martinsson


    Full Text Available Abstract Background To achieve a sustainable working life it is important to know more about what could encourage employers to increase the use of preventive and health promotive interventions. The objective of the study is to explore and describe the employer perspective regarding what incentives influence their use of preventive and health promotive workplace interventions. Method Semi-structured focus group interviews were carried out with 20 representatives from 19 employers across Sweden. The economic sectors represented were municipalities, government agencies, defence, educational, research, and development institutions, health care, manufacturing, agriculture and commercial services. The interviews were transcribed verbatim and the data were analysed using latent content analysis. Results Various incentives were identified in the analysis, namely: “law and provisions”, “consequences for the workplace”, “knowledge of worker health and workplace health interventions”, “characteristics of the intervention”, “communication and collaboration with the provider”. The incentives seemed to influence the decision-making in parallel with each other and were not only related to positive incentives for engaging in workplace health interventions, but also to disincentives. Conclusions This study suggests that the decision to engage in workplace health interventions was influenced by several incentives. There are those incentives that lead to a desire to engage in a workplace health intervention, others pertain to aspects more related to the intervention use, such as the characteristics of the employer, the provider and the intervention. It is important to take all incentives into consideration when trying to understand the decision-making process for workplace health interventions and to bridge the gap between what is produced through research and what is used in practice.

  3. Incentive Use in Research: Protecting Vulnerable Populations from Exploitation

    Directory of Open Access Journals (Sweden)

    Haruna Muwonge


    Full Text Available Global investment in Medical Research and Development has markedly increased in the last few decades. However, due to the decreasing public altruism, researchers have come under increased pressures from the funding bodies to produce results. Out of desperation, some researchers have resorted to using incentives as a means of sourcing for volunteers. Consequently, the research burden has disproportionately been shared among the most vulnerable populations in the society. Incentives especially monetary ones present an ethical dilemma because of the uncertainties’ surrounding the morality, amount and type of payment, vulnerability of volunteers and possible threats to voluntary participation. Several studies done on the use of incentives in medical research have noted that financial motivation was the number one reason for subjects to volunteer in Medical research. Mutual benefit and freedom of choice by participants were given as reasons to support their use. However, scientists who are against the use of incentives believe that they are coercive or undue inducements, and may influence a subjects’ ability to give an informed consent. Guidelines exist that protect vulnerable groups from exploitation, although none sheds light into the use of incentives. Nonetheless, in the face of the waning public altruism, the benefits of using incentives far outweigh the dangers, although researchers should avoid situations where their use may become problematic. As a mode of payment to research subjects, researchers should adopt a combination of the Dickerts’ Wage and re-imbursement models as guides in quantifying the incentive. [Archives Medical Review Journal 2013; 22(3.000: 408-417

  4. Implementation of Client Incentives within a Recovery Navigation Program. (United States)

    Brolin, Mary; Torres, Maria; Hodgkin, Dominic; Horgan, Constance; Lee, Margaret; Merrick, Elizabeth; Ritter, Grant; Panas, Lee; DeMarco, Natasha; Hopwood, Jonna; Gewirtz, Andrea; Straus, John; Harrington, Janice; Lane, Nancy


    Multiple detoxification admissions among clients with substance use disorders (SUD) are costly to the health care system. This study explored the impact on behavior and cost outcomes of recovery support navigator (RSN) services delivered with and without a contingent incentive intervention. New intakes at four detoxification programs were offered RSN-only (N=1116) or RSN plus incentive (RSN+I; N=1551) services. The study used a group-level cross-over design with the intervention in place at each clinic reversed halfway through the enrollment period. RSN+I clients could earn up to $240 in gift cards for accomplishing 12 different recovery-oriented target behaviors. All eligible clients entering the detoxification programs were included in the analyses, regardless of actual service use. Among RSN+I clients, 35.5% accessed any RSN services compared to 22.3% in the RSN-only group (p<.01). Of RSN+I clients, 19% earned one, 12% earned two and 18% earned three or more incentives; 51% did not earn any incentives. The majority of incentives earned were for meeting with the RSN either during or after detoxification. Adjusted average monthly health care costs among clients in the RSN-only and RSN+I groups increased at a similar rate over 12 months post-detoxification. Possible explanations for limited uptake of the incentive program discussed include features of the incentive program itself, navigator-client communication, organizational barriers and navigator bias. The findings provide lessons to consider for future design and implementation of multi-target contingency management interventions in real-world settings. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis. (United States)

    Haff, Nancy; Patel, Mitesh S; Lim, Raymond; Zhu, Jingsan; Troxel, Andrea B; Asch, David A; Volpp, Kevin G


    To evaluate the use of behavioral economics to design financial incentives to promote health behavior change and to explore associations with demographic characteristics. Studies performed by the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania published between January 2006 and March 2014. Randomized, controlled trials with available participant-level data. Studies that did not use financial incentives to promote health behavior change were excluded. Participant-level data from seven studies were pooled. Meta-analysis on the pooled sample using a random-effects model with interaction terms to examine treatment effects and whether they varied by incentive structure or demographic characteristics. The pooled study sample comprised 1403 participants, of whom 35% were female, 70% were white, 24% were black, and the mean age was 48 years (standard deviation 11.2 years). In the fully adjusted model, participants offered financial incentives had higher odds of behavior change (odds ratio [OR]: 3.96; p financial incentives and gender, age, race, income, or education. When further adjusting for incentive structure, blacks had higher odds than whites of achieving behavior change (OR: 1.67; p Financial incentives designed using concepts from behavioral economics were effective for promoting health behavior change. There were no large and consistent relationships between the effectiveness of financial incentives and observable demographic characteristics. Second-order examinations of incentive structure suggest potential relationships among the effectiveness of financial incentives, incentive structure, and the demographic characteristics of race and income.

  6. Implementing the physician quality reporting system in an academic multispecialty group practice: lessons learned and policy implications. (United States)

    Berman, Bettina; Pracilio, Valerie P; Crawford, Albert; Behm, William R; Jacoby, Richard; Nash, David B; Goldfarb, Neil I


    The Centers for Medicare and Medicaid Services (CMS) introduced the Physician Quality Reporting System (PQRS) in 2007. PQRS was developed as a value-based, pay-for-reporting initiative intended to increase quality and decrease costs. Jefferson University Physicians (JUP) was an early participant in this voluntary program. In this article, the policy context for CMS's launch of PQRS and JUP's implementation strategy, lessons learned, and an account of benefits and barriers to participation are reviewed. In 2010, JUP achieved 94% provider participation and an average incentive of $772 per participating provider. Net incentives earned across JUP in 2010 topped $171 000, although these earnings were significantly offset by implementation and maintenance costs. PQRS represents CMS's first step toward aligning quality and cost in the ambulatory care setting. Faculty practice plans must be prepared to meet this challenge in order to avoid future penalties and to advance quality of care.

  7. Virtual colleagues, virtually colleagues--physicians' use of Twitter: a population-based observational study. (United States)

    Brynolf, Anne; Johansson, Stefan; Appelgren, Ester; Lynoe, Niels; Edstedt Bonamy, Anna-Karin


    To investigate potential violations of patient confidentiality or other breaches of medical ethics committed by physicians and medical students active on the social networking site Twitter. Population-based cross-sectional observational study. The social networking site Twitter (Swedish-speaking users, n=298819). Physicians and medical students (Swedish-speaking users, n=237) active on the social networking site Twitter between July 2007 and March 2012. Postings that reflect unprofessional behaviour and ethical breaches among physicians and medical students. In all, 237 Twitter accounts were established as held by physicians and medical students and a total of 13 780 tweets were analysed by content. In all, 276 (1.9%) tweets were labelled as 'unprofessional'. Among these, 26 (0.2%) tweets written by 15 (6.3%) physicians and medical students included information that could violate patient privacy. No information on the personal ID number or names was disclosed, but parts of the patient documentation or otherwise specific indicatory information on patients were found. Unprofessional tweets were more common among users writing under a pseudonym and among medical students. In this study of physicians and medical students on Twitter, we observed potential violations of patient privacy and other breaches of medical ethics. Our findings underline that every physician and medical student has to consider his or her presence on social networking sites. It remains to be investigated if the introduction of social networking site guidelines for medical professionals will improve awareness.

  8. An observational study of the effectiveness of practice guideline implementation strategies examined according to physicians' cognitive styles

    Directory of Open Access Journals (Sweden)

    Kowalski Christine P


    Full Text Available Abstract Background Reviews of guideline implementation recommend matching strategies to the specific setting, but provide little specific guidance about how to do so. We hypothesized that the highest level of guideline-concordant care would be achieved where implementation strategies fit well with physicians' cognitive styles. Methods We conducted an observational study of the implementation of guidelines for hypertension management among patients with diabetes at 43 Veterans' Health Administration medical center primary care clinics. Clinic leaders provided information about all implementation strategies employed at their sites. Guidelines implementation strategies were classified as education, motivation/incentive, or barrier reduction using a pre-specified system. Physician's cognitive styles were measured on three scales: evidence vs. experience as the basis of knowledge, sensitivity to pragmatic concerns, and conformity to local practices. Doctors' decisions were designated guideline-concordant if the patient's blood pressure was within goal range, or if the blood pressure was out of range and a dose change or medication change was initiated, or if the patient was already using medications from three classes. Results The final sample included 163 physicians and 1,174 patients. All of the participating sites used one or more educational approaches to implement the guidelines. Over 90% of the sites also provided group or individual feedback on physician performance on the guidelines, and over 75% implemented some type of reminder system. A minority of sites used monetary incentives, penalties, or barrier reduction. The only type of intervention that was associated with increased guideline-concordant care in a logistic model was barrier reduction (p Conclusion Guidelines implementation strategies that were designed to reduce physician time pressure and task complexity were the only ones that improved performance. Education may have been

  9. Nurse pactitioners' substitution for physicians

    Directory of Open Access Journals (Sweden)

    Robbins RA


    Full Text Available Background: To deal with a physician shortage and reduce salary costs, nurse practitioners (NPs are seeing increasing numbers of patients especially in primary care. In Arizona, SB1473 has been introduced in the state legislature which would expand the scope of practice for NPs and nurse anesthetists to be fully independent practitioners. However, whether nurses provide equal quality of care at similar costs is unclear. Methods: Relevant literature was reviewed and physician and nurse practitioner education and care were compared. Included were study design and metrics, quality of care, and efficiency of care. Results: NP and physicians differ in the length of education. Most clinical studies comparing NP and physician care were poorly designed often comparing metrics such as patient satisfaction. While increased care provided by NPs has the potential to reduce direct healthcare costs, achieving such reductions depends on the particular context of care. In a minority of clinical situations, NPs appear to have increased costs compared to physicians. Savings in cost depend on the magnitude of the salary differential between doctors and NPs, and may be offset by lower productivity and more extensive testing by NPs compared to physicians. Conclusions: The findings suggest that in most primary care situations NPs can produce as high quality care as primary care physicians. However, this conclusion should be viewed with caution given that studies to assess equivalence of care were poor and many studies had methodological limitations.

  10. Characteristics of patients seeking health information online via social health networks versus general Internet sites: a comparative study. (United States)

    Magnezi, Racheli; Grosberg, Dafna; Novikov, Ilya; Ziv, Arnona; Shani, Mordechai; Freedman, Laurence S

    2015-03-01, a Hebrew-language social health network offers advice, consultation, and connection to others with chronic illness. This study compared characteristics and objectives of users and individuals seeking medical information through general Internet sites. Similar questionnaires were sent to 1009 Internet and 900 Camoni users. Cluster analysis defined four modes of online social health network use: "acquiring information and support", "communicating", "networking" and "browsing". Six hundred and five Internet and 125 Camoni users responded. Diabetes, hypertension, obesity and lung diseases were found more often among general Internet users than Camoni users. Among Camoni users, "acquiring information and support" was the main motivation for individuals over age 55 years, women, those with lower income, chronic pain, obesity and depression. "Communicating" was the main incentive of men, those 20-34 years old, those with less education, or an eating disorder. "Networking" was the most significant motivation for those with multiple sclerosis or depression. Browsing was most frequent among individuals with multiple sclerosis. Identifying needs of social health network surfers will allow planning unique contents and enhancing social health sites. Physicians might advise patients to use them to obtain support and information regarding their conditions, possibly leading to improved compliance and self-management.

  11. Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial. (United States)

    Côté, Pierre; Cassidy, J David; Carette, Simon; Boyle, Eleanor; Shearer, Heather M; Stupar, Maja; Ammendolia, Carlo; van der Velde, Gabrielle; Hayden, Jill A; Yang, Xiaoqing; van Tulder, Maurits; Frank, John W


    Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms) who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care) will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse events between intervention groups. The results of this study

  12. Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

    Directory of Open Access Journals (Sweden)

    Ammendolia Carlo


    Full Text Available Abstract Background Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. Methods and Design We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse

  13. Physician and patient willingness to pay for electronic cardiovascular disease management. (United States)

    Deal, Ken; Keshavjee, Karim; Troyan, Sue; Kyba, Robert; Holbrook, Anne Marie


    Cardiovascular disease (CVD) is an important target for electronic decision support. We examined the potential sustainability of an electronic CVD management program using a discrete choice experiment (DCE). Our objective was to estimate physician and patient willingness-to-pay (WTP) for the current and enhanced programs. Focus groups, expert input and literature searches decided the attributes to be evaluated for the physician and patient DCEs, which were carried out using a Web-based program. Hierarchical Bayes analysis estimated preference coefficients for each respondent and latent class analysis segmented each sample. Simulations were used to estimate WTP for each of the attributes individually and for an enhanced vascular management system. 144 participants (70 physicians, 74 patients) completed the DCE. Overall, access speed to updated records and monthly payments for a nurse coordinator were the main determinants of physician choices. Two distinctly different segments of physicians were identified - one very sensitive to monthly subscription fee and speed of updating the tracker with new patient data and the other very sensitive to the monthly cost of the nurse coordinator and government billing incentives. Patient choices were most significantly influenced by the yearly subscription cost. The estimated physician WTP was slightly above the estimated threshold for sustainability while the patient WTP was below. Current willingness to pay for electronic cardiovascular disease management should encourage innovation to provide economies of scale in program development, delivery and maintenance to meet sustainability thresholds. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Attitudes toward physician-assisted suicide among physicians in Vermont. (United States)

    Craig, Alexa; Cronin, Beth; Eward, William; Metz, James; Murray, Logan; Rose, Gail; Suess, Eric; Vergara, Maria E


    Legislation on physician-assisted suicide (PAS) is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians. To determine variables predictive of physicians' opinions on PAS in a rural state, Vermont, USA. Cross-sectional mailing survey. 1052 (48% response rate) physicians licensed by the state of Vermont. Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation (42% vs 34%). Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness (48% vs 33%). 30% of the respondents had experienced a request for assistance with suicide. Vermont physicians' opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor-patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management.

  15. Motivating employees through incentives: productive or a counterproductive strategy. (United States)

    Qayum, Mehran; Sawal, Shefa Haider; Khan, Hassan Mehmood


    The disparity between human resource in health and provision of health services is a growing concern worldwide. Many developing countries are facing this crisis and therefore human resource in health is considered a high priority on their agenda.This imbalance between supplies of human resource is exacerbated by migration of health workers in many countries. Understanding the motivational factor is an important aspect to retain the migrating health workforce. This paper analyses the role of financial and non financial incentives in motivating the health work force. A review of available literature was conducted to understand the role of motivational factor in retaining health workforce. A review of current literature found that an incentive plays a key role in motivating a health worker. Financial incentives are useful in improving the compliance to standard policies and procedures. Comprehensive integrated incentive system approach should be established to develop a sustainable health workforce with required skill. Likewise monetary incentives should be linked to adherence to provincial and national guidelines and procedures. Sustainability could be ensured by commitment of government, political will and involvement of key stakeholders and decision makers.

  16. Implementation of state solar incentives: a preliminary assessment

    Energy Technology Data Exchange (ETDEWEB)

    Ashworth, J.; Green, B.; Pollock, P.; Odland, R.; Saltonstall, R.; Perelman, L.J.


    This paper reports the findings of a six-month pilot project designed to gather, analyze, and disseminate information on the operation of state incentives for solar energy. The primary purpose of this report is to provide timely and practical information on the lessons learned from and the problems encountered to date in state incentive programs for solar energy diffusion, adoption, and commercialization. The secondary intent of this SERI program is to identify those research areas within the broad spectrum of implementation experience which require more-extensive future examination to improve the effectiveness of state solar energy incentive programs. The focus of this study is the implementation of official state solar energy incentives programs. Questions of incentive design and program effectiveness are addressed in certain portions of the text, but the bulk of the research effort is directed toward examining how laws and legislative mandates have been transformed into rules, regulations, eligibility criteria, standards, comprehensive land-use plans, grants, tax deductions, and demonstration projects. Most of the programs discussed will be official governmental actions, although the roles of private groups, advisory councils, and universities are addressed. Programs were examined in Arizona, California, Florida, Maine, Massachusetts, Minnesota, Montana, New Mexico, and Oregon. (MCW)

  17. Designing institutions and incentives in hospitals: an organization economics methodology. (United States)

    Eid, Florence


    Recent seminal developments in organization economics, namely the decision rights approach, offer an opportunity to shed new light on an old question, the design of effective institutions. Drawing on conclusions about how and why firm organizational boundaries change, the decision rights approach is used in this article as an analytical lens to develop a new method for assessing institutional and incentive design in restructured hospitals. The article explains the decision rights approach and shows how the Decision Rights Framework developed from it, is a way of mapping of incentive structures to allow a comparative assessment of institutional design, an understudied area, as most work on hospitals has focused on assessing equity versus efficiency tradeoffs. The new method is illustrated drawing on one example from a case study of an innovative self-corporatized hospital in Lebanon that was at the vanguard of hospital restructuring legislation, adopted for system-wide reforms. A country with a strong private sector tradition, Lebanon was fertile territory for analyzing how high-powered incentive schemes emerge from a public sector setting, in a manner similar to the evolution of a firm in reaction to market forces. Among the findings revealed by the approach is that key to "good" design is the identification of requisite incentives and the matching up of incentives with goals through decision rights allocations. The appropriate organizational form is then a logical result.

  18. Managing risk selection incentives in health sector reforms. (United States)

    Puig-Junoy, J


    The object of the paper is to review theoretical and empirical contributions to the optimal management of risk selection incentives ('cream skimming') in health sector reforms. The trade-off between efficiency and risk selection is fostered in health sector reforms by the introduction of competitive mechanisms such as price competition or prospective payment systems. The effects of two main forms of competition in health sector reforms are observed when health insurance is mandatory: competition in the market for health insurance, and in the market for health services. Market and government failures contribute to the assessment of the different forms of risk selection employed by insurers and providers, as the effects of selection incentives on efficiency and their proposed remedies to reduce the impact of these perverse incentives. Two European (Netherlands and Spain) and two Latin American (Chile and Colombia) case studies of health sector reforms are examined in order to observe selection incentives, their effects on efficiency and costs in the health system, and regulation policies implemented in each country to mitigate incentives to 'cream skim' good risks.

  19. Intermediaries in Trust: Indirect Reciprocity, Incentives, and Norms

    Directory of Open Access Journals (Sweden)

    Giangiacomo Bravo


    Full Text Available Any trust situation involves a certain amount of risk for trustors that trustees could abuse. In some cases, intermediaries exist who play a crucial role in the exchange by providing reputational information. To examine under what conditions intermediary opinion could have a positive impact on cooperation, we designed two experiments based on a modified version of the investment game where intermediaries rated the behaviour of trustees under various incentive schemes and different role structures. We found that intermediaries can increase trust if there is room for indirect reciprocity between the involved parties. We also found that the effect of monetary incentives and social norms cannot be clearly separable in these situations. If properly designed, monetary incentives for intermediaries can have a positive effect. On the one hand, when intermediary rewards are aligned with the trustor’s interest, investments and returns tend to increase. On the other hand, fixed monetary incentives perform less than any other incentive schemes and endogenous social norms in ensuring trust and fairness. These findings should make us reconsider the mantra of incentivization of social and public conventional policy.

  20. Parental financial incentives for increasing preschool vaccination uptake: systematic review. (United States)

    Wigham, Sarah; Ternent, Laura; Bryant, Andrew; Robalino, Shannon; Sniehotta, Falko F; Adams, Jean


    Financial incentives have been used to promote vaccination uptake but are not always viewed as acceptable. Quasimandatory policies, such as requiring vaccinations for school enrollment, are widely implemented in some countries. A systematic review was conducted to determine the effectiveness, acceptability, and economic costs and consequences of parental financial incentives and quasimandatory schemes for increasing the uptake of preschool vaccinations in high-income countries. Electronic databases and gray literature were searched for randomized controlled trials, controlled before-and-after studies, and time series analyses examining the effectiveness of parental financial incentives and quasimandatory schemes, as well as any empirical studies exploring acceptability. All included studies were screened for information on economic costs and consequences. Two reviewers independently assessed studies for inclusion, extracted data, and assessed the quality of selected articles by using established instruments. Studies were synthesized in narrative reviews. Four studies on the effectiveness and 6 on the acceptability of parental financial incentives and quasimandatory interventions met the inclusion criteria. Only 1 study reported on costs and consequences. Studies of effectiveness had low risk of bias but displayed substantial heterogeneity in terms of interventions and methods. There was insufficient evidence to conclude whether these interventions were effective. Studies of acceptability suggested a preference, in settings where this already occurs, for incentives linking vaccinations to access to education. There was insufficient evidence to draw conclusions on economic costs and consequences. Copyright © 2014 by the American Academy of Pediatrics.

  1. Anti-double dipping rules for federal tax incentives

    Energy Technology Data Exchange (ETDEWEB)

    Ing, E.T.C. [Law Office of Edwin T.C. Ing, Washington, DC (United States)


    Political as well as technological changes are now reshaping the electric utility industry. While accommodating these changes, state legislative and regulatory agencies have the opportunity to promote public policies. In this regard, various state entities are evaluating appropriate incentives for renewable energy development so as to introduce greater competition in electric generation. For example, the California legislature is considering a supplemental production payment and the State of Iowa has instituted a low-interest loan program for wind and other alternative energy generation. By complementing the existing federal tax incentives, state incentives can spur the wind industry`s growth. If structured in the wrong way, however, state assistance programs will undercut the value of the federal tax incentives. The federal anti-double dipping rules apply to certain state programs. If a developer utilizes the wrong type of state assistance for a wind project, the anti-double dipping rules will reduce the federal tax incentives and this in turn will decrease the project`s profitability. Rather than suffer these results, very few if any developer will use the state program. Despite the time and effort a state may expend to enact a program for alternative energy development, the state assistance will be ineffectual. This paper reviews the counterproductive results which state assistance can have on a wind project because of the federal anti-double dipping rules.

  2. Institutional incentives for altruism: gifting blood in China. (United States)

    Yu, Chengpu; Holroyd, Eleanor; Cheng, Yu; Lau, Joseph Tak Fai


    In mainland China, the motivation behind voluntary blood donation is a relatively new and understudied behavior. In recent times provincial governments in China have implemented various institutional incentive measures. However, little is known regarding the effectiveness of such measures. This qualitative study investigated the nature and outcomes of some identified institutionalized mechanisms, in particular how these were created and distributed in the form of incentives for voluntary blood donation. Participatory observations were conducted at two blood donation stations and four blood collecting vehicles in Changsha city, China. In-depth interviews were conducted with 17 staff and 58 blood donors at the aforementioned venues from May to October 2008 in Changsha. Thematic analysis revealed the operation of four primary type incentives: policy-driven, symbolic, information feedback and role models, which constituted the system of institutional incentives. The current blood reimbursement system was not the primary motivation for blood donation; instead this system was a subtheme of future assurance for emergency blood needs. It was evident that symbolic incentives stressed the meaning and value of blood donation. Furthermore, post-donation information services and the inherent mechanisms of communication, enhanced by some public role models, served to draw the public to donate blood. At the institutional level, blood donation was not only informed by altruism, but also carried a system of benefit and reward for the donors and their family members. We would recommend that such arrangements, if accommodated effectively into China's health promotion strategies, would increase the likelihood of blood donation.

  3. Incentives and enablers to improve adherence in tuberculosis. (United States)

    Lutge, Elizabeth E; Wiysonge, Charles Shey; Knight, Stephen E; Sinclair, David; Volmink, Jimmy


    Patient adherence to medications, particularly for conditions requiring prolonged treatment such as tuberculosis (TB), is frequently less than ideal and can result in poor treatment outcomes. Material incentives to reward good behaviour and enablers to remove economic barriers to accessing care are sometimes given in the form of cash, vouchers, or food to improve adherence. To evaluate the effects of material incentives and enablers in patients undergoing diagnostic testing, or receiving prophylactic or curative therapy, for TB. We undertook a comprehensive search of the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; LILACS; Science Citation Index; and reference lists of relevant publications up to 5 June 2015. Randomized controlled trials of material incentives in patients being investigated for TB, or on treatment for latent or active TB. At least two review authors independently screened and selected studies, extracted data, and assessed the risk of bias in the included trials. We compared the effects of interventions using risk ratios (RR), and presented RRs with 95% confidence intervals (CI). The quality of the evidence was assessed using GRADE. We identified 12 eligible trials. Ten were conducted in the USA: in adolescents (one trial), in injection drug or cocaine users (four trials), in homeless adults (three trials), and in prisoners (two trials). The remaining two trials, in general adult populations, were conducted in Timor-Leste and South Africa. Sustained incentive programmesOnly two trials have assessed whether material incentives and enablers can improve long-term adherence and completion of treatment for active TB, and neither demonstrated a clear benefit (RR 1.04, 95% CI 0.97 to 1.14; two trials, 4356 participants; low quality evidence). In one trial, the incentive, given as a daily hot meal, was not well received by the population due to the inconvenience of

  4. Inter-domain incentives and Internet architecture


    Rajahalme, Jarno


    Recent experience in networking research has shown protocol and architecture deployment to be problematic, to say the least. We argue that the typically non-uniform distribution of costs and benefits inherent in many inter-domain designs is a roadblock on the path of deployment that is extremely hard, or costly, to circumvent after the fact. Therefore, the voluntary inter-domain structure that has evolved along with the transition to the commercial Internet of today should be consciously embr...

  5. Repeated, Close Physician Coronary Artery Bypass Grafting Teams Associated with Greater Teamwork. (United States)

    Everson, Jordan; Funk, Russell J; Kaufman, Samuel R; Owen-Smith, Jason; Nallamothu, Brahmajee K; Pagani, Francis D; Hollingsworth, John M


    To determine whether observed patterns of physician interaction around shared patients are associated with higher levels of teamwork as perceived by physicians. Michigan Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) procedures at 24 hospitals in the state between 2008 and 2011. We assessed hospital teamwork using the teamwork climate scale in the Safety Attitudes Questionnaire. After aggregating across CABG discharges at these hospitals, we mapped the physician referral networks (including both surgeons and nonsurgeons) that served them and measured three network properties: (1) reinforcement, (2) clustering, and (3) density. We then used multilevel regression models to identify associations between network properties and teamwork at the hospitals on which the networks were anchored. In hospitals where physicians repeatedly cared for patients with the same colleagues, physicians perceived better teamwork (β-reinforcement = 3.28, p = .003). When physicians who worked together also had other colleagues in common, the reported teamwork was stronger (β clustering = 1.71, p = .001). Reported teamwork did not change when physicians worked with a higher proportion of other physicians at the hospital (β density = -0.58, p = .64). In networks with higher levels of reinforcement and clustering, physicians perceive stronger teamwork, perhaps because the strong ties between them create a shared understanding; however, sharing patients with more physicians overall (i.e., density) did not lead to stronger teamwork. Clinical and organizational leaders may consider designing the structure of clinical teams to increase interactions with known colleagues and repeated interactions between providers. © Health Research and Educational Trust.

  6. Collaborating internationally on physician leadership education: first steps. (United States)

    Matlow, Anne; Chan, Ming-Ka; Bohnen, Jordan David; Blumenthal, Daniel Mark; Sánchez-Mendiola, Melchor; de Camps Meschino, Diane; Samson, Lindy Michelle; Busari, Jamiu


    Purpose Physicians are often ill-equipped for the leadership activities their work demands. In part, this is due to a gap in traditional medical education. An emergent international network is developing a globally relevant leadership curriculum for postgraduate medical education. The purpose of this article is to share key learnings from this process to date. Design/methodology/approach The Toronto International Summit on Leadership Education for Physicians (TISLEP) was hosted by the Royal College of Physicians and Surgeons of Canada, and the University of Toronto's Faculty of Medicine and Institute of Health Policy, Management and Evaluation. Of 64 attendees from eight countries, 34 joined working groups to develop leadership competencies. The CanMEDS Competency Framework, stage of learner development and venue of learning formed the scaffold for the work. Emotional intelligence was selected as the topic to test the feasibility of fruitful international collaboration; results were presented at TISLEP 2015. Findings Dedicated international stakeholders engaged actively and constructively through defined working groups to develop a globally relevant, competency-based curriculum for physician leadership education. Eleven principles are recommended for consideration in physician leadership curriculum development. Defining common language and taxonomy is essential for a harmonized product. The importance of establishing an international network to support implementation, evaluation, sustainability and dissemination of the work was underscored. Originality/value International stakeholders are collaborating successfully on a graduated, competency-based leadership curriculum for postgraduate medical learners. The final product will be available for adaptation to local needs. An international physician leadership education network is being developed to support and expand the work underway.

  7. Special article: physician burnout-the experience of three physicians

    Directory of Open Access Journals (Sweden)

    Raschke RA


    Full Text Available No abstract available. Article truncated at 150 words. Our fellowship held a discussion on physician burnout which was facilitated by Kris Cooper PhD, a psychologist who has long experience working with struggling physicians. We were joined by three physicians who volunteered to share their personal experiences regarding burnout. Each of these three physicians are exceptional in their devotion to their profession, high self-expectation, and level of professional achievement. Yet the commendable personal characteristics they share may have actually set them up to ultimately suffer burnout. Each of them responded to burnout in a different way. The first physician is an intensivist who left work suddenly 6 months ago, likely never to return. Over a long career, this physician had earned the respect of his colleagues and was beloved by the nurses for seeming to always knowing the right thing to do and dedicating himself fully to the care of the sickest patients and their families. For most of ...

  8. Military physician recruitment and retention: a survey of students at the Uniformed Services University of the Health Sciences. (United States)

    Holmes, Samuel L; Lee, Daniel J; Charny, Grigory; Guthrie, Jeff A; Knight, John G


    Recent strategies employed in response to military physician recruitment shortfalls have consisted of increasing financial incentives for students in the Health Professions Scholarship Program (HPSP) while offering no increased incentive for attendance at the Uniformed Services University of the Health Sciences (USUHS). To gauge the impact of these incentive increases on the decision of medical students to attend USUHS, a prospective e-mail survey of current USUHS medical students was conducted. The survey was distributed to 674 USUHS medical students from all four class years, of which 41% responded. Students were asked to prioritize incentives and disincentives for military service and USUHS, as well as respond to whether recent incentives applied solely to the HPSP would have affected their decision to attend USUHS. Data were assessed using a weighted scale with responses ranked highest receiving a score of 3, responses ranked second receiving a weighted score of 2, and those ranked third receiving a weighted score of 1. The total weighted sum for each question response across the respondent population was then tallied in aggregate and assigned a weighted score to identify factors consistently ranked highest among the students. Patriotic duty and serving uniformed personnel were ranked most appealing about military service. Combat and deployment considerations were ranked least appealing about military service. Also of note, numerous survey comment box responses highlighted the perceived advantages of pooling resources between the two programs to benefit military medical student recruitment and training. Survey results suggested that current enhanced financial incentives and shorter service obligation offered by the HPSP make attendance of USUHS less appealing for current USUHS students and may negatively impact recruitment and retention of USUHS medical officers. Commensurate incentives such as promotion and credit for time in service while attending USUHS were

  9. Practices of French family physicians concerning varicella vaccination for teenagers. (United States)

    Blaizeau, F; Lasserre, A; Rossignol, L; Blanchon, T; Kernéis, S; Hanslik, T; Levy-Bruhl, D


    The authors assessed the knowledge and practices of French family physicians concerning the application of the new 2007 varicella vaccination guidelines for non-immune teenagers, 12 to 18 years of age. They also estimated the vaccination coverage in this population. A questionnaire link was sent by to 1008 family physicians of the French Inserm Sentinel network. Each family physician had to include the last teenager aged 12 to 18 years seen in consultation, with no or uncertain history of clinical varicella. One hundred and forty-one family physicians agreed to participate and included one patient (participation rate=14%) between 4th November 2010 and 4th January 2011. One hundred and thirty-three questionnaires out of 141 (94%) were analyzed. Three patients were vaccinated and 127 were not, giving a weak vaccination coverage in the investigated population at 2%. Eighty-nine family physicians (70%) did not know about the recommendation, and 90 (71%) declared that they had no intention to vaccinate their patient against varicella. Guidelines on varicella vaccination of non-immune teenagers are poorly followed and accepted by family physicians. Vaccination coverage is very low, and efforts should be made to improve application of recommendations. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  10. Physicians' assessments of their ability to provide high-quality care in a changing health care system. (United States)

    Reschovsky, J; Reed, M; Blumenthal, D; Landon, B


    With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptions. Bivariate and multivariate analyses of the Community Tracking Study Physician Survey, a cross-sectional, nationally representative telephone survey of 12,385 patient-care physicians conducted in 1996/1997. The response rate was 65%. Physicians who provide direct patient care for > or =20 h/wk, excluding federal employees and those in selected specialties. Level of agreement with 4 statements: 1 regarding overall ability to provide high-quality care and 3 regarding aspects of care delivery associated with quality. Between 21% and 31% of physicians disagreed with the quality statements. Specialists were generally 50% more likely than primary care physicians to express concerns about their ability to provide quality care. Generally, the number of managed care contracts, but not the percent of practice revenue from managed care, was negatively associated with perceived quality. Market-level managed care penetration independently affected physicians' perceptions. Practice setting affected perceptions of quality, with physicians in group settings less likely to express concerns than physicians in solo and 2-physician practices. Specific financial incentives and care management tools had limited positive or negative associations with perceived quality. Managed care involvement is only modestly associated with reduced perceptions of quality among physicians, with some specific tools enhancing perceived quality. Physicians may be able to moderate some negative effects of managed care by altering their practice arrangements.

  11. ERISA litigation and physician autonomy. (United States)

    Jacobson, P D; Pomfret, S D


    The Employee Retirement Income Security Act (ERISA), enacted in 1974 to regulate pension and health benefit plans, is a complex statute that dominates the managed care environment. Physicians must understand ERISA's role in the relationship between themselves and managed care organizations (MCOs), including how it can influence clinical decision making and physician autonomy. This article describes ERISA's central provisions and how ERISA influences health care delivery in MCOs. We analyze ERISA litigation trends in 4 areas: professional liability, utilization management, state legislative initiatives, and compensation arrangements. This analysis demonstrates how courts have interpreted ERISA to limit physician autonomy and subordinate clinical decision making to MCOs' cost containment decisions. Physicians should support efforts to amend ERISA, thus allowing greater state regulatory oversight of MCOs and permitting courts to hold MCOs accountable for their role in medical decision making.

  12. Physician Compare National Downloadable File (United States)

    U.S. Department of Health & Human Services — The Physician Compare National Downloadable File is organized at the individual eligible professional level; each line is unique at the professional/enrollment...

  13. [Activity Polish Physicians of Transcarpathian]. (United States)

    Ar, Pułyk


    The article presents the history of founding of the Organisation of Polish Physicians of Transcarpathian and their participation in presentation of the achievements of Polish Medical Sciences in Ukraine.

  14. American College of Emergency Physicians (United States)

    ... monthly webinar series to protect your revenue, get benchmarking data, & complete your MOC Part-IV & clinical practice ... Read More More Than 850 Hours of Online Education Log In Now > Physicians Podcasts and Apps Reimbursement ...

  15. Today's Physicians Seek Career Direction. (United States)

    Morgan-Haker, Veronica R.


    Changes in the role of the physician in today's society have made their career choices risky. Career specialists have an opportunity to assist those who do not normally seek career advice outside their own profession. (JOW)

  16. [Collaboration between occupational physicians and other specialists including insurance physicians]. (United States)

    Rijkenberg, A M; van Sprundel, M; Stassijns, G


    Collaboration between various stakeholders is essential for a well-operating vocational rehabilitation process. Researchers have mentioned, among other players, insurance physicians, the curative sector and employers. In 2011 the WHO organised the congress "Connecting Health and Labour: What role for occupational health in primary care". The congress was also attended by representatives of the WONCA (World Organisations of Family Medicine). In general, everyone agreed that occupational health aspects should continue to be seen as an integral part of primary health care. However, it is not easy to find literature on this subject. For this reason we conducted a review. We searched for literature relating to collaboration with occupational physicians in Dutch, English and German between 2001 and autumn 2011. Our attention focused on cooperation with specialists and insurance physicians. Therefore, we searched PUBMED using MeSH terms and made use of the database from the "Tijdschrift voor bedrijfs- en verzekeringsgeneeskunde (TBV) [Dutch Journal for Occupational - and Insurance Medicine]". We also checked the database from the "Deutsches Arzteblatt [German Medical Journal]" and made use of the online catalogue from THIEME - eJOURNALS. Last but not least, I used the online catalogue from the German paper "Arbeits -, Sozial -, Umweltmedizin [Occupational -, Social -, Milieu Medicine]". Additionally, we made use of the "snowball - method" to find relevant literature. We found many references to this subject. The Netherlands in particular has done a lot of research in this field. However, there is little research on the cooperation between occupational physicians and specialists; in particular insurance physicians. This is interesting, because several authors have mentioned its importance. However, cooperation with other specialists seems not to be the norm. Therefore, cooperation between curative physicians (specialists but also family doctors), insurance physicians and

  17. Quality-Aware Incentive Mechanism for Mobile Crowd Sensing

    Directory of Open Access Journals (Sweden)

    Ling-Yun Jiang


    Full Text Available Mobile crowd sensing (MCS is a novel sensing paradigm which can sense human-centered daily activities and the surrounding environment. The impact of mobility and selfishness of participants on the data reliability cannot be ignored in most mobile crowd sensing systems. To address this issue, we present a universal system model based on the reverse auction framework and formulate the problem as the Multiple Quality Multiple User Selection (MQMUS problem. The quality-aware incentive mechanism (QAIM is proposed to meet the quality requirement of data reliability. We demonstrate that the proposed incentive mechanism achieves the properties of computational efficiency, individual rationality, and truthfulness. And meanwhile, we evaluate the performance and validate the theoretical properties of our incentive mechanism through extensive simulation experiments.

  18. Designing incentive market mechanisms for improving restructured power system reliabilities

    DEFF Research Database (Denmark)

    Ding, Yi; Østergaard, Jacob; Wu, Qiuwei


    In a restructured power system, the monopoly generation utility is replaced by different electricity producers. There exists extreme price volatility caused by random failures by generation or/and transmission systems. In these cases, producers' profits can be much higher than those in the normal...... state. The reliability management of producers usually cannot be directly controlled by the system operators in a restructured power system. Producers may have no motivation to improve their reliabilities, which can result in serious system unreliability issues in the new environment. Incentive market...... mechanisms for improving the restructured power system reliabilities have been designed in this paper. In the proposed incentive mechanisms, penalty will be implemented on a producer if the failures of its generator(s) result in the variation of electricity prices. Incentive market mechanisms can motivate...

  19. The Impact of Tax Incentives on Research and Development

    Directory of Open Access Journals (Sweden)

    Petr Svoboda


    Full Text Available The goal of this article is to analyze the impact of tax incentives on research and development and compare its effectiveness to direct government support of research and development. The analysis is based on regression analysis, which compares effect of tax incentives for research and development and direct government support (as percentage of GDP in 28 countries of OECD in 2013 on innovative effectiveness of these countries measured by number of registered triadic patent families per billion GDP in the same year. Results suggest that tax incentives are more effective form of research and development support than direct government funding. Research also revealed interesting case of Switzerland’s research and development performance backed by almost none government support, which should be subject to future study.

  20. Nudge or not: can incentives change health behaviours? (United States)

    Ries, Nola M


    The approach of "nudging" people toward healthier behaviours is currently in vogue, and user financial incentives (UFIs) are one possible nudge tool. Interesting debates arise as to the criteria UFIs must meet to qualify as a nudge. The more pressing issue, however, is to determine how UFIs can be structured and implemented to motivate and sustain health behaviour change. To date, Canadian public health strategies to promote physical activity and balanced nutrition focus mainly on information provision, with some product regulation measures and indirect financial incentives. Governments cannot afford direct UFI programs to incent all 60% of overweight and obese Canadians to reduce their body mass, but governments could consider UFIs targeted to specific risk groups where a shorter-term intervention could have long-term payoffs.