WorldWideScience

Sample records for providing financial incentives

  1. The influence of provider characteristics and market forces on response to financial incentives.

    Science.gov (United States)

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

    2017-11-01

    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.

  2. Effectiveness of providing financial incentives to healthcare professionals for smoking cessation activities: systematic review.

    Science.gov (United States)

    Hamilton, F L; Greaves, F; Majeed, A; Millett, C

    2013-01-01

    Financial incentives are seen as one approach to encourage more systematic use of smoking cessation interventions by healthcare professionals. A systematic review was conducted to examine the evidence for this. Medline, Embase, PsychINFO, Cochrane Library, ISI Web of Science and sources of grey literature were used as data sources. Studies were included if they reported the effects of any financial incentive provided to healthcare professionals to undertake smoking cessation-related activities. Data extraction and quality assessment for each study were conducted by one reviewer and checked by a second. A total of 18 studies were identified, consisting of 3 randomised controlled trials and 15 observational studies. All scored in the mid range for quality. In all, 8 studies examined smoking cessation activities alone and 10 studied the UK's Quality and Outcomes Framework targeting quality measures for chronic disease management including smoking recording or cessation activities. Five non-Quality and Outcomes Framework studies examined the effects of financial incentives on individual doctors and three examined effects on groups of healthcare professionals based in clinics and general practices. Most studies showed improvements in recording smoking status and smoking cessation advice. Five studies examined the impact of financial incentives on quit rates and longer-term abstinence and these showed mixed results. Financial incentives appear to improve recording of smoking status, and increase the provision of cessation advice and referrals to stop smoking services. Currently there is not sufficient evidence to show that financial incentives lead to reductions in smoking rates.

  3. Effectiveness of UK provider financial incentives on quality of care: a systematic review.

    Science.gov (United States)

    Mandavia, Rishi; Mehta, Nishchay; Schilder, Anne; Mossialos, Elias

    2017-11-01

    Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency. To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care. Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as 'positive', those that were 'intermediate' showed improvement in some measures, and those classified as 'negative' showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist. Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points. The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives - if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK. © British Journal of General Practice 2017.

  4. Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes

    Science.gov (United States)

    Lorincz, Ilona S.; Lawson, Brittany C. T.

    2012-01-01

    Incentive programs directed at both providers and patients have become increasingly widespread. Pay-for-performance (P4P) where providers receive financial incentives to carry out specific care or improve clinical outcomes has been widely implemented. The existing literature indicates they probably spur initial gains which then level off or partially revert if incentives are withdrawn. The literature also indicates that process measures are easier to influence through P4P programs but that intermediate outcomes such as glucose, blood pressure, and cholesterol control are harder to influence, and the long term impact of P4P programs on health is largely unknown. Programs directed at patients show greater promise as a means to influence patient behavior and intermediate outcomes such as weight loss; however, the evidence for long term effects are lacking. In combination, both patient and provider incentives are potentially powerful tools but whether they are cost-effective has yet to be determined. PMID:23225214

  5. Financial assistance for investments in wind power in Germany. Business incentives provided by the Deutsche Ausgleichsbank

    Energy Technology Data Exchange (ETDEWEB)

    Koch, M. [Deutsche Ausgleichsbank, Bonn (Germany)

    1995-12-31

    Within a generous financial framework investments in wind energy power have rapidly increased in Germany since the late 1980`s. In addition to direct subsidies or incentive stipulated by statutory provisions the DtA has encouraged investments in wind energy projects by loans at preferential interest rates with tremendous success and it will continue to do so. At present especially new ways of supporting environmental investments are being seek which have a cross-border environmental impact. The goal is to provide financial assistance both to domestic and foreign companies willing to invest in transboundary projects which may be located in East European Countries

  6. The effect of financial incentives on the quality of health care provided by primary care physicians.

    Science.gov (United States)

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

    2011-09-07

    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

  7. Financial incentives and weight control.

    Science.gov (United States)

    Jeffery, Robert W

    2012-11-01

    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.

  8. The cost-effectiveness of using financial incentives to improve provider quality: a framework and application

    DEFF Research Database (Denmark)

    Meacock, R.; Kristensen, Søren Rud; Sutton, M.

    2014-01-01

    , and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the 13m pound total programme costs. By generating approximately 5200 quality-adjusted life years and 4.4m......Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered......, before proposing a new more comprehensive framework, which we apply to the first P4P scheme introduced for hospitals in England. We emphasise that evaluations of cost-effectiveness need to consider who the residual claimant is on any cost savings, the possibility of positive and negative spillovers...

  9. Effect of provider and patient reminders, deployment of nurse practitioners, and financial incentives on cervical and breast cancer screening rates.

    Science.gov (United States)

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

    2013-06-01

    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.

  10. Estimating Acceptability of Financial Health Incentives

    Science.gov (United States)

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

    2017-01-01

    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…

  11. Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity - a systematic review.

    Science.gov (United States)

    Ananthapavan, J; Peeterson, A; Sacks, G

    2017-12-20

    Curbing the obesity epidemic is likely to require a suite of interventions targeting the obesogenic environment as well as individual behaviour. Evidence suggests that the effectiveness of behaviour modification programmes can be enhanced by financial incentives that immediately reward weight loss behaviour. This systematic review investigated the effectiveness of incentives with a focus on assessing the relative effectiveness of incentives that target different behaviours as well as factors of importance when implementing these programmes in real-world settings (health insurer settings). A narrative review of the academic and grey literature including a variety of study designs was undertaken. Twenty studies met inclusion criteria and were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results suggest that incentivizing weight loss is effective in the short term while the incentives are in place. There are various incentive designs, and although the relative effectiveness of each of these on weight loss is not clear, it appears that positive incentives increase the uptake into programmes and may reduce dropouts. As with other weight loss initiatives, there is a need to explore ways to maintain weight loss in the longer term - incentives for weight maintenance could play a role. © 2017 World Obesity Federation.

  12. Financial Incentives to Enable Clean Energy Deployment: Policy Overview and Good Practices

    Energy Technology Data Exchange (ETDEWEB)

    Cox, Sadie [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-02-24

    Financial incentives have been widely implemented by governments around the world to support scaled up deployment of renewable energy and energy efficiency technologies and practices. As of 2015, at least 48 countries have adopted financial incentives to support renewable energy and energy efficiency deployment. Broader clean energy strategies and plans provide a crucial foundation for financial incentives that often complement regulatory policies such as renewable energy targets, standards, and other mandates. This policy brief provides a primer on key financial incentive design elements, lessons from different country experiences, and curated support resources for more detailed and country-specific financial incentive design information.

  13. [Financial incentives for quality improvement].

    Science.gov (United States)

    Belicza, Eva; Evetovits, Tamás

    2010-05-01

    Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

  14. Financial Incentives to Promote Active Travel

    Science.gov (United States)

    Martin, Adam; Suhrcke, Marc; Ogilvie, David

    2012-01-01

    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

  15. Health, Financial Incentives and Retirement in Spain

    NARCIS (Netherlands)

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

    2008-01-01

    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

  16. Financial incentives to improve progression through the HIV treatment cascade.

    Science.gov (United States)

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

    2015-11-01

    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.

  17. Improving the cost effectiveness of financial incentives in managing travel demand management (TDM).

    Science.gov (United States)

    2013-10-01

    Providing financial incentives to commuters to use alternative modes is a common element of managing transportation demand. Although these incentives have become common during the past two decades as elements of transportation demand management (TDM)...

  18. Calculations of Financial Incentives for Providers in a Pay-for-Performance Program: Manual Review Versus Data From Structured Fields in Electronic Health Records.

    Science.gov (United States)

    Urech, Tracy H; Woodard, LeChauncy D; Virani, Salim S; Dudley, R Adams; Lutschg, Meghan Z; Petersen, Laura A

    2015-10-01

    Hospital report cards and financial incentives linked to performance require clinical data that are reliable, appropriate, timely, and cost-effective to process. Pay-for-performance plans are transitioning to automated electronic health record (EHR) data as an efficient method to generate data needed for these programs. To determine how well data from automated processing of structured fields in the electronic health record (AP-EHR) reflect data from manual chart review and the impact of these data on performance rewards. Cross-sectional analysis of performance measures used in a cluster randomized trial assessing the impact of financial incentives on guideline-recommended care for hypertension. A total of 2840 patients with hypertension assigned to participating physicians at 12 Veterans Affairs hospital-based outpatient clinics. Fifty-two physicians and 33 primary care personnel received incentive payments. Overall, positive and negative agreement indices and Cohen's kappa were calculated for assessments of guideline-recommended antihypertensive medication use, blood pressure (BP) control, and appropriate response to uncontrolled BP. Pearson's correlation coefficient was used to assess how similar participants' calculated earnings were between the data sources. By manual chart review data, 72.3% of patients were considered to have received guideline-recommended antihypertensive medications compared with 65.0% by AP-EHR review (κ=0.51). Manual review indicated 69.5% of patients had controlled BP compared with 66.8% by AP-EHR review (κ=0.87). Compared with 52.2% of patients per the manual review, 39.8% received an appropriate response by AP-EHR review (κ=0.28). Participants' incentive payments calculated using the 2 methods were highly correlated (r≥0.98). Using the AP-EHR data to calculate earnings, participants' payment changes ranged from a decrease of $91.00 (-30.3%) to an increase of $18.20 (+7.4%) for medication use (interquartile range, -14.4% to 0

  19. Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study.

    Science.gov (United States)

    Hoddinott, Pat; Thomson, Gill; Morgan, Heather; Crossland, Nicola; MacLennan, Graeme; Dykes, Fiona; Stewart, Fiona; Bauld, Linda; Campbell, Marion K

    2015-11-13

    To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Cross-sectional survey and qualitative interviews. Scotland and North West England. Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; pservices/rights-and-licensing/

  20. Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

    Science.gov (United States)

    Hoddinott, Pat; Thomson, Gill; Morgan, Heather; Crossland, Nicola; MacLennan, Graeme; Dykes, Fiona; Stewart, Fiona; Bauld, Linda; Campbell, Marion K

    2015-01-01

    Objective To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Design Cross-sectional survey and qualitative interviews. Setting Scotland and North West England. Participants Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Methods Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Results Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; pbreastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were ‘moral tensions around acceptability’, ‘need for incentives’, ‘goals’, ‘collective or divisive action’ and ‘monitoring and proof’. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. Conclusions

  1. Acceptability of Financial Incentives for Health Behaviours: A Discrete Choice Experiment.

    Directory of Open Access Journals (Sweden)

    Emma L Giles

    Full Text Available Healthy behaviours are important determinants of health and disease, but many people find it difficult to perform these behaviours. Systematic reviews support the use of personal financial incentives to encourage healthy behaviours. There is concern that financial incentives may be unacceptable to the public, those delivering services and policymakers, but this has been poorly studied. Without widespread acceptability, financial incentives are unlikely to be widely implemented. We sought to answer two questions: what are the relative preferences of UK adults for attributes of financial incentives for healthy behaviours? Do preferences vary according to the respondents' socio-demographic characteristics?We conducted an online discrete choice experiment. Participants were adult members of a market research panel living in the UK selected using quota sampling. Preferences were examined for financial incentives for: smoking cessation, regular physical activity, attendance for vaccination, and attendance for screening. Attributes of interest (and their levels were: type of incentive (none, cash, shopping vouchers or lottery tickets; value of incentive (a continuous variable; schedule of incentive (same value each week, or value increases as behaviour change is sustained; other information provided (none, written information, face-to-face discussion, or both; and recipients (all eligible individuals, people living in low-income households, or pregnant women.Cash or shopping voucher incentives were preferred as much as, or more than, no incentive in all cases. Lower value incentives and those offered to all eligible individuals were preferred. Preferences for additional information provided alongside incentives varied between behaviours. Younger participants and men were more likely to prefer incentives. There were no clear differences in preference according to educational attainment.Cash or shopping voucher-type financial incentives for healthy

  2. Acceptability of Financial Incentives for Health Behaviours: A Discrete Choice Experiment.

    Science.gov (United States)

    Giles, Emma L; Becker, Frauke; Ternent, Laura; Sniehotta, Falko F; McColl, Elaine; Adams, Jean

    2016-01-01

    Healthy behaviours are important determinants of health and disease, but many people find it difficult to perform these behaviours. Systematic reviews support the use of personal financial incentives to encourage healthy behaviours. There is concern that financial incentives may be unacceptable to the public, those delivering services and policymakers, but this has been poorly studied. Without widespread acceptability, financial incentives are unlikely to be widely implemented. We sought to answer two questions: what are the relative preferences of UK adults for attributes of financial incentives for healthy behaviours? Do preferences vary according to the respondents' socio-demographic characteristics? We conducted an online discrete choice experiment. Participants were adult members of a market research panel living in the UK selected using quota sampling. Preferences were examined for financial incentives for: smoking cessation, regular physical activity, attendance for vaccination, and attendance for screening. Attributes of interest (and their levels) were: type of incentive (none, cash, shopping vouchers or lottery tickets); value of incentive (a continuous variable); schedule of incentive (same value each week, or value increases as behaviour change is sustained); other information provided (none, written information, face-to-face discussion, or both); and recipients (all eligible individuals, people living in low-income households, or pregnant women). Cash or shopping voucher incentives were preferred as much as, or more than, no incentive in all cases. Lower value incentives and those offered to all eligible individuals were preferred. Preferences for additional information provided alongside incentives varied between behaviours. Younger participants and men were more likely to prefer incentives. There were no clear differences in preference according to educational attainment. Cash or shopping voucher-type financial incentives for healthy behaviours are

  3. Financial Incentives for Steering Education and Training. Getting Skills Right

    Science.gov (United States)

    OECD Publishing, 2017

    2017-01-01

    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)…

  4. Financial incentive schemes in primary care

    Directory of Open Access Journals (Sweden)

    Gillam S

    2015-09-01

    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

  5. The effect of explicit financial incentives on physician behavior.

    Science.gov (United States)

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

    2001-05-28

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

    OpenAIRE

    Ofer H. Azar

    2003-01-01

    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...

  7. Financial incentives for smoking cessation in pregnancy: randomised controlled trial.

    Science.gov (United States)

    Tappin, David; Bauld, Linda; Purves, David; Boyd, Kathleen; Sinclair, Lesley; MacAskill, Susan; McKell, Jennifer; Friel, Brenda; McConnachie, Alex; de Caestecker, Linda; Tannahill, Carol; Radley, Andrew; Coleman, Tim

    2015-01-27

    To assess the efficacy of a financial incentive added to routine specialist pregnancy stop smoking services versus routine care to help pregnant smokers quit. Phase II therapeutic exploratory single centre, individually randomised controlled parallel group superiority trial. One large health board area with a materially deprived, inner city population in the west of Scotland, United Kingdom. 612 self reported pregnant smokers in NHS Greater Glasgow and Clyde who were English speaking, at least 16 years of age, less than 24 weeks pregnant, and had an exhaled carbon monoxide breath test result of 7 ppm or more. 306 women were randomised to incentives and 306 to control. The control group received routine care, which was the offer of a face to face appointment to discuss smoking and cessation and, for those who attended and set a quit date, the offer of free nicotine replacement therapy for 10 weeks provided by pharmacy services, and four, weekly support phone calls. The intervention group received routine care plus the offer of up to £400 of shopping vouchers: £50 for attending a face to face appointment and setting a quit date; then another £50 if at four weeks' post-quit date exhaled carbon monoxide confirmed quitting; a further £100 was provided for continued validated abstinence of exhaled carbon monoxide after 12 weeks; a final £200 voucher was provided for validated abstinence of exhaled carbon monoxide at 34-38 weeks' gestation. The primary outcome was cotinine verified cessation at 34-38 weeks' gestation through saliva (incentives were documented. Significantly more smokers in the incentives group than control group stopped smoking: 69 (22.5%) versus 26 (8.6%). The relative risk of not smoking at the end of pregnancy was 2.63 (95% confidence interval 1.73 to 4.01) Pincentives need to be offered to achieve one extra quitter in late pregnancy) was 7.2 (95% confidence interval 5.1 to 12.2). The mean birth weight was 3140 g (SD 600 g) in the incentives group

  8. Development and Preliminary Results of the Financial Incentive Coercion Assessment (FICA) Questionnaire

    Science.gov (United States)

    Byrne, Margaret M.; Croft, Jason R.; French, Michael T.; Dugosh, Karen L.; Festinger, David S.

    2013-01-01

    Financial incentives are often used in research, yet no measure exists to determine whether they lead to perceptions of coercion in subjects. We present a preliminary evaluation of a recently developed Financial Incentive Coercion Assessment (FICA) questionnaire. FICA measures perceived coercion specifically related to payment for participation in a research study. Two hundred and sixty-six subjects were recruited from a large randomized controlled trial; 152 returned for a six-month follow-up and completed the FICA. Approximately 30% of participants reported the major reason for participating was “for the money,” but less than 5% felt that the financial incentives were coercive. FICA results are consistent with levels of perceived coercion using an alternative measure. Initial assessment of responses on the FICA suggests that it may provide a novel approach to measuring perceived coercion from financial incentives in research. Future work will refine the FICA and analyze its psychometric properties. PMID:22116011

  9. Development and preliminary results of the Financial Incentive Coercion Assessment questionnaire.

    Science.gov (United States)

    Byrne, Margaret M; Croft, Jason R; French, Michael T; Dugosh, Karen L; Festinger, David S

    2012-07-01

    Financial incentives are often used in research, yet no measure exists to determine whether they lead to perceptions of coercion in subjects. We present a preliminary evaluation of a recently developed Financial Incentive Coercion Assessment (FICA) questionnaire. FICA measures perceived coercion specifically related to payment for participation in a research study. Two hundred sixty-six subjects were recruited from a large randomized controlled trial; 152 returned for a 6-month follow-up and completed the FICA. Approximately 30% of participants reported the major reason for participating was "for the money," but less than 5% felt that the financial incentives were coercive. FICA results are consistent with levels of perceived coercion using an alternative measure. Initial assessment of responses on the FICA suggests that it may provide a novel approach to measuring perceived coercion from financial incentives in research. Future work will refine the FICA and analyze its psychometric properties. Copyright © 2012. Published by Elsevier Inc.

  10. The effect of physician disclosure of financial incentives on trust.

    Science.gov (United States)

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

    2005-03-28

    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.

  11. Investigating financial incentives for maternal health: an introduction.

    Science.gov (United States)

    Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge

    2013-12-01

    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

  12. Public attitudes to financial incentive models for organs

    DEFF Research Database (Denmark)

    Hoeyer, Klaus; Schicktanz, Silke; Deleuran, Ida

    2013-01-01

    Waiting lists for organs have stimulated interest in the use of financial incentives for organ donation (FIs), but the literature does not contain an adequate overview of studies of public attitudes toward this mode of procurement. We conducted a literature review of international peer-reviewed r......Waiting lists for organs have stimulated interest in the use of financial incentives for organ donation (FIs), but the literature does not contain an adequate overview of studies of public attitudes toward this mode of procurement. We conducted a literature review of international peer...... scientific studies on, public attitudes (excluding professionals and medical students). The review reveals a broad divergence of public opinions on financial incentives. However, quantitative studies showed a low overall level of acceptance of payment for organs in living donation (LD); only a slightly...

  13. Parental financial incentives for increasing preschool vaccination uptake: systematic review.

    Science.gov (United States)

    Wigham, Sarah; Ternent, Laura; Bryant, Andrew; Robalino, Shannon; Sniehotta, Falko F; Adams, Jean

    2014-10-01

    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.

  14. Testing novel patient financial incentives to increase breast cancer screening.

    Science.gov (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

    2015-11-01

    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.

  15. 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 consequences.Clinicaltrials.gov Identifier: NCT

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

    Science.gov (United States)

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

    2017-01-01

    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. Clinicaltrials.gov Identifier: NCT00302718.

  17. The effect of financial incentives on chlamydia testing rates: Evidence from a randomized experiment☆

    Science.gov (United States)

    Dolan, Paul; Rudisill, Caroline

    2014-01-01

    Financial incentives have been used in a variety of settings to motivate behaviors that might not otherwise be undertaken. They have been highlighted as particularly useful in settings that require a single behavior, such as appointment attendance or vaccination. They also have differential effects based on socioeconomic status in some applications (e.g. smoking). To further investigate these claims, we tested the effect of providing different types of non-cash financial incentives on the return rates of chlamydia specimen samples amongst 16–24 year-olds in England. In 2011 and 2012, we ran a two-stage randomized experiment involving 2988 young people (1489 in Round 1 and 1499 in Round 2) who requested a chlamydia screening kit from Freetest.me, an online and text screening service run by Preventx Limited. Participants were randomized to control, or one of five types of financial incentives in Round 1 or one of four financial incentives in Round 2. We tested the effect of five types of incentives on specimen sample return; reward vouchers of differing values, charity donation, participation in a lottery, choices between a lottery and a voucher and including vouchers of differing values in the test kit prior to specimen return. Financial incentives of any type, did not make a significant difference in the likelihood of specimen return. The more deprived individuals were, as calculated using Index of Multiple Deprivation (IMD), the less likely they were to return a sample. The extent to which incentive structures influenced sample return was not moderated by IMD score. Non-cash financial incentives for chlamydia testing do not seem to affect the specimen return rate in a chlamydia screening program where test kits are requested online, mailed to requestors and returned by mail. They also do not appear more or less effective in influencing test return depending on deprivation level. PMID:24373390

  18. The effect of financial incentives on chlamydia testing rates: evidence from a randomized experiment.

    Science.gov (United States)

    Dolan, Paul; Rudisill, Caroline

    2014-03-01

    Financial incentives have been used in a variety of settings to motivate behaviors that might not otherwise be undertaken. They have been highlighted as particularly useful in settings that require a single behavior, such as appointment attendance or vaccination. They also have differential effects based on socioeconomic status in some applications (e.g. smoking). To further investigate these claims, we tested the effect of providing different types of non-cash financial incentives on the return rates of chlamydia specimen samples amongst 16-24 year-olds in England. In 2011 and 2012, we ran a two-stage randomized experiment involving 2988 young people (1489 in Round 1 and 1499 in Round 2) who requested a chlamydia screening kit from Freetest.me, an online and text screening service run by Preventx Limited. Participants were randomized to control, or one of five types of financial incentives in Round 1 or one of four financial incentives in Round 2. We tested the effect of five types of incentives on specimen sample return; reward vouchers of differing values, charity donation, participation in a lottery, choices between a lottery and a voucher and including vouchers of differing values in the test kit prior to specimen return. Financial incentives of any type, did not make a significant difference in the likelihood of specimen return. The more deprived individuals were, as calculated using Index of Multiple Deprivation (IMD), the less likely they were to return a sample. The extent to which incentive structures influenced sample return was not moderated by IMD score. Non-cash financial incentives for chlamydia testing do not seem to affect the specimen return rate in a chlamydia screening program where test kits are requested online, mailed to requestors and returned by mail. They also do not appear more or less effective in influencing test return depending on deprivation level. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. The Effects of Financial Incentives on Retirement Decisions:

    DEFF Research Database (Denmark)

    Søgaard, Jakob Egholt; Anton Schultz, Esben; Schaarup, Jonas Zielke

    2013-01-01

    We exploit a temporary tax rebate introduced in Denmark in 2008 to estimate the effect of financial incentives on retirement decisions. The scheme offered individuals in a limited number of cohorts a tax rebate of up to 100,000 DKK (approximately $20,000) if they stayed on the labor market until...

  20. Health spending, illicit financial flows and tax incentives in Malawi

    African Journals Online (AJOL)

    Malawi Medical Journal; 26(4) 133-137 December 2014. Health spending 133. MMJ 26(4) December 2014 www.mmj.medcol.mw. Health spending, illicit financial flows and tax incentives in Malawi. Abstract. This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps.

  1. Entrepreneurship and Financial Incentives of Return, Risk, and Skew

    DEFF Research Database (Denmark)

    Berkhout, Peter; Hartog, Joop; Van Praag, Mirjam

    2016-01-01

    . The focus on earnings forgone may help to solve the lack of robust empirical support for the effect of financial incentives on the decision to become an entrepreneur. We find, consistent with standard theory, that a higher mean, lower variance, and higher skew in the relevant wage distribution reduce...

  2. A systematic review of financial incentives given in the health care setting

    DEFF Research Database (Denmark)

    Molema, Claudia C.M.; Wendel-Vos, G.C Wanda; Pujik, Lisanne

    2016-01-01

    of them were screened on in- and exclusion criteria based on the full-text publication. Results: Three studies were included in the review. Two studies have combined a financial incentive with nutrition classes or motivational interviewing. One of which provided a free membership to a sports facility...... and the other one provided vouchers each for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short...

  3. Impact of Provider Incentives on Quality and Value of Health Care.

    Science.gov (United States)

    Doran, Tim; Maurer, Kristin A; Ryan, Andrew M

    2017-03-20

    The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

  4. Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials.

    Science.gov (United States)

    Barnato, Amber E; Moore, Robert; Moore, Charity G; Kohatsu, Neal D; Sudore, Rebecca L

    2017-07-01

    Medicaid populations have low rates of advance care planning (ACP). Potential policy interventions include financial incentives. To test the effectiveness of patient plus provider financial incentive compared with provider financial incentive alone for increasing ACP discussions among Medicaid patients. Between April 2014 and July 2015, we conducted two sequential assessor-blinded pragmatic randomized trials in a health plan that pays primary care providers (PCPs) $100 to discuss ACP: 1) a parallel cluster trial (provider-delivered patient incentive) and 2) an individual-level trial (mail-delivered patient incentive). Control and intervention arms included encouragement to complete ACP, instructions for using an online ACP tool, and (in the intervention arm) $50 for completing the online ACP tool and a small probability of $1000 (i.e., lottery) for discussing ACP with their PCP. The primary outcome was provider-reported ACP discussion within three months. In the provider-delivered patient incentive study, 38 PCPs were randomized to the intervention (n = 18) or control (n = 20) and given 10 patient packets each to distribute. Using an intention-to-treat analysis, there were 27 of 180 ACP discussions (15%) in the intervention group and 5 of 200 (2.5%) in the control group (P = .0391). In the mail-delivered patient incentive study, there were 5 of 187 ACP discussions (2.7%) in the intervention group and 5 of 189 (2.6%) in the control group (P = .99). ACP rates were low despite an existing provider financial incentive. Adding a provider-delivered patient financial incentive, but not a mail-delivered patient incentive, modestly increased ACP discussions. PCP encouragement combined with a patient incentive may be more powerful than either encouragement or incentive alone. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  5. A systematic review of financial incentives for dietary behavior change.

    Science.gov (United States)

    Purnell, Jason Q; Gernes, Rebecca; Stein, Rick; Sherraden, Margaret S; Knoblock-Hahn, Amy

    2014-07-01

    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.

  6. The influence of financial incentive programs in promoting sustainable forestry on the nation's family forests

    Science.gov (United States)

    Michael A. Kilgore; John L. Greene; Michael G. Jacobson; Thomas J. Straka; Steven E. Daniels

    2007-01-01

    Financial incentive programs were evaluated to assess their contribution to promoting sustainable forestry practices on the nation’s family forests. The evaluation consisted of an extensive review of the literature on financial incentive programs, a mail survey of the lead administrator of financial incentive programs in each state forestry agency, and focus groups...

  7. Financial valuation of incentive arrangements in managed care contracts: a real options approach.

    Science.gov (United States)

    Maurer, R T

    2001-01-01

    Managed care provider contracts with risk-based compensation arrangements are similar to derivative securities in that the value of a contract depends on the value of a more fundamental asset: the health plan's investment in the provider's member panel. As such, the financial value of the incentive to avoid investing in the health of the member panel can be modeled using financial engineering techniques.

  8. SMART Money: Do Financial Incentives Encourage College Students to Study Science?

    Science.gov (United States)

    Evans, Brent

    2017-01-01

    Increasing the number of science, technology, engineering, and mathematics (STEM) degrees is a major federal education priority. I investigate whether providing a $4,000 financial incentive to low-income students in their junior and senior years of college induces them to major in a STEM field. Using administrative data from Ohio public colleges,…

  9. Social values and the corruption argument against financial incentives for healthy behaviour.

    Science.gov (United States)

    Brown, Rebecca C H

    2017-03-01

    Financial incentives may provide a way of reducing the burden of chronic diseases by motivating people to adopt healthy behaviours. While it is still uncertain how effective such incentives could be for promoting health, some argue that, even if effective, there are ethical objections that preclude their use. One such argument is made by Michael Sandel, who suggests that monetary transactions can have a corrupting effect on the norms and values that ordinarily regulate exchange and behaviour in previously non-monetised contexts. In this paper, I outline Sandel's corruption argument and consider its validity in the context of health incentives. I distinguish between two forms of corruption that are implied by Sandel's argument: efficiency corruption and value corruption While Sandel's thought-provoking discussion provides a valuable contribution to debates about health policies generally and health incentives specifically, I suggest the force of his criticism of health incentives is limited: further empirical evidence and theoretical reasoning are required to support the suggestion that health incentives are an inappropriate tool for promoting health. While I do not find Sandel's corruption argument compelling, this only constitutes a partial defence of health incentives, since other criticisms relating to their use may prove more successful. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Shared vision and autonomous motivation vs. financial incentives driving success in corporate acquisitions

    Science.gov (United States)

    Clayton, Byron C.

    2015-01-01

    Successful corporate acquisitions require its managers to achieve substantial performance improvements in order to sufficiently cover acquisition premiums, the expected return of debt and equity investors, and the additional resources needed to capture synergies and accelerate growth. Acquirers understand that achieving the performance improvements necessary to cover these costs and create value for investors will most likely require a significant effort from mergers and acquisitions (M&A) management teams. This understanding drives the common and longstanding practice of offering hefty performance incentive packages to key managers, assuming that financial incentives will induce in-role and extra-role behaviors that drive organizational change and growth. The present study debunks the assumptions of this common M&A practice, providing quantitative evidence that shared vision and autonomous motivation are far more effective drivers of managerial performance than financial incentives. PMID:25610406

  11. Shared Vision and Autonomous Motivation versus Financial Incentives Driving Success in Corporate Acquisitions

    Directory of Open Access Journals (Sweden)

    Byron C Clayton

    2015-01-01

    Full Text Available Successful corporate acquisitions require its managers to achieve substantial performance improvements in order to sufficiently cover acquisition premiums, the expected return of debt and equity investors, and the additional resources needed to capture synergies and accelerate growth. Acquirers understand that achieving the performance improvements necessary to cover these costs and create value for investors will most likely require a significant effort from mergers and acquisitions (M&A management teams. This understanding drives the common and longstanding practice of offering hefty performance incentive packages to key managers, assuming that financial incentives will induce in-role and extra-role behaviors that drive organizational change and growth. The present study debunks the assumptions of this common M&A practice, providing quantitative evidence that shared vision and autonomous motivation are far more effective drivers of managerial performance than financial incentives.

  12. Shared vision and autonomous motivation vs. financial incentives driving success in corporate acquisitions.

    Science.gov (United States)

    Clayton, Byron C

    2014-01-01

    Successful corporate acquisitions require its managers to achieve substantial performance improvements in order to sufficiently cover acquisition premiums, the expected return of debt and equity investors, and the additional resources needed to capture synergies and accelerate growth. Acquirers understand that achieving the performance improvements necessary to cover these costs and create value for investors will most likely require a significant effort from mergers and acquisitions (M&A) management teams. This understanding drives the common and longstanding practice of offering hefty performance incentive packages to key managers, assuming that financial incentives will induce in-role and extra-role behaviors that drive organizational change and growth. The present study debunks the assumptions of this common M&A practice, providing quantitative evidence that shared vision and autonomous motivation are far more effective drivers of managerial performance than financial incentives.

  13. Financial incentives and coverage of child health interventions: a systematic review and meta-analysis.

    Science.gov (United States)

    Bassani, Diego G; Arora, Paul; Wazny, Kerri; Gaffey, Michelle F; Lenters, Lindsey; Bhutta, Zulfiqar A

    2013-01-01

    Financial incentives are widely used strategies to alleviate poverty, foster development, and improve health. Cash transfer programs, microcredit, user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America, Sub-Saharan Africa, and more recently in Southeast Asia. Until now, no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted. The objective of this review is to provide estimates on the effect of six types of financial incentive programs: (i) Unconditional cash transfers (CT), (ii) Conditional cash transfers (CCT), (iii) Microcredit (MC), (iv) Conditional Microcredit (CMC), (v) Voucher schemes (VS) and (vi) User fee removal (UFR) on the uptake and coverage of health interventions targeting children under the age of five years. We conducted systematic searches of a series of databases until September 1st, 2012, to identify relevant studies reporting on the impact of financial incentives on coverage of health interventions and behaviors targeting children under 5 years of age. The quality of the studies was assessed using the CHERG criteria. Meta-analyses were undertaken to estimate the effect when multiple studies meeting our inclusion criteria were available. Our searches resulted in 1671 titles identified 25 studies reporting on the impact of financial incentive programs on 5 groups of coverage indicators: breastfeeding practices (breastfeeding incidence, proportion of children receiving colostrum and early initiation of breastfeeding, exclusive breastfeeding for six months and duration of breastfeeding); vaccination (coverage of full immunization, partial immunization and specific antigens); health care use (seeking healthcare when child was ill, visits to health facilities for preventive reasons, visits to health facilities for any reason, visits for health

  14. Country Review of Energy-Efficiency Financial Incentives in the Residential Sector

    Energy Technology Data Exchange (ETDEWEB)

    Can, Stephane de la Rue du; Shah, Nihar; Phadke, Amol

    2011-07-13

    A large variety of energy-efficiency policy measures exist. Some are mandatory, some are informative, and some use financial incentives to promote diffusion of efficient equipment. From country to country, financial incentives vary considerably in scope and form, the type of framework used to implement them, and the actors that administer them. They range from rebate programs administered by utilities under an Energy-Efficiency Resource Standards (EERS) regulatory framework (California, USA) to the distribution of Eco-points rewarding customers for buying highly efficient appliances (Japan). All have the primary objective of transforming the current market to accelerate the diffusion of efficient technologies by addressing up-front cost barriers faced by consumers; in most instances, efficient technologies require a greater initial investment than conventional technologies. In this paper, we review the different market transformation measures involving the use of financial incentives in the countries belonging to the Major Economies Forum. We characterize the main types of measures, discuss their mechanisms, and provide information on program impacts to the extent that ex-ante or ex-post evaluations have been conducted. Finally, we identify best practices in financial incentive programs and opportunities for coordination between Major Economies Forum countries as envisioned under the Super Efficient Appliance Deployment (SEAD) initiative.

  15. Shared Vision and Autonomous Motivation versus Financial Incentives Driving Success in Corporate Acquisitions

    National Research Council Canada - National Science Library

    Byron C Clayton

    2015-01-01

    .... This understanding drives the common and longstanding practice of offering hefty performance incentive packages to key managers, assuming that financial incentives will induce in-role and extra-role...

  16. Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review.

    Science.gov (United States)

    Tambor, Marzena; Pavlova, Milena; Golinowska, Stanisława; Arsenijevic, Jelena; Groot, Wim

    2016-09-05

    To motivate people to lead a healthier life and to engage in disease prevention, explicit financial incentives, such as monetary rewards for attaining health-related targets (e.g. smoking cessation, weight loss or increased physical activity) or disincentives for reverting to unhealthy habits, are applied. A review focused on financial incentives for health promotion among older people is lacking. Attention to this group is necessary because older people may respond differently to financial incentives, e.g. because of differences in opportunity costs and health perceptions. To outline how explicit financial incentives for healthy lifestyle and disease prevention work among older persons, this study reviews the recent evidence on this topic. We applied the method of systematic literature review and we searched in PUBMED, ECONLIT and COCHRANE LIBRARY for studies focused on explicit financial incentives targeted at older adults to promote health and stimulate primary prevention as well as screening. The publications selected as relevant were analyzed based on directed (relational) content analysis. The results are presented in a narrative manner complemented with an appendix table that describes the study details. We assessed the design of the studies reported in the publications in a qualitative manner. We also checked the quality of our review using the PRISMA 2009 checklist. We identified 15 studies on the role of explicit financial incentives in changing health-related behavior of older people. They include both, quantitative studies on the effectiveness of financial rewards as well as qualitative studies on the acceptability of financial incentives. The quantitative studies are characterized by a great diversity of designs and provide mixed results on the effects of explicit financial incentives. The results of the qualitative studies indicate limited trust of older people in the use of explicit financial incentives for health promotion and prevention. More

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

    Science.gov (United States)

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

    2016-07-01

    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. Physician practice responses to financial incentive programs: exploring the concept of implementation mechanisms.

    Science.gov (United States)

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

    2012-01-01

    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

  19. Public attitudes to financial incentive models for organs: a literature review suggests that it is time to shift the focus from 'financial incentives' to 'reciprocity'.

    Science.gov (United States)

    Hoeyer, Klaus; Schicktanz, Silke; Deleuran, Ida

    2013-04-01

    Waiting lists for organs have stimulated interest in the use of financial incentives for organ donation (FIs), but the literature does not contain an adequate overview of studies of public attitudes toward this mode of procurement. We conducted a literature review of international peer-reviewed research published between 2002 and 2012 on how members of the public position themselves toward FIs. We identified and analyzed 23 studies using MEDLINE, PsycINFO, Sociological Abstracts and cross-reference search. The search included whole organs, donation, quantitative and empirical qualitative social scientific studies on, public attitudes (excluding professionals and medical students). The review reveals a broad divergence of public opinions on financial incentives. However, quantitative studies showed a low overall level of acceptance of payment for organs in living donation (LD); only a slightly higher one for deceased donation (DD); and a general preference for alternative forms, such as removal of disincentives or expressions of social reciprocity. Across different national and methodological settings we observed a considerable preference of noncommercial forms. This does not preclude the opportunity to consider various types of acknowledgement of economic value given in return for the organ. This provides reason to shift the focus from incentives to reciprocity. © 2013 The Authors Transplant International © 2013 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.

  20. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India

    Directory of Open Access Journals (Sweden)

    Gopalan Saji S

    2012-09-01

    Full Text Available Abstract Background Demand side financing (DSF is a widely employed strategy to enhance utilization of healthcare. The impact of DSF on health care seeking in general and that of maternal care in particular is already known. Yet, its effect on financial access to care, out-of-pocket spending (OOPS and provider motivations is not considerably established. Without such evidence, DSFs may not be recommendable to build up any sustainable healthcare delivery approach. This study explores the above aspects on India’s Janani Suraksha Yojana (JSY program. Methods This study employed design and was conducted in three districts of Orissa, selected through a three-stage stratified sampling. The quantitative method was used to review the Health Management Information System (HMIS. The qualitative methods included focus groups discussions with beneficiaries (n = 19 and community intermediaries (n = 9, and interviews (n = 7 with Ministry of Health officials. HMIS data enabled to review maternal healthcare utilization. Group discussions and interviews explored the perceived impact of JSY on in-facility delivery, OOPS, healthcare costs, quality of care and performance motivation of community health workers. Results The number of institutional deliveries, ante-and post-natal care visits increased after the introduction of JSY with an annual net growth of 18.1%, 3.6% and 5% respectively. The financial incentive provided partial financial risk-protection as it could cover only 25.5% of the maternal healthcare cost of the beneficiaries in rural areas and 14.3% in urban areas. The incentive induced fresh out-of-pocket spending for some mothers and it could not address maternal care requirements comprehensively. An activity-based community worker model was encouraging to augment maternal healthcare consumption. However, the existing level of financial incentives and systemic support were inadequate to motivate the volunteers optimally on their

  1. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India.

    Science.gov (United States)

    Gopalan, Saji S; Durairaj, Varatharajan

    2012-09-15

    Demand side financing (DSF) is a widely employed strategy to enhance utilization of healthcare. The impact of DSF on health care seeking in general and that of maternal care in particular is already known. Yet, its effect on financial access to care, out-of-pocket spending (OOPS) and provider motivations is not considerably established. Without such evidence, DSFs may not be recommendable to build up any sustainable healthcare delivery approach. This study explores the above aspects on India's Janani Suraksha Yojana (JSY) program. This study employed design and was conducted in three districts of Orissa, selected through a three-stage stratified sampling. The quantitative method was used to review the Health Management Information System (HMIS). The qualitative methods included focus groups discussions with beneficiaries (n = 19) and community intermediaries (n = 9), and interviews (n = 7) with Ministry of Health officials. HMIS data enabled to review maternal healthcare utilization. Group discussions and interviews explored the perceived impact of JSY on in-facility delivery, OOPS, healthcare costs, quality of care and performance motivation of community health workers. The number of institutional deliveries, ante-and post-natal care visits increased after the introduction of JSY with an annual net growth of 18.1%, 3.6% and 5% respectively. The financial incentive provided partial financial risk-protection as it could cover only 25.5% of the maternal healthcare cost of the beneficiaries in rural areas and 14.3% in urban areas. The incentive induced fresh out-of-pocket spending for some mothers and it could not address maternal care requirements comprehensively. An activity-based community worker model was encouraging to augment maternal healthcare consumption. However, the existing level of financial incentives and systemic support were inadequate to motivate the volunteers optimally on their performance. Demand side financial incentive could enhance financial

  2. The impact of financial and nonfinancial incentives on business-unit outcomes over time.

    Science.gov (United States)

    Peterson, Suzanne J; Luthans, Fred

    2006-01-01

    Unlike previous behavior management research, this study used a quasi-experimental, control group design to examine the impact of financial and nonfinancial incentives on business-unit (21 stores in a fast-food franchise corporation) outcomes (profit, customer service, and employee turnover) over time. The results showed that both types of incentives had a significant impact on all measured outcomes. The financial incentive initially had a greater effect on all 3 outcomes, but over time, the financial and nonfinancial incentives had an equally significant impact except in terms of employee turnover. (c) 2006 APA, all rights reserved.

  3. Actuarial neutrality and financial incentives for early retirement in the Austrian pension system

    OpenAIRE

    Christl, Michael; Kucsera, Dénes

    2016-01-01

    This paper studies actuarial neutrality in the Austrian pension system. It is often argued that actuarial neutrality constitutes an incentive for people to retire. We show that there are almost no financial incentives within the Austrian pension corridor, when we use the traditional definition of actuarial neutrality. Taking taxation into account, our results suggest that financial incentives for early retirement stem mainly from the Austrian tax system and not from the pension system itself.

  4. Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

    Science.gov (United States)

    Squitieri, Lee; Chung, Kevin C

    2017-07-01

    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.

  5. Enhancing physical activity and reducing obesity through smartcare and financial incentives: A pilot randomized trial.

    Science.gov (United States)

    Shin, Dong Wook; Yun, Jae Moon; Shin, Jung-Hyun; Kwon, Hyuktae; Min, Hye Yeon; Joh, Hee-Kyung; Chung, Won Joo; Park, Jin Ho; Jung, Kee-Taig; Cho, BeLong

    2017-02-01

    A pilot randomized trial assessed the feasibility and effectiveness of an intervention combining Smartcare (activity tracker with a smartphone application) and financial incentives. A three-arm, open-label randomized controlled trial design involving traditional education, Smartcare, and Smartcare with financial incentives was involved in this study. The latter group received financial incentives depending on the achievement of daily physical activity goals (process incentive) and weight loss targets (outcome incentive). Male university students (N = 105) with body mass index of ≥27 were enrolled. The average weight loss in the traditional education, Smartcare, and Smartcare with financial incentives groups was -0.4, -1.1, and -3.1 kg, respectively, with significantly greater weight loss in the third group (both Ps incentives groups (odds ratio for the Smartcare with financial incentive vs. Smartcare = 7.27, 95% confidence interval: 1.45-36.47). Levels of physical activity were significantly higher in this group. The addition of financial incentives to Smartcare was effective in increasing physical activity and reducing obesity. © 2017 The Obesity Society.

  6. Financial incentives for exercise adherence in adults: systematic review and meta-analysis.

    Science.gov (United States)

    Mitchell, Marc S; Goodman, Jack M; Alter, David A; John, Leslie K; Oh, Paul I; Pakosh, Maureen T; Faulkner, Guy E

    2013-11-01

    Less than 5% of U.S. adults accumulate the required dose of exercise to maintain health. Behavioral economics has stimulated renewed interest in economic-based, population-level health interventions to address this issue. Despite widespread implementation of financial incentive-based public health and workplace wellness policies, the effects of financial incentives on exercise initiation and maintenance in adults remain unclear. A systematic search of 15 electronic databases for RCTs reporting the impact of financial incentives on exercise-related behaviors and outcomes was conducted in June 2012. A meta-analysis of exercise session attendance among included studies was conducted in April 2013. A qualitative analysis was conducted in February 2013 and structured along eight features of financial incentive design. Eleven studies were included (N=1453; ages 18-85 years and 50% female). Pooled results favored the incentive condition (z=3.81, pstudies. One study determined that incentives can sustain exercise for longer periods (>1 year), and two studies found exercise adherence persisted after the incentive was withdrawn. Promising incentive design feature attributes were noted. Assured, or "sure thing," incentives and objective behavioral assessment in particular appear to moderate incentive effectiveness. Previously sedentary adults responded favorably to incentives 100% of the time (n=4). The effect estimate from the meta-analysis suggests that financial incentives increase exercise session attendance for interventions up to 6 months in duration. Similarly, a simple count of positive (n=8) and null (n=3) effect studies suggests that financial incentives can increase exercise adherence in adults in the short term (<6 months). © 2013 American Journal of Preventive Medicine.

  7. Corruption of pharmaceutical markets: addressing the misalignment of financial incentives and public health.

    Science.gov (United States)

    Gagnon, Marc-André

    2013-01-01

    This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives. © 2013 American Society of Law, Medicine & Ethics, Inc.

  8. Financial Incentives and Physician Practice Participation in Medicare's Value-Based Reforms.

    Science.gov (United States)

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

    2017-07-26

    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

  9. Pharmaceutical policies: effects of financial incentives for prescribers.

    Science.gov (United States)

    Rashidian, Arash; Omidvari, Amir-Houshang; Vali, Yasaman; Sturm, Heidrun; Oxman, Andrew D

    2015-08-04

    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

  10. The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis.

    Science.gov (United States)

    Haff, Nancy; Patel, Mitesh S; Lim, Raymond; Zhu, Jingsan; Troxel, Andrea B; Asch, David A; Volpp, Kevin G

    2015-01-01

    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.

  11. Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis.

    Science.gov (United States)

    Misra-Hebert, Anita D; Hu, Bo; Taksler, Glen; Zimmerman, Robert; Rothberg, Michael B

    2016-08-01

    Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse. To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals. Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008-December 2012. Employee patients with diabetes covered by the organization's self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance. Financial incentives for employer-sponsored disease management program participation and achieving goals. Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight. A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p > 0.05). Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.

  12. Financial Incentives for Linkage to Care and Viral Suppression Among HIV-Positive Patients

    Science.gov (United States)

    Donnell, Deborah; Beauchamp, Geetha; Hall, H. Irene; Torian, Lucia V.; Zingman, Barry; Lum, Garret; Kharfen, Michael; Elion, Richard; Leider, Jason; Gordin, Fred M.; Elharrar, Vanessa; Burns, David; Zerbe, Allison; Gamble, Theresa; Branson, Bernard

    2017-01-01

    Importance Achieving linkage to care and viral suppression in human immunodeficiency virus (HIV)-positive patients improves their well-being and prevents new infections. Current gaps in the HIV care continuum substantially limit such benefits. Objective To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients. Design, Setting, and Participants A large community-based clinical trial that randomized 37 HIV test and 39 HIV care sites in the Bronx, New York, and Washington, DC, to financial incentives or standard of care. Interventions Participants at financial incentive test sites who had positive test results for HIV received coupons redeemable for $125 cash-equivalent gift cards upon linkage to care. HIV-positive patients receiving antiretroviral therapy at financial incentive care sites received $70 gift cards quarterly, if virally suppressed. Main Outcomes and Measures Linkage to care: proportion of HIV-positive persons at the test site who linked to care within 3 months, as indicated by CD4+ and/or viral load test results done at a care site. Viral suppression: proportion of established patients at HIV care sites with suppressed viral load (<400 copies/mL), assessed at each calendar quarter. Outcomes assessed through laboratory test results reported to the National HIV Surveillance System. Results A total of 1061 coupons were dispensed for linkage to care at 18 financial incentive test sites and 39 359 gift cards were dispensed to 9641 HIV-positive patients eligible for gift cards at 17 financial incentive care sites. Financial incentives did not increase linkage to care (adjusted odds ratio, 1.10; 95% CI, 0.73-1.67; P = .65). However, financial incentives significantly increased viral suppression. The overall proportion of patients with viral suppression was 3.8% higher (95% CI, 0.7%-6.8%; P = .01) at financial incentive sites compared with standard of care sites. Among patients not

  13. The impact of financial incentives on physical activity in adults: a systematic review protocol.

    Science.gov (United States)

    Luong, My-Linh Nguyen; Bennell, Kim L; Hall, Michelle; Harris, Anthony; Hinman, Rana S

    2018-01-25

    Most adults fail to meet global physical activity guidelines set out by the World Health Organization. In recent years, behavioural economic principles have been used to design novel interventions that increase physical activity. Immediate financial rewards, for instance, can motivate an individual to change physical activity behaviour by lowering the opportunity costs of exercise. This systematic review will summarise the evidence about the effectiveness of financial incentive interventions for improving physical activity in adults. We will search MEDLINE, Embase, Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, PsycINFO, EconLit, SPORTDiscus, the National Health Service Economic Evaluation Database, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform from inception using a comprehensive, electronic search strategy. The search strategy will include terms related to 'financial incentive' and 'physical activity'. Only randomised controlled trials that investigate the effect of financial incentives on physical activity in adult populations and that are written in the English language will be included. Two review authors will independently screen abstracts and titles, complete full text reviews and extract data on objective and self-reported physical activity outcomes. The authors will also assess the study quality using the Cochrane risk of bias tool and provide a systematic presentation and synthesis of the included studies' characteristics and results. If more than two studies are sufficiently similar in population, settings and interventions, we will pool the data to conduct a meta-analysis. If we are unable to perform a meta-analysis, we will conduct a narrative synthesis of the results and produce forest plots for individual studies. Our subgroup analyses will examine the differential effects of an intervention in healthy

  14. A case study of a workplace wellness program that offers financial incentives for weight loss.

    Science.gov (United States)

    Cawley, John; Price, Joshua A

    2013-09-01

    Employers are increasingly adopting workplace wellness programs designed to improve employee health and decrease employer costs associated with health insurance and job absenteeism. This paper examines the outcomes of 2635 workers across 24 worksites who were offered financial incentives for weight loss that took various forms, including fixed payments and forfeitable bonds. We document extremely high attrition and modest weight loss associated with the financial incentives in this program, which contrasts with the better outcomes associated with pilot programs. We conclude by offering suggestions, motivated by behavioral economics, for increasing the effectiveness of financial incentives for weight loss. Copyright © 2013 Elsevier B.V. All rights reserved.

  15. Administrator Responses to Financial Incentives: Insights from a TIF Program

    Science.gov (United States)

    King Rice, Jennifer; Malen, Betty; Jackson, Cara; Hoyer, Kathleen Mulvaney

    2017-01-01

    This article provides evidence and generates insights about the power of financial rewards to motivate school administrators and the design features that influence their motivational potency. The multi-year mixed-methods study is grounded in expectancy and goal setting theories that suggest (a) awards must be salient and sizable enough to appeal…

  16. Effect of incentives on the financial attractiveness of solar industrial process heating in India★

    Directory of Open Access Journals (Sweden)

    Sharma Ashish K.

    2017-01-01

    Full Text Available India has a huge industrial demand for process heating at temperatures that can be provided with commercially available solar collectors. Government of India with support from multi-lateral agencies has initiated an ambitious programme for promoting large scale adoption of Solar Industrial Process Heating (SIPH in the industrial sector of the country. This paper presents the details of an attempt to study the effect of several existing and potential incentives on the financial attractiveness of SIPH systems in India. A case of solar process heating in dairy industry has been presented to demonstrate the relative efficacy of different incentives on the economics of SIPH systems in terms of their impact on levelized cost of useful thermal energy delivered. Finally, policy implications of the results obtained have been discussed.

  17. Should we pay the student? A randomised trial of financial incentives in medical education.

    Science.gov (United States)

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

    2013-09-01

    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.

  18. Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study.

    Science.gov (United States)

    O'Donnell, Amy; Haighton, Catherine; Chappel, David; Shevills, Colin; Kaner, Eileen

    2016-11-25

    Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact. A sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations. Screening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs' beliefs about patient-centred practice. Financial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol

  19. Financial incentives for return of service in underserved areas: a systematic review

    Directory of Open Access Journals (Sweden)

    Bärnighausen Till

    2009-05-01

    Full Text Available Abstract Background In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. Methods We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives. In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations. We reviewed program results (descriptions of recruitment, retention, and participant satisfaction, program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas, and program impacts (effectiveness in influencing health systems and health outcomes

  20. Financial incentives for return of service in underserved areas: a systematic review.

    Science.gov (United States)

    Bärnighausen, Till; Bloom, David E

    2009-05-29

    In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future) health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives). In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation) and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations). We reviewed program results (descriptions of recruitment, retention, and participant satisfaction), program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas), and program impacts (effectiveness in influencing health systems and health outcomes). Of the 43 reviewed studies 34

  1. Paying to Learn: The Effect of Financial Incentives on Elementary School Test Scores. NBER Working Paper No. 16333

    Science.gov (United States)

    Bettinger, Eric P.

    2010-01-01

    Policymakers and academics are increasingly interested in applying financial incentives to individuals in education. This paper presents evidence from a pay for performance program taking place in Coshocton, Ohio. Since 2004, Coshocton has provided cash payments to students in grades three through six for successful completion of their…

  2. Financial Incentives for Teen Parents to Stay in School. What Works Clearinghouse Intervention Report

    Science.gov (United States)

    What Works Clearinghouse, 2006

    2006-01-01

    Financial incentives for teen parents are components of state welfare programs intended to encourage enrollment, attendance, and completion of high school as a means of increasing employment and earnings and reducing welfare dependence. The incentives take the form of bonuses and sanctions to the welfare grant related to school enrollment,…

  3. Financial Incentives and Student Achievement: Evidence from Randomized Trials. NBER Working Paper No. 15898

    Science.gov (United States)

    Fryer, Roland G., Jr.

    2010-01-01

    This paper describes a series of school-based randomized trials in over 250 urban schools designed to test the impact of financial incentives on student achievement. In stark contrast to simple economic models, our results suggest that student incentives increase achievement when the rewards are given for inputs to the educational production…

  4. Federal Financial Incentives to Induce Early Experience Producing Unconventional Liquid Fuels

    National Research Council Canada - National Science Library

    Camm, Frank; Bartis, James T; Bushman, Charles J

    2008-01-01

    This technical report explains an analytic way to design and assess packages of financial incentives that the government can use to cost effectively promote early experience with coal-to-liquids (CTL...

  5. Improving the cost effectiveness of financial incentives in managing travel demand management (TDM) : [technical summary].

    Science.gov (United States)

    2013-10-01

    During the last two decades, financial incentives : have become common in efforts to reduce : demand on roadways by motivating commuters to : use alternative modes of transportation. Despite : common use, limited effort has been made to : understand ...

  6. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

    National Research Council Canada - National Science Library

    Bärnighausen, Till; Bloom, David E

    2009-01-01

    .... Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate...

  7. Internet access and investment incentives for broadband service providers

    OpenAIRE

    Baranes, Edmond; Poudou, Jean-Christophe

    2011-01-01

    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,...

  8. Financial incentive increases CPAP acceptance in patients from low socioeconomic background.

    Directory of Open Access Journals (Sweden)

    Ariel Tarasiuk

    Full Text Available OBJECTIVE: We explored whether financial incentives have a role in patients' decisions to accept (purchase a continuous positive airway pressure (CPAP device in a healthcare system that requires cost sharing. DESIGN: Longitudinal interventional study. PATIENTS: The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI 38.7±19.9 events/hr and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22 underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330-660; the financial incentive group paid a subsidized price of $55. RESULTS: CPAP acceptance was 43% greater (p = 0.02 in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113 (adjusting for age, gender, BMI, tobacco smoking was enhanced by financial incentive (OR, 95% CI (3.43, 1.09-10.85, age (1.1, 1.03-1.17, AHI (>30 vs. 30 vs. 30 vs. <30 (5.25, 1.34-18.5. CONCLUSIONS: Minimizing cost sharing reduces a barrier for CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients.

  9. Impact of financial incentives on behavior change program participation and risk reduction in worksite health promotion.

    Science.gov (United States)

    Gingerich, Stefan B; Anderson, David R; Koland, Heidi

    2012-01-01

    To examine the impact of financial incentives on behavior change program registration, completion, and risk improvement rates. Retrospective cohort study conducted to observe the relationship between financial incentives and behavior change program registration, completion, and risk improvement rates. Large public- or private-sector employers. Twenty-four organizations (n = 511,060 eligible employees) that offered comprehensive worksite health promotion (WHP) programs. Financial incentives offered for completion of a behavior change program as part of a WHP program. Behavior change program registration and completion data were obtained from standard reports. Company-level risk change was calculated from the average per-person number of risks on baseline and follow-up health risk assessments. Incentive design was determined from questionnaires completed by WHP program managers. Average registration rates, program completion rates, and risk improvement rates were compared using t-tests for companies that did versus did not offer incentives. Comparisons were also made between companies with incentives of less than $100 and those with incentives of $100 or more. Correlations between incentive value and outcome variables were assessed using Pearson correlations. Companies that offered incentives had significantly higher health coaching completion rates than companies not offering an incentive (82.9% vs. 76.4%, respectively, p = .017) but there was no significant association with registration (p = .384) or risk improvement rates (p = .242). Incentive values were not significantly associated with risk improvement rates (p = .240). Offering incentives for completing behavior change programs may increase completion rates, but increased health improvement does not necessarily follow.

  10. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

    Directory of Open Access Journals (Sweden)

    Bärnighausen Till

    2009-06-01

    Full Text Available Abstract In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments; promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers; selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals; placement (programmes should match participants to areas in order to maximize participant satisfaction and

  11. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

    Science.gov (United States)

    Bärnighausen, Till; Bloom, David E

    2009-06-26

    In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes

  12. Paying for the wrong kind of performance? Financial incentives and behaviour changes in National Health Service dentistry 1992-2009.

    Science.gov (United States)

    Tickle, Martin; McDonald, Ruth; Franklin, Jarrod; Aggarwal, Vishal R; Milsom, Keith; Reeves, David

    2011-10-01

    There is a tension between financial incentives and professional codes and norms, both of which are believed to influence the behaviour of health care professionals. This study examined the impact of changes to financial incentive structures on the behaviour of dentists working in the English National Health Service (NHS) as a result of a new national contract. Comparison of six reference treatments delivered by all NHS dentists in England for the period 1992-2009. Large and abrupt changes in the provision of the reference treatments coincided with the introduction of changes in the incentive structure in 2006. Treatments which can be provided in the least amount of time (and therefore costs to dentists) such as extractions increased and treatments which are time consuming or have significant additional materials costs such as bridgework, crowns, root fillings and radiographs reduced substantially. Changes to financial incentive structures can produce large and abrupt changes in professional behaviours. In the context of multiple and conflicting goals, greater thought needs to be given to policies to change incentive structures to mitigate their unintended consequences. © 2011 John Wiley & Sons A/S.

  13. Patient-centered financial incentives for health: Can employers get change for their dollars?

    Science.gov (United States)

    Kullgren, Jeffrey T; Williams, Geoffrey C; An, Lawrence C

    2013-12-01

    While employer-sponsored financial incentives for healthy behaviors have demonstrated the potential to promote short-term employee behavior change, the effectiveness of such incentives in promoting long-term health behavior change has often been disappointing. This paucity of sustained change could be explained by the many factors that shape employees' health behaviors, only some of which may be influenced by incentives. We discuss how employer-sponsored incentives for healthy behaviors could become more patient-centered, and thus perhaps more effective, by integrating insights from self-determination theory and health behavior theories, targeting employees' capacity for change, and using tailoring. Published by Elsevier Inc.

  14. Financial Analysis of Incentive Mechanisms to Promote Energy Efficiency: Case Study of a Prototypical Southwest Utility

    Energy Technology Data Exchange (ETDEWEB)

    Cappers, Peter; Goldman, Charles; Chait, Michele; Edgar, George; Schlegel, Jeff; Shirley, Wayne

    2009-03-04

    Many state regulatory commissions and policymakers want utilities to aggressively pursue energy efficiency as a strategy to mitigate demand and energy growth, diversify the resource mix, and provide an alternative to building new, costly generation. However, as the National Action Plan for Energy Efficiency (NAPEE 2007) points out, many utilities continue to shy away from aggressively expanding their energy efficiency efforts when their shareholder's fundamental financial interests are placed at risk by doing so. Thus, there is increased interest in developing effective ratemaking and policy approaches that address utility disincentives to pursue energy efficiency or lack of incentives for more aggressive energy efficiency efforts. New regulatory initiatives to promote increased utility energy efficiency efforts also affect the interests of consumers. Ratepayers and their advocates are concerned with issues of fairness, impacts on rates, and total consumer costs. From the perspective of energy efficiency advocates, the quid pro quo for utility shareholder incentives is the obligation to acquire all, or nearly all, achievable cost-effective energy efficiency. A key issue for state regulators and policymakers is how to maximize the cost-effective energy efficiency savings attained while achieving an equitable sharing of benefits, costs and risks among the various stakeholders. In this study, we modeled a prototypical vertically-integrated electric investor-owned utility in the southwestern US that is considering implementing several energy efficiency portfolios. We analyze the impact of these energy efficiency portfolios on utility shareholders and ratepayers as well as the incremental effect on each party when lost fixed cost recovery and/or utility shareholder incentive mechanisms are implemented. A primary goal of our quantitative modeling is to provide regulators and policymakers with an analytic framework and tools that assess the financial impacts of

  15. Financial incentives to promote health care quality: the hospital acquired conditions nonpayment policy.

    Science.gov (United States)

    Kavanagh, Kevin T

    2011-01-01

    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.

  16. Offering financial incentives to increase adherence to antipsychotic medication: the clinician experience.

    Science.gov (United States)

    Highton-Williamson, Elizabeth; Barnicot, Kirsten; Kareem, Tarrannum; Priebe, Stefan

    2015-04-01

    Financial incentives for medication adherence in patients with psychotic disorders are controversial. It is not yet known whether fears expressed by clinicians are borne out in reality. We aimed to explore community mental health clinicians' experiences of the consequences of giving patients with psychotic disorders a financial incentive to take their depot medication. We implemented descriptive and thematic analyses of semistructured interviews with the clinicians of patients assigned to receive incentives within a randomized controlled trial. Fifty-nine clinicians were interviewed with regard to the effect of the incentives on 73 of the 78 patients allocated to receive incentives in the trial. Most commonly, the clinicians reported benefits for clinical management including improved adherence, contact, patient monitoring, communication, and trust (n = 52). Positive effects on symptoms, insight, or social functioning were reported for some (n = 33). Less commonly, problems for patient management were reported (n = 19) such as monetarization of the therapeutic relationship or negative consequences for the patient (n = 15) such as increased drug and alcohol use. Where requests for increased money occurred, they were rapidly resolved. It seems that, in most cases, the clinicians found that using incentives led to benefits for patient management and for patient health. However, in 33% of cases, some adverse effects were reported. It remains unclear whether certain clinical characteristics are associated with increased risk for adverse effects of financial incentives. The likelihood of benefit versus the smaller risk for adverse effects should be weighed up when deciding whether to offer incentives to individual patients.

  17. Case Studies on the Effectiveness of State Financial Incentives for Renewable Energy

    Energy Technology Data Exchange (ETDEWEB)

    Gouchoe, S.; Everette, V.; Haynes, R.

    2002-09-01

    The North Carolina Solar Center at NC State University, in collaboration with the National Renewable Energy Laboratory, examined 10 state financial-incentive programs in six states using a case-study approach in order to clarify the key factors-both internal and external to the program-that influence their effectiveness at stimulating deployment of renewable energy technologies. While existing information resources such as the National Database of State Incentives for Renewable Energy (DSIRE, www.dsireusa.org) have documented what incentive programs are available, the effectiveness of such programs is not well understood. Understanding the impact of current financial incentives on the deployment of renewables and the factors that influence their effectiveness is critical to a variety of stakeholders, particularly in states considering new incentives or interested in improving or discarding existing ones.

  18. Financial Incentives: Only One Piece of the Workplace Wellness Puzzle; Comment on “Corporate Wellness Programs: Implementation Challenges in the Modern American Workplace”

    Directory of Open Access Journals (Sweden)

    Kristin Van Busum

    2013-11-01

    Full Text Available In this commentary, we argue that financial incentives are only one of many key components that employers should consider when designing and implementing a workplace wellness program. Strategies such as social encouragement and providing token rewards may also be effective in improving awareness and engagement. Should employers choose to utilize financial incentives, they should tailor them to the goals for the program as well as the targeted behaviors and health outcomes.

  19. Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study

    Directory of Open Access Journals (Sweden)

    Emma L. Giles

    2016-09-01

    Full Text Available Abstract Background Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI. Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. Methods We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Results Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential ‘gaming’, and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI – including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for ‘gaming the system’. Secondly, a tension between participants’ own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants’ personal distaste of HPFI; and their professional view that

  20. Financial incentives for healthy behavior: ethical safeguards for behavioral economics.

    Science.gov (United States)

    Lunze, Karsten; Paasche-Orlow, Michael K

    2013-06-01

    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.

  1. Financial incentive increases CPAP acceptance in patients from low socioeconomic background.

    Science.gov (United States)

    Tarasiuk, Ariel; Reznor, Gally; Greenberg-Dotan, Sari; Reuveni, Haim

    2012-01-01

    We explored whether financial incentives have a role in patients' decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing. Longitudinal interventional study. The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI) 38.7±19.9 events/hr) and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22) underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330-660; the financial incentive group paid a subsidized price of $55. CPAP acceptance was 43% greater (p = 0.02) in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113) (adjusting for age, gender, BMI, tobacco smoking) was enhanced by financial incentive (OR, 95% CI) (3.43, 1.09-10.85), age (1.1, 1.03-1.17), AHI (>30 vs. CPAP (4.29, 1.05-17.51). Among average/high-income patients (n = 145) CPAP acceptance was affected by AHI (>30 vs. CPAP adherence was similar in the financial incentive and control groups, 35% and 39%, respectively (p = 0.82). Adherence rate was sensitive to education (+yr) (1.28, 1.06-1.55) and AHI (>30 vs. CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients.

  2. Do financial incentives linked to ownership of specialty hospitals affect physicians' practice patterns?

    Science.gov (United States)

    Mitchell, Jean M

    2008-07-01

    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.

  3. "It Makes You Feel Like Someone Cares" acceptability of a financial incentive intervention for HIV viral suppression in the HPTN 065 (TLC-Plus) study.

    Science.gov (United States)

    Greene, Elizabeth; Pack, Allison; Stanton, Jill; Shelus, Victoria; Tolley, Elizabeth E; Taylor, Jamilah; El Sadr, Wafaa M; Branson, Bernard M; Leider, Jason; Rakhmanina, Natella; Gamble, Theresa

    2017-01-01

    HPTN 065 (TLC-Plus) evaluated the feasibility and effectiveness of providing quarterly $70 gift card financial incentives to HIV-infected patients on antiretroviral therapy (ART) to encourage ART adherence and viral suppression, and represents the largest study to-date of a financial incentive intervention for HIV viral suppression. A post-trial qualitative substudy was undertaken to examine acceptability of the financial incentives among those receiving and implementing the intervention. Between July and October 2013, semi-structured interviews were conducted with 72 patients and 12 investigators from 14 sites; three focus groups were conducted with 12 staff from 10 sites. Qualitative data collection elicited experiences with and attitudes about the intervention, including philosophical viewpoints and implementation experiences. Transcripts were analyzed in NVivo 10. Memos and matrices were developed to explore themes from different participant group perspectives. Patients, investigators, and staff found the intervention highly acceptable, primarily due to the emotional benefits gained through giving or receiving the incentive. Feeling rewarded or cared for was a main value perceived by patients; this was closely tied to the financial benefit for some. Other factors influencing acceptability for all included perceived effectiveness and health-related benefits, philosophical concerns about the use of incentives for health behavior change, and implementation issues. The termination of the incentive at the end of the study was disappointing to participants and unexpected by some, but generally accepted. Positive experiences with the financial incentive intervention and strategies used to facilitate implementation led to high acceptability of the intervention, despite some reluctance in principle to the use of incentives. The findings of this analysis provide encouraging evidence in support of the acceptability of a large-scale financial incentive intervention for HIV

  4. Effects of a financial incentive on health researchers' response to an online survey: a randomized controlled trial.

    Science.gov (United States)

    Wilson, Paul M; Petticrew, Mark; Calnan, Mike; Nazareth, Irwin

    2010-05-10

    Nonresponse to questionnaires can affect the validity of surveys and introduce bias. Offering financial incentives can increase response rates to postal questionnaires, but the effect of financial incentives on response rates to online surveys is less clear. As part of a survey, we aimed to test whether knowledge of a financial incentive would increase the response rate to an online questionnaire. A randomized controlled trial of 485 UK-based principal investigators of publicly funded health services and population health research. Participants were contacted by email and invited to complete an online questionnaire via an embedded URL. Participants were randomly allocated to groups with either "knowledge of" or "no knowledge of" a financial incentive ( pound10 Amazon gift voucher) to be provided on completion of the survey. At the end of the study, gift vouchers were given to all participants who completed the questionnaire regardless of initial randomization status. Four reminder emails (sent from the same email address as the initial invitation) were sent out to nonrespondents at one, two, three, and four weeks; a fifth postal reminder was also undertaken. The primary outcome measure for the trial was the response rate one week after the second reminder. Response rate was also measured at the end of weeks one, two, three, four, and five, and after a postal reminder was sent. In total, 243 (50%) questionnaires were returned (232 completed, 11 in which participation was declined). One week after the second reminder, the response rate in the "knowledge" group was 27% (66/244) versus 20% (49/241) in the "no knowledge" group (chi(2) (1) = 3.0, P = .08). The odds ratio for responding among those with knowledge of an incentive was 1.45 (95% confidence interval [CI] 0.95 - 2.21). At the third reminder, participants in the "no knowledge" group were informed about the incentive, ending the randomized element of the study. However we continued to follow up all participants

  5. Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods.

    Science.gov (United States)

    Giles, Emma L; Robalino, Shannon; Sniehotta, Falko F; Adams, Jean; McColl, Elaine

    2015-04-01

    Financial incentives are effective in encouraging healthy behaviours, yet concerns about acceptability remain. We conducted a systematic review exploring acceptability of financial incentives for encouraging healthy behaviours. Database, reference, and citation searches were conducted from the earliest available date to October 2014, to identify empirical studies and scholarly writing that: had an English language title, were published in a peer-reviewed journal, and explored acceptability of financial incentives for healthy behaviours in members of the public, potential recipients, potential practitioners or policy makers. Data was analysed using thematic analysis. Eighty one papers were included: 59 pieces of scholarly writing and 22 empirical studies, primarily exploring acceptability to the public. Five themes were identified: fair exchange, design and delivery, effectiveness and cost-effectiveness, recipients, and impact on individuals and wider society. Although there was consensus that if financial incentives are effective and cost effective they are likely to be considered acceptable, a number of other factors also influenced acceptability. Financial incentives tend to be acceptable to the public when they are effective and cost-effective. Programmes that benefit recipients and wider society; are considered fair; and are delivered to individuals deemed appropriate are likely to be considered more acceptable. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy-A Randomized Controlled Trial.

    Science.gov (United States)

    Mehta, Shivan J; Feingold, Jordyn; Vandertuyn, Matthew; Niewood, Tess; Cox, Catherine; Doubeni, Chyke A; Volpp, Kevin G; Asch, David A

    2017-11-01

    Behavioral economic approaches could increase uptake for colorectal cancer screening. We performed a randomized controlled trial of 2245 employees to determine whether an email containing a phone number for scheduling (control), an email with the active choice to opt in or opt out (active choice), or the active choice email plus a $100 incentive (financial incentive) increased colonoscopy completion within 3 months. Higher proportions of participants in the financial incentive group underwent screening (3.7%) than in the control (1.6%) or active choice groups (1.5%) (P = .01 and P < .01). We found no difference in uptake of screening between the active choice and control groups (P = .88). The $100 conditional incentive modestly but significantly increased colonoscopy use. ClinicalTrials.gov no: NCT02660671. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  7. Do incentives matter? Providing benefits to families of organ donors.

    Science.gov (United States)

    Bryce, C L; Siminoff, L A; Ubel, P A; Nathan, H; Caplan, A; Arnold, R M

    2005-12-01

    Whether the number of organs available for transplant would be positively or negatively affected by providing benefits to families of organ donors has been debated by policymakers, ethicists and the transplant community at large. We designed a telephone survey to measure public opinion regarding the use of benefits in general and of five types in particular: funeral benefits, charitable contributions, travel/lodging expenses, direct payments and medical expenses. Of the 971 adults who completed the survey (response rate = 69%), all were from Pennsylvania households, 45.6% were registered organ donors, and 51.7% were nonwhite. Although 59% of respondents favored the general idea of incentives, support for specific incentives ranged from 53% (direct payment) to 84% (medical expenses). Among those registered as donors, more nonwhites than whites supported funeral benefits (88% vs. 81%; p = 0.038), direct payment (63% vs. 41%; p donation but would influence the behavior of others. While benefits appear to be favored, their true impact can only be assessed through pilot programs.

  8. Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels

    Science.gov (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.

    2017-01-01

    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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    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....

  10. "Not Just for the Money?" How Financial Incentives Affect the Number of Publications at Danish Research Institutions

    DEFF Research Database (Denmark)

    Andersen, Lotte Bøgh; Pallesen, Thomas

    2008-01-01

    Do public employees work "for the money?" Do financial incentives determine their work effort? The literature gives conflicting answers, but Frey (1997) offers a possible explanation: If financial incentives are perceived as supportive, they can "crowd in" intrinsic motivation and increase the work...... effort. But if financial incentives are perceived as controlling, the intrinsic motivation is "crowded out," and the work effort decreases with increasing financial incentives to work. However, the empirical evidence concerning Frey's proposition is limited, and our article aims to fill part of this gap....... We investigate how the introduction of financial incentives to publish affects the number of publications at 162 Danish research institutions (17 government research institutions and subunits of 10 universities) when the perception of the incentives is taken into account. The results show...

  11. A systematic review of the use of financial incentives and penalties to encourage uptake of healthy behaviors: protocol.

    Science.gov (United States)

    Adams, Jean; Giles, Emma L; Robalino, Shannon; McColl, Elaine; Sniehotta, Falko F

    2012-10-31

    The use of financial incentives and penalties to encourage uptake of healthy behaviors is increasingly seen as a viable intervention in developed countries. Previous reviews of the effectiveness of financial incentives and penalties for encouraging the uptake of healthy behaviors have focused on individual behaviors making it difficult to draw overall conclusions about the effectiveness of such interventions. This systematic review will explore the effectiveness of financial incentives and penalties for encouraging a wide range of behaviors, including: smoking cessation, increased physical activity, healthier dietary intake, sensible patterns of alcohol consumption, safe sun, safe sex, and primary preventive clinical behaviors. Systematic methods will be used to search existing literature and screen studies for inclusion. All studies that meet the following inclusion criteria will be included in the review: participants were 18 years old or older and living in high-income countries; interventions included cash or cash-like incentives to promote the uptake of healthy behaviors, or cash or cash-like penalties to discourage unhealthy behaviors; the comparator was usual care or no intervention; study design was randomized controlled trial, cluster randomized controlled trial, controlled before and after study, or interrupted time series analysis. Two reviewers will independently screen the publications to ensure they meet the inclusion criteria. Quality will be assessed by two researchers, working independently, using the Cochrane risk of bias tool. Meta-analysis will be conducted, if appropriate. Any studies identified as at 'high risk of bias' will be excluded from meta-analysis. This systematic review will provide policy-relevant recommendations for the use of financial incentives and penalties as a method of encouraging uptake of healthy behaviors.

  12. The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review.

    Science.gov (United States)

    Jackson, Tracy; Shields, Michael D; Heaney, Liam G; Kendall, Marilyn; Pearce, Christina J; Hui, Chi Yan; Pinnock, Hilary

    2017-01-01

    Financial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets. To systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management. We followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017) including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies. We identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7), UK (n = 4) and Canada (n = 1). Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10), written action plans for asthma (n = 1) and hospital/emergency department visits (n = 1). Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving 'perfect care' (including providing a written action plan) increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one. Results for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health outcomes in asthma. Further research is needed to confirm

  13. Financial Incentive Increases CPAP Acceptance in Patients from Low Socioeconomic Background

    OpenAIRE

    Tarasiuk, Ariel; Reznor, Gally; Greenberg-Dotan, Sari; Reuveni, Haim

    2012-01-01

    OBJECTIVE: We explored whether financial incentives have a role in patients' decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing. DESIGN: Longitudinal interventional study. PATIENTS: The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI) 38.7±19.9 events/hr) and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22) underwent attendant titration and a two-week adaptation ...

  14. 42 CFR 495.310 - Medicaid provider incentive payments.

    Science.gov (United States)

    2010-10-01

    ... 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...

  15. Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction.

    Science.gov (United States)

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

    1999-04-01

    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

  16. Evaluating Patient Preferences for Different Incentive Programs to Optimize Pharmacist-Provided Patient Care Program Enrollment.

    Science.gov (United States)

    Tomaszewski, Daniel; Cernohous, Tim; Vaidyanathan, Rajiv

    2017-11-01

    Employers have increased efforts to engage employees in health and wellness programs. Providing employees with incentives to participate in these programs has been shown to improve overall enrollment and engagement. One program that has had challenges with enrollment and engagement is medication therapy management (MTM). To (a) determine how individuals evaluate different financial incentives to improve participation in an MTM program and (b) measure the effect of participant characteristics on incentive preference. This study was composed of a paper-based survey administered to participants after focus group sessions. Participants included MTM-eligible beneficiaries from 2 employer groups and included MTM-naive and MTM-experienced participants. Incentive preference was measured based on 3 bipolar scales that compared 3 incentives: $100 gift certificates, $8 copay reduction for 6 months, and $100 added to paycheck. A total of 72 participants completed the survey: 34 participants were MTM experienced, and 38 were MTM naive. Overall participant preference reporting resulted in inconsistencies. Copay reduction was preferred to a gift certificate (55.6% vs. 37.5%); money in paycheck was preferred over copay reduction (48.6% vs. 40.3%); and gift certificates were preferred over money in paycheck (56.9% vs. 22.2%). However, subgroup analysis resulted in a more consistent preference reporting, with MTM-experienced participants consistently preferring copay reduction over gift certificates (67.6% vs. 23.5%) and money in paycheck (55.9% vs. 29.4%). MTM-naive participants preferred a gift certificate over copay reduction (51.4% vs. 44.7%) and cash in paycheck (68.4% vs. 23.7%). The results of this study suggest that gift certificates were preferred by MTM-naive participants, which supports the use of gift certificates as an incentive for MTM-naive patients to enroll in an MTM program. Conversely, the use of a copay reduction program was preferred by MTM

  17. Financial Protection of Patients through Compensation of Providers: The Impact of Health Equity Funds in Cambodia

    NARCIS (Netherlands)

    G. Flores (Gabriela); I. Por; C.R. Men; O.A. O'Donnell (Owen); E.K.A. van Doorslaer (Eddy)

    2011-01-01

    textabstractPublic providers have no financial incentive to respect their legal obligation to exempt the poor from user fees. Health Equity Funds (HEFs) aim to make exemptions effective by giving NGOs responsibility for assessing eligibility and compensating providers for lost revenue. We use the

  18. A systematic review of financial incentives for physical activity: The effects on physical activity and related outcomes

    NARCIS (Netherlands)

    Barte, J.C.M.; Wendel-Vos, G.C.W.

    2017-01-01

    The aim of this review is to give an overview of the available evidence on the effects of financial incentives to stimulate physical activity. Therefore, a systematic literature search was performed for randomized trials that investigate the effects of physical-activity-related financial incentives

  19. The Feasibility of Financial Incentives to Increase Exercise Among Canadian Cardiac Rehabilitation Patients.

    Science.gov (United States)

    Mitchell, Marc S; Goodman, Jack M; Alter, David A; Oh, Paul I; Leahey, Tricia M; Faulkner, Guy E J

    2016-01-01

    To examine the feasibility of conducting a randomized controlled trial investigating the effectiveness of financial incentives for exercise self-monitoring in cardiac rehabilitation (CR). A 12-week, 2 parallel-arm, single-blind feasibility study design was employed. A volunteer sample of CR program graduates was randomly assigned to an exercise self-monitoring intervention only (control; n = 14; mean age ± SD, 62.7 ± 14.6 years), or an exercise self-monitoring plus incentives approach (incentive; n = 13; mean age ± SD, 63.6 ± 11.8 years). Control group participants received a "home-based" exercise self-monitoring program following CR program completion (exercise diaries could be submitted online or by mail). Incentive group participants received the "home-based" program, plus voucher-based incentives for exercise diary submissions ($2 per day). A range of feasibility outcomes is presented, including recruitment and retention rates, and intervention acceptability. Data for the proposed primary outcome of a definitive trial, aerobic fitness, are also reported. Seventy-four CR graduates were potentially eligible to participate, 27 were enrolled (36.5% recruitment rate; twice the expected rate), and 5 were lost to followup (80% retention). Intervention acceptability was high with three-quarters of participants indicating that they would likely sign up for an incentive program at baseline. While group differences in exercise self-monitoring (the incentive "target") were not observed, modest but nonsignificant changes in aerobic fitness were noted with fitness increasing by 0.23 mL·kg-·min- among incentive participants and decreasing by 0.68 mL·kg-·min- among controls. This preliminary study demonstrates the feasibility of studying incentives in a CR context, and the potential for incentives to be readily accepted in the broader context of the Canadian health care system.

  20. The effectiveness of financial incentives for health behaviour change: systematic review and meta-analysis.

    Science.gov (United States)

    Giles, Emma L; Robalino, Shannon; McColl, Elaine; Sniehotta, Falko F; Adams, Jean

    2014-01-01

    Financial incentive interventions have been suggested as one method of promoting healthy behaviour change. To conduct a systematic review of the effectiveness of financial incentive interventions for encouraging healthy behaviour change; to explore whether effects vary according to the type of behaviour incentivised, post-intervention follow-up time, or incentive value. Searches were of relevant electronic databases, research registers, www.google.com, and the reference lists of previous reviews; and requests for information sent to relevant mailing lists. Controlled evaluations of the effectiveness of financial incentive interventions, compared to no intervention or usual care, to encourage healthy behaviour change, in non-clinical adult populations, living in high-income countries, were included. The Cochrane Risk of Bias tool was used to assess all included studies. Meta-analysis was used to explore the effect of financial incentive interventions within groups of similar behaviours and overall. Meta-regression was used to determine if effect varied according to post-intervention follow up time, or incentive value. Seventeen papers reporting on 16 studies on smoking cessation (n = 10), attendance for vaccination or screening (n = 5), and physical activity (n = 1) were included. In meta-analyses, the average effect of incentive interventions was greater than control for short-term (≤ six months) smoking cessation (relative risk (95% confidence intervals): 2.48 (1.77 to 3.46); long-term (>six months) smoking cessation (1.50 (1.05 to 2.14)); attendance for vaccination or screening (1.92 (1.46 to 2.53)); and for all behaviours combined (1.62 (1.38 to 1.91)). There was not convincing evidence that effects were different between different groups of behaviours. Meta-regression found some, limited, evidence that effect sizes decreased as post-intervention follow-up period and incentive value increased. However, the latter effect may be confounded by the former. The

  1. Can preventive care activities in general practice be sustained when financial incentives and external audit plus feedback are removed? ACCEPt-able: a cluster randomised controlled trial protocol.

    Science.gov (United States)

    Hocking, Jane S; Temple-Smith, Meredith; van Driel, Mieke; Law, Matthew; Guy, Rebecca; Bulfone, Liliana; Wood, Anna; Low, Nicola; Donovan, Basil; Fairley, Christopher K; Kaldor, John; Gunn, Jane

    2016-09-13

    Financial incentives and audit plus feedback on performance are two strategies commonly used by governments to motivate general practitioners (GP) to undertake specific healthcare activities. However, in recent years, governments have reduced or removed incentive payments without evidence of the potential impact on GP behaviour and patient outcomes. This trial (known as ACCEPt-able) aims to determine whether preventive care activities in general practice are sustained when financial incentives and/or external audit plus feedback on preventive care activities are removed. The activity investigated is annual chlamydia testing for 16- to 29-year-old adults, a key preventive health strategy within this age group. ACCEPt-able builds on a large cluster randomised controlled trial (RCT) that evaluated a 3-year chlamydia testing intervention in general practice. GPs were provided with a support package to facilitate annual chlamydia testing of all sexually active 16- to 29-year-old patients. This package included financial incentive payments to the GP for each chlamydia test conducted and external audit plus feedback on each GP's chlamydia testing rates. ACCEPt-able is a factorial cluster RCT in which general practices are randomised to one of four groups: (i) removal of audit plus feedback-continue to receive financial incentive payments for each chlamydia test; (ii) removal of financial incentive payments-continue to receive audit plus feedback; (iii) removal of financial incentive payments and audit plus feedback; and (iv) continue financial incentive payments and audit plus feedback. The primary outcome is chlamydia testing rate measured as the proportion of sexually active 16- to 29-year-olds who have a GP consultation within a 12-month period and at least one chlamydia test. This will be the first RCT to examine the impact of removal of financial incentive payments and audit plus feedback on the chlamydia testing behaviour of GPs. This trial is particularly timely

  2. Personal financial incentives in health promotion: where do they fit in an ethic of autonomy?

    Science.gov (United States)

    Ashcroft, Richard E

    2011-06-01

    This paper reviews the ethical controversy concerning the use of monetary incentives in health promotion, focussing specifically on the arguments relating to the impact on personal autonomy of such incentives. Offering people small amounts of money in the context of health promotion and medical care has been attempted in a number of settings in recent years. This use of personal financial incentives has attracted a degree of ethical controversy. One form of criticism is that such schemes interfere with the autonomy of the patient or citizen in an illegitimate way. This paper presents a thematic analysis of the main arguments concerning personal autonomy and the use of monetary incentives in behaviour change. The main moral objections to the uses of incentives are that they may be in general or in specific instances paternalistic, coercive, involve bribery, or undermine the agency of the person. While incentive schemes may engage these problems on occasion, there is no good reason to think that they do so inherently and of necessity. We need better behavioural science evidence to understand how incentives work, in order to evaluate their moral effects in practice. © 2011 Blackwell Publishing Ltd.

  3. The effect of performance-based financial incentives on improving patient care experiences: a statewide evaluation.

    Science.gov (United States)

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

    2009-12-01

    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.

  4. Effect of Financial Incentive on Productivity in a Postgraduate General Dentistry Program.

    Science.gov (United States)

    Jensen, Oivind E.; And Others

    1990-01-01

    The advanced education in general dentistry program at the Eastman Dental Center (Rochester, NY) operates an after-hours clinic simulating private practice. With an optional financial incentive program for students in lieu of a fixed stipend, the clinic's fee income has increased substantially. Advantages and potential abuses are discussed. (MSE)

  5. Influence and effectiveness of financial incentive programs in promoting sustainable forestry in the south

    Science.gov (United States)

    Michael G. Jacobson; John L. Greene; Thomas J. Straka; Steven E. Daniels; Michael A. Kilgore

    2009-01-01

    State forestry officials responsible for forestry incentive programs in each of the 13 southern states were surveyed concerning their opinions on financial incentiveprograms available to nonindustrial private forest owners. The forestry officials were asked to name and describe the public and...

  6. Financial incentives to promote active travel: an evidence review and economic framework.

    Science.gov (United States)

    Martin, Adam; Suhrcke, Marc; Ogilvie, David

    2012-12-01

    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. 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. 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. 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. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Effectiveness of financial incentive programs in promoting sustainable forestry in the west

    Science.gov (United States)

    John L. Greene; Steven E. Daniels; Michael A. Kilgore; Thomas J. Straka; Michael G. Jacobson

    2011-01-01

    Selected forestry officials in each of the 13 western states were surveyed in 2005 concerning their opinions on the public and private financial incentive programs available to nonindustrial private forest owners in their state. The officials were asked to name and describe the programs and to assess forest owners’ awareness of each one, its appeal among owners aware...

  8. Financial incentive programs' influence in promoting sustainable forestry in the northern region

    Science.gov (United States)

    Michael G. Jacobson; Thomas J. Straka; John L. Greene; Michael A. Kilgore; Steven E. Daniels

    2009-01-01

    Selected forestry officials in each of the 20 northern states were surveyed concerning their opinions on the public and private financial incentive programs available to nonindustrial private forest owners in their state. The officials were asked to name and describe the programs and to assess forest owners' awareness of each one, its appeal among the owners aware...

  9. Influence and effectiveness of financial incentive programs in programs in promoting sustainable forestry in the South

    Science.gov (United States)

    John L. Greene; Thomas J. Straka; Steven E. Daniels; Michael G. Jacobson; Michael A. Kilgore

    2009-01-01

    Selected state agency foresters in each of the 13 southern states were surveyed about the financial incentive programs available to nonindustrial private forest owners. The foresters were asked to name and describe the public and private programs available in their state, to assess forest owners’ awareness of each program, its appeal among the owners aware of it, its...

  10. Perceptions and experiences of financial incentives: a qualitative study of dialysis care in England

    NARCIS (Netherlands)

    Abma, I.L.; Jayanti, A.; Bayer, S.; Mitra, S.; Barlow, J.

    2014-01-01

    OBJECTIVE: The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices. DESIGN: The study followed a qualitative design. Data collection involved 32 in-depth

  11. Assessment of non-financial incentives for volunteer community health workers - the case of Wukro district, Tigray, Ethiopia.

    Science.gov (United States)

    Haile, Fisaha; Yemane, Dejen; Gebreslassie, Azeb

    2014-09-22

    Volunteer community health workers (VCHW) are health care providers who are trained but do not have any professional certification. They are intended to fill the gap for unmet curative, preventative, and health promotion health needs of communities. This study aims to investigate the non-financial incentives for VCHWs and factors affecting their motivation. A cross-sectional quantitative study was performed from February to March 2013. A total of 400 randomly selected female VCHWs were included using the district health office registers. Finally, multivariate logistic regression was used to determine the independent predictors of VCHW motivation. Significant numbers (48%) of study participants have mentioned future training as a major non-financial incentive. Age between 20 and 36 years old (adjusted odds ratio (AOR) = 1.45, 95% CI = 1.18, 2.13), married VCHWs (AOR = 3.84, 95% CI = 1.73, 5.02), presence of children under five years old (AOR = 0.2, 95% CI = 0.09, 0.71), allowing volunteer withdrawal (AOR = 1.35, 95% CI = 1.06, 2.47), and establishment of a local endowment fund for community health workers after they left volunteerism (AOR = 1.11, 95% CI = 1.05, 1.91) are all factors associated with VCHW motivation. Future training was mentioned as the prime non-financial incentive. Age, marital status, presence of children under five, allowing volunteer withdrawal, and establishment of a local endowment fund were identified as the independent predictors of motivation. Therefore, considering a non-financial incentive package, including further training and allowing volunteer withdrawal, would be helpful to sustain volunteerism.

  12. Acceptability of financial incentives for breastfeeding: thematic analysis of readers' comments to UK online news reports.

    Science.gov (United States)

    Giles, Emma L; Holmes, Matthew; McColl, Elaine; Sniehotta, Falko F; Adams, Jean M

    2015-05-16

    Whilst it is recommended that babies are breastfed exclusively for the first six months, many mothers do not maintain breastfeeding for this length of time. Previous research confirms that women and midwives value financial incentives for breastfeeding, but limited research has explored the wider acceptability of these interventions to the general public. This paper examines opinion towards financial incentives for breastfeeding using reader responses to UK on-line media coverage of a study undertaken in this area. This study used netnography to undertake a thematic analysis of 3,373 reader comments posted in response to thirteen articles, published in November 2013, which reported findings from a feasibility study of financial incentives for breastfeeding. All articles were published on one of six UK news websites that achieved a monthly audience of at least five million viewers across laptop and desktop computers and mobile devices during April-May 2013. Nine analytical themes were identified, with a majority view that financial incentives for breastfeeding are unacceptable. These themes cover a range of opinions: from negligent parents unable to take responsibility for their own actions; through to psychologically vulnerable members of society who should be protected from coercion and manipulation; to capable and responsible women who can, and should be allowed to, make their own decisions. Many views focused on the immediate costs of the intervention, concluding that this was something that was currently unaffordable to fund (e.g. by the NHS). Others contrasted the value of the incentive against other 'costs' of breastfeeding. There was some consideration of the issue of cost-effectiveness and cost-saving, where the potential future benefit from initial investment was identified. Many commenters identified that financial incentives do not address the many structural and cultural barriers to breastfeeding. Overall, those commenting on the on-line UK news

  13. Perceived ethical acceptability of financial incentives to improve diabetic eye screening attendance.

    Science.gov (United States)

    Wadge, Hester; Bicknell, Colin; Vlaev, Ivo

    2015-01-01

    To test the ethical acceptability of using financial incentives to increase diabetic retinopathy screening attendance. Financial incentives could be an effective way to increase attendance at screening for diabetic retinopathy, although there can be ethical concerns about this approach. Survey of people with diabetes in North West London. Those who were due to attend a screening appointment were invited to complete a questionnaire. Key demographic variables included age, gender, and deprivation. A questionnaire was issued to those invited to attend screening in North West London and those who run the screening service. The questionnaire captured views on aspects of the ethical problem and different incentive types. It captured views on the different dimensions of the ethical problem and different types of incentive. In order to understand how views might vary within a population, demographic variables were used to analyze the results. Vouchers were found to be the most acceptable form of incentive, significantly more so than cash payments. Most rejected the notion of targeting those who need incentivizing, preferring equality. Age was an important factor, with those aged between 40 and 64 the most optimistic about the potential benefits. Higher levels of deprivation were linked to increased acceptability scores. While some ethical concerns are strongly held among certain groups, there is also much support for the principle of incentivizing positive behaviors. This paves the way for future research into the effectiveness of incentivizing diabetic retinopathy screening attendance.

  14. Quality-based financial incentives in health care: can we improve quality by paying for it?

    Science.gov (United States)

    Conrad, Douglas A; Perry, Lisa

    2009-01-01

    This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.

  15. Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis.

    Science.gov (United States)

    Mantzari, Eleni; Vogt, Florian; Shemilt, Ian; Wei, Yinghui; Higgins, Julian P T; Marteau, Theresa M

    2015-06-01

    Uncertainty remains about whether personal financial incentives could achieve sustained changes in health-related behaviors that would reduce the fast-growing global non-communicable disease burden. This review aims to estimate whether: i. financial incentives achieve sustained changes in smoking, eating, alcohol consumption and physical activity; ii. effectiveness is modified by (a) the target behavior, (b) incentive value and attainment certainty, (c) recipients' deprivation level. Multiple sources were searched for trials offering adults financial incentives and assessing outcomes relating to pre-specified behaviors at a minimum of six months from baseline. Analyses included random-effects meta-analyses and meta-regressions grouped by timed endpoints. Of 24,265 unique identified articles, 34 were included in the analysis. Financial incentives increased behavior-change, with effects sustained until 18months from baseline (OR: 1.53, 95% CI 1.05-2.23) and three months post-incentive removal (OR: 2.11, 95% CI 1.21-3.67). High deprivation increased incentive effects (OR: 2.17; 95% CI 1.22-3.85), but only at >6-12months from baseline. Other assessed variables did not independently modify effects at any time-point. Personal financial incentives can change habitual health-related behaviors and help reduce health inequalities. However, their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal. Copyright © 2015. Published by Elsevier Inc.

  16. Carrots, sticks and health behaviours: a framework for documenting the complexity of financial incentive interventions to change health behaviours.

    Science.gov (United States)

    Adams, Jean; Giles, Emma L; McColl, Elaine; Sniehotta, Falko F

    2014-01-01

    Financial incentive interventions are increasingly used as a method of encouraging healthy behaviours, from attending for vaccinations to taking part in regular physical activity. There is a growing body of research on the effectiveness of financial incentive interventions for health behaviours. Wide variations in the nature of these interventions make it difficult to draw firm conclusions about what makes an effective incentive, for whom and under what circumstances. Whilst there has been some recognition of the theoretical complexity of financial incentive interventions for health behaviours, there is no framework that categorises these interventions. This limits the research community's ability to clearly establish which components of financial incentives interventions are more and less effective, and how these components might interact to enable behavioural change. We propose a framework for describing health-promoting financial incentive interventions. Drawing on our experience of a recently completed systematic review, we identify nine domains that are required to describe any financial incentive intervention designed to help individuals change their health behaviours. These are: direction, form, magnitude, certainty, target, frequency, immediacy, schedule and recipient. Our framework should help researchers and policy-makers identify the most effective incentive configurations for helping individuals adopt healthy behaviours.

  17. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

    Science.gov (United States)

    Flodgren, Gerd; Eccles, Martin P; Shepperd, Sasha; Scott, Anthony; Parmelli, Elena; Beyer, Fiona R

    2014-01-01

    review according to the AMSTAR criteria. We included systematic reviews of studies evaluating the effectiveness of any type of financial incentive. We grouped financial incentives into five groups: payment for working for a specified time period; payment for each service, episode or visit; payment for providing care for a patient or specific population; payment for providing a pre-specified level or providing a change in activity or quality of care; and mixed or other systems. We summarised data using vote counting. Main results We identified four reviews reporting on 32 studies. Two reviews scored 7 on the AMSTAR criteria (moderate, score 5 to 7, quality) and two scored 9 (high, score 8 to 11, quality). The reported quality of the included studies was, by a variety of methods, low to moderate. Payment for working for a specified time period was generally ineffective, improving 3/11 outcomes from one study reported in one review. Payment for each service, episode or visit was generally effective, improving 7/10 outcomes from five studies reported in three reviews; payment for providing care for a patient or specific population was generally effective, improving 48/69 outcomes from 13 studies reported in two reviews; payment for providing a pre-specified level or providing a change in activity or quality of care was generally effective, improving 17/20 reported outcomes from 10 studies reported in two reviews; and mixed and other systems were of mixed effectiveness, improving 20/31 reported outcomes from seven studies reported in three reviews. When looking at the effect of financial incentives overall across categories of outcomes, they were of mixed effectiveness on consultation or visit rates (improving 10/17 outcomes from three studies in two reviews); generally effective in improving processes of care (improving 41/57 outcomes from 19 studies in three reviews); generally effective in improving referrals and admissions (improving 11/16 outcomes from 11 studies in four

  18. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes.

    Science.gov (United States)

    Flodgren, Gerd; Eccles, Martin P; Shepperd, Sasha; Scott, Anthony; Parmelli, Elena; Beyer, Fiona R

    2011-07-06

    criteria. We included systematic reviews of studies evaluating the effectiveness of any type of financial incentive. We grouped financial incentives into five groups: payment for working for a specified time period; payment for each service, episode or visit; payment for providing care for a patient or specific population; payment for providing a pre-specified level or providing a change in activity or quality of care; and mixed or other systems. We summarised data using vote counting. We identified four reviews reporting on 32 studies. Two reviews scored 7 on the AMSTAR criteria (moderate, score 5 to 7, quality) and two scored 9 (high, score 8 to 11, quality). The reported quality of the included studies was, by a variety of methods, low to moderate. Payment for working for a specified time period was generally ineffective, improving 3/11 outcomes from one study reported in one review. Payment for each service, episode or visit was generally effective, improving 7/10 outcomes from five studies reported in three reviews; payment for providing care for a patient or specific population was generally effective, improving 48/69 outcomes from 13 studies reported in two reviews; payment for providing a pre-specified level or providing a change in activity or quality of care was generally effective, improving 17/20 reported outcomes from 10 studies reported in two reviews; and mixed and other systems were of mixed effectiveness, improving 20/31 reported outcomes from seven studies reported in three reviews. When looking at the effect of financial incentives overall across categories of outcomes, they were of mixed effectiveness on consultation or visit rates (improving 10/17 outcomes from three studies in two reviews); generally effective in improving processes of care (improving 41/57 outcomes from 19 studies in three reviews); generally effective in improving referrals and admissions (improving 11/16 outcomes from 11 studies in four reviews); generally ineffective in improving

  19. Financial Statements in Providing Financial Security of Agricultural Enterprises

    OpenAIRE

    Olha Vdovenko

    2014-01-01

    In conditions of severe market competition and economic turmoil financial security of agricultural businesses largely depends on the effectiveness of management decisions, reporting being the information support to ensure such decision making. Thus, the practice of preparing accounting figures and their adjustment has a direct effect on agricultural businesses financial security. Having been generalized at the industry level, statistical and financial statements are used for the development o...

  20. Financial Incentives for Linkage to Care and Viral Suppression Among HIV-Positive Patients: A Randomized Clinical Trial (HPTN 065).

    Science.gov (United States)

    El-Sadr, Wafaa M; Donnell, Deborah; Beauchamp, Geetha; Hall, H Irene; Torian, Lucia V; Zingman, Barry; Lum, Garret; Kharfen, Michael; Elion, Richard; Leider, Jason; Gordin, Fred M; Elharrar, Vanessa; Burns, David; Zerbe, Allison; Gamble, Theresa; Branson, Bernard

    2017-08-01

    Achieving linkage to care and viral suppression in human immunodeficiency virus (HIV)-positive patients improves their well-being and prevents new infections. Current gaps in the HIV care continuum substantially limit such benefits. To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients. A large community-based clinical trial that randomized 37 HIV test and 39 HIV care sites in the Bronx, New York, and Washington, DC, to financial incentives or standard of care. Participants at financial incentive test sites who had positive test results for HIV received coupons redeemable for $125 cash-equivalent gift cards upon linkage to care. HIV-positive patients receiving antiretroviral therapy at financial incentive care sites received $70 gift cards quarterly, if virally suppressed. Linkage to care: proportion of HIV-positive persons at the test site who linked to care within 3 months, as indicated by CD4+ and/or viral load test results done at a care site. Viral suppression: proportion of established patients at HIV care sites with suppressed viral load (incentive test sites and 39 359 gift cards were dispensed to 9641 HIV-positive patients eligible for gift cards at 17 financial incentive care sites. Financial incentives did not increase linkage to care (adjusted odds ratio, 1.10; 95% CI, 0.73-1.67; P = .65). However, financial incentives significantly increased viral suppression. The overall proportion of patients with viral suppression was 3.8% higher (95% CI, 0.7%-6.8%; P = .01) at financial incentive sites compared with standard of care sites. Among patients not previously consistently virally suppressed, the proportion virally suppressed was 4.9% higher (95% CI, 1.4%-8.5%; P = .007) at financial incentive sites. In addition, continuity in care was 8.7% higher (95% CI, 4.2%-13.2%; P incentive sites. Financial incentives, as used in this study (HPTN 065), significantly increased viral

  1. Financial Incentives for Adherence to Hepatitis C Virus Clinical Care and Treatment: A Randomized Trial of Two Strategies

    Science.gov (United States)

    Allmon, Andrew G.; Evon, Donna; Hurt, Christopher; Reifeis, Sarah Ailleen; Thirumurthy, Harsha; Straub, Becky; Edwards, Angela; Mollan, Katie R.

    2017-01-01

    Abstract Background. Although rates of sustained virologic response (SVR) after hepatitis C virus (HCV) treatment with direct-acting antivirals (DAAs) surpass 90% in trials and some more “real world” settings, some patients, such as those with substance use disorders, will be challenged to adhere to HCV care. Methods. To assess the feasibility of 2 strategies for financially incentivizing adherence to HCV care, patients with a substance use history prescribed 12 weeks of a sofosbuvir-containing regimen were randomized to either fixed or lottery-based monetary incentives for attending clinic appointments, pill count adherence >90%, and SVR achievement. Electronic medication monitoring provided an objective measure of DAA adherence. Results. Fifty-nine participants were randomized to the lottery (n = 31) or fixed-incentive (n = 28) arms. All 31 (100%) in the lottery arm and 24 of 28 (86%) in the fixed arm completed 12 weeks of therapy. By intent-to-treat, 93% in the lottery arm and 92% in the fixed arm achieved SVR (estimated difference: 0.5%; 95% confidence interval, −17.5 to 18.8). Overall, 92% of scheduled visits were attended without significant differences between arms. The mean adherence ratio (days with ≥1 bottle opening:monitored days) was 0.91 for lottery and 0.92 for fixed arms. Conclusions. In this pilot, fixed- and lottery-based financial incentives were successfully implemented and accepted by patients with a substance use history. High levels of HCV therapy and care adherence, as well as rates of SVR, were observed. Financial incentives may be useful to support treatment adherence in patients with substance use disorders and should be tested in a larger, randomized, controlled trial. PMID:28695144

  2. Why are financial incentives not effective at influencing some smokers to quit? Results of a process evaluation of a worksite trial assessing the efficacy of financial incentives for smoking cessation.

    Science.gov (United States)

    Kim, Annice; Kamyab, Kian; Zhu, Jingsan; Volpp, Kevin

    2011-01-01

    Process evaluation of a worksite intervention in which employees were offered $750 to complete a cessation program and to quit smoking. Awareness and attitudes about financial incentives were assessed following a randomized controlled trial of 878 smokers at a US-based company. Cessation program attendance was higher in incentive group versus control (20.2% vs 7.1%, P motivated to quit and reported that they would have quit for less money, said incentives were "not at all" or only "somewhat" important. Most nonquitters in the incentive group reported that even $1500 would not have motivated them to quit. Financial incentives are ineffective at motivating some smokers to quit. Internal motivation and readiness to quit need to be sufficiently high for relatively modest incentives to be effective.

  3. Do family physicians need more payment for working better? Financial incentives in primary care.

    Science.gov (United States)

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

    2014-05-01

    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.

  4. Incentive-based demand response programs designed by asset-light retail electricity providers for the day-ahead market

    DEFF Research Database (Denmark)

    Fotouhi Ghazvini, Mohammad Ali; Faria, Pedro; Ramos, Sergio

    2015-01-01

    Following the deregulation experience of retail electricity markets in most countries, the majority of the new entrants of the liberalized retail market were pure REP (retail electricity providers). These entities were subject to financial risks because of the unexpected price variations, price...... to hedge the financial losses in the market. A two-stage stochastic programming problem is formulated. It aims to establish the financial incentive-based DR programs and the optimal dispatch of the DG units and ESSs. The uncertainty of the forecasted day-ahead load demand and electricity price is also...... taken into account with a scenario-based approach. The principal advantage of this model for REPs is reducing the risk of financial losses in DAMs, and the main benefit for the whole system is market power mitigation by virtually increasing the price elasticity of demand and reducing the peak demand....

  5. A Simulation Modeling Framework to Optimize Programs Using Financial Incentives to Motivate Health Behavior Change.

    Science.gov (United States)

    Basu, Sanjay; Kiernan, Michaela

    2016-01-01

    While increasingly popular among mid- to large-size employers, using financial incentives to induce health behavior change among employees has been controversial, in part due to poor quality and generalizability of studies to date. Thus, fundamental questions have been left unanswered: To generate positive economic returns on investment, what level of incentive should be offered for any given type of incentive program and among which employees? We constructed a novel modeling framework that systematically identifies how to optimize marginal return on investment from programs incentivizing behavior change by integrating commonly collected data on health behaviors and associated costs. We integrated "demand curves" capturing individual differences in response to any given incentive with employee demographic and risk factor data. We also estimated the degree of self-selection that could be tolerated: that is, the maximum percentage of already-healthy employees who could enroll in a wellness program while still maintaining positive absolute return on investment. In a demonstration analysis, the modeling framework was applied to data from 3000 worksite physical activity programs across the nation. For physical activity programs, the incentive levels that would optimize marginal return on investment ($367/employee/year) were higher than average incentive levels currently offered ($143/employee/year). Yet a high degree of self-selection could undermine the economic benefits of the program; if more than 17% of participants came from the top 10% of the physical activity distribution, the cost of the program would be expected to always be greater than its benefits. Our generalizable framework integrates individual differences in behavior and risk to systematically estimate the incentive level that optimizes marginal return on investment. © The Author(s) 2015.

  6. Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial.

    Science.gov (United States)

    Paloyo, Alfredo R; Reichert, Arndt R; Reuss-Borst, Monika; Tauchmann, Harald

    2015-11-01

    There is a paucity of evidence on the heterogeneous impacts of financial incentives on weight loss. Between March 2010 and January 2012, in a randomized controlled trial, we assigned 700 obese persons to three experimental arms. We test whether particular subgroups react differently to financial incentives for weight loss. Two treatment groups obtained a cash reward (€150 and €300 with 237 and 229 participants, respectively) for achieving an individually-assigned target weight within four months; the control group (234 participants) was not incentivized. Participants and administrators were not blinded to the intervention. We find that monetary rewards effectively induced obese individuals to reduce weight across all subgroups. However, there is no evidence for treatment-effect heterogeneity for those groups that were incentivized. Among those who were in the €300 group, statistically significant and large weight losses were observed for women, singles, and those who are not working (all above 4 kg in four months). In addition, the magnitude of the reward matters only for women and migrants. The effectiveness of financial incentives to reduce weight nevertheless raises sensitive ethical issues that should be taken into consideration by policymakers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Financial incentives for generic drugs: case study on a reimbursement program

    Directory of Open Access Journals (Sweden)

    Marcos Inocencio

    2010-06-01

    Full Text Available Objective: To discuss the use of financial incentives in choice of medication and to assess the economic results concerning the use of financial incentives to promote the use of genetic medication in lieu of reference drugs in a company with a reimbursement program. Methods: A case study was carried out in a large supermarket. The data was obtained in the company responsible for managing medication. The study reached 83,625 users between August 2005 and July 2007. The data was submitted to regressions in order to analyze trends and hypothesis tests to assess differences in medication consumption. The results were compared with general data regarding medication consumption of five other organizations and also with data about the national consumption of generic medication in Brazil. Results: The use of financial incentives to replace brand medications for generics, in the company studied, increased the consumption of generic drugs without reducing the company expenses with the reimbursement programs. Conclusions: This study show the occurrence of unplanned results (increase in the consumption of medications and the positive consequences of the reimbursement program concerning access to medication.

  8. The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review.

    Directory of Open Access Journals (Sweden)

    Tracy Jackson

    Full Text Available Financial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets.To systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management.We followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017 including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies.We identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7, UK (n = 4 and Canada (n = 1. Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10, written action plans for asthma (n = 1 and hospital/emergency department visits (n = 1. Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving 'perfect care' (including providing a written action plan increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one.Results for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health outcomes in asthma. Further research is needed to

  9. Coupling Financial Incentives with Direct Mail in Population-Based Practice: A Randomized Trial of Mammography Promotion

    Science.gov (United States)

    Slater, Jonathan S.; Parks, Michael J.; Malone, Michael E.; Henly, George A.; Nelson, Christina L.

    2017-01-01

    Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy. However, little is known about how to translate incentive-based strategies to public health practice geared toward improving population-level health, and a dearth of research exists on how individuals respond…

  10. Effects of financial incentives for the purchase of healthy groceries on dietary intake and weight outcomes among older adults: A randomized pilot study.

    Science.gov (United States)

    Kral, Tanja V E; Bannon, Annika L; Moore, Reneé H

    2016-05-01

    Providing financial incentives can be a useful behavioral economics strategy for increasing fruit and vegetable intake among consumers. It remains to be determined whether financial incentives can promote intake of other low energy-dense foods and if consumers who are already using promotional tools for their grocery purchases may be especially responsive to receiving incentives. This randomized controlled trial tested the effects of offering financial incentives for the purchase of healthy groceries on 3-month changes in dietary intake, weight outcomes, and the home food environment among older adults. A secondary aim was to compare frequent coupon users (FCU) and non-coupon users (NCU) on weight status, home food environment, and grocery shopping behavior. FCU (n = 28) and NCU (n = 26) were randomly assigned to either an incentive or a control group. Participants in the incentive group received $1 for every healthy food or beverage they purchased. All participants completed 3-day food records and a home food inventory and had their height, weight, and waist circumference measured at baseline and after 3 months. Participants who were responsive to the intervention and received financial incentives significantly increased their daily vegetable intake (P = 0.04). Participants in both groups showed significant improvements in their home food environment (P = 0.0003). No significant changes were observed in daily energy intake or weight-related outcomes across groups (P environment may be considered 'obesogenic' (P > 0.73). Increased consumption of vegetables did not replace intake of more energy-dense foods. Incentivizing consumers to make healthy food choices while simultaneously reducing less healthy food choices may be important. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Effects of financial incentives for the purchase of healthy groceries on dietary intake and weight outcomes among older adults: A randomized pilot study

    Science.gov (United States)

    Kral, Tanja V.E.; Bannon, Annika L.; Moore, Reneé H.

    2016-01-01

    Providing financial incentives can be a useful behavioral economics strategy for increasing fruit and vegetable intake among consumers. It remains to be determined whether financial incentives can promote intake of other low energy-dense foods and if consumers who are already using promotional tools for their grocery purchases may be especially responsive to receiving incentives. This randomized controlled trial tested the effects of offering financial incentives for the purchase of healthy groceries on 3-month changes in dietary intake, weight outcomes, and the home food environment among older adults. A secondary aim was to compare frequent coupon users (FCU) and non-coupon users (NCU) on weight status, home food environment, and grocery shopping behavior. FCU (n = 28) and NCU (n = 26) were randomly assigned to either an incentive or a control group. Participants in the incentive group received $1 for every healthy food or beverage they purchased. All participants completed 3-day food records and a home food inventory and had their height, weight, and waist circumference measured at baseline and after 3 months. Participants who were responsive to the intervention and received financial incentives significantly increased their daily vegetable intake (P = 0.04). Participants in both groups showed significant improvements in their home food environment (P = 0.0003). No significant changes were observed in daily energy intake or weight-related outcomes across groups (P 0.73). Increased consumption of vegetables did not replace intake of more energy-dense foods. Incentivizing consumers to make healthy food choices while simultaneously reducing less healthy food choices may be important. PMID:26879224

  12. Efficacy of Team-Based Financial Incentives for Smoking Cessation in the Workplace

    Science.gov (United States)

    Yeo, Chang Dong; Lee, Hea Yeon; Ha, Jick Hwan; Kang, Hyeon Hui; Kang, Ji Young; Kim, Sung Kyoung; Kim, Myung Sook; Moon, Hwa Sik

    2015-01-01

    Worksite smoking cessation programs offer accessibility of the target population, availability of occupational health support, and the potential for peer pressure and peer support. The purpose of this study was to identify the efficacy of the financial incentives given to various teams in the workplace. St. Paul's Hospital's employees were enrolled. Each team of employees consisted of smoking participants and non-smoking fellow workers from the same department. The financial incentive of 50000 won (about $45) was rewarded to the team for each successful participant-not to individual members-after the first week and then after one month. If the smokers in the team remained abstinent for a longer time period, the team was given an incentive of 100000 won for each successful participant after 3 and 6 months. A total 28 smoking participants and 6 teams were enrolled. Self-reported abstinence rates validated by urinary cotinine test at 3, 6, and 12 months after the initial cessation were 61%, 54%, and 50%, respectively. Smokers with high nicotine dependence scores or those who began participation 1 month after enrollment initiation had a lower abstinence rate at 3 months, but not at 6 and 12 months. Participants who succeeded at smoking cessation at 12 months were more likely to be older and have a longer smoking duration history. The financial incentives given to teams could be promising and effective to improve long-term rates of smoking cessation. This approach could use peer pressure and peer support in the workplace over a longer period. PMID:25510778

  13. Financial incentives research and lending market impact analysis

    Energy Technology Data Exchange (ETDEWEB)

    Smith, R.F.; Bryant, P.S.; Cour, E.E.; Kouchoukos, P.C.

    1977-11-01

    The U.S. Energy Research and Development Administration has been authorized by recent legislation to enter into loan guaranty and interest assistance agreements related to specific energy programs. These loan guaranty programs are designed to encourage the private sector to participate in the development of alternative energy sources and the conservation of energy. Two programs are currently authorized: one dealing with geothermal energy; the other dealing with electric and hybrid vehicles. A third program currently under consideration by the Congress addresses the conversion of organic waste products into alternative fuels. An introductory overview provides a brief summary of: energy legislation, ERDA loan guaranty programs, basis of and purpose for the investigation, and scope. Subsequent sections of this report address related background information; methodology employed; data collection and analysis of the information obtained; and specific recommendations based upon the results of the analysis. Supporting information and reference data are included as appendices. (MCW)

  14. Do financial incentives trump clinical guidance? Hip Replacement in England and Scotland.

    Science.gov (United States)

    Papanicolas, Irene; McGuire, Alistair

    2015-12-01

    Following devolution in 1999 England and Scotland's National Health Services diverged, resulting in major differences in hospital payment. England introduced a case payment mechanism from 2003/4, while Scotland continued to pay through global budgets. We investigate the impact this change had on activity for Hip Replacement. We examine the financial reimbursement attached to uncemented Hip Replacement in England, which has been more generous than for its cemented counterpart, although clinical guidance from the National Institute for Clinical Excellence recommends the later. In Scotland this financial differential does not exist. We use a difference-in-difference estimator, using Scotland as a control, to test whether the change in reimbursement across the two countries had an influence on treatment. Our results indicate that financial incentives are directly linked to the faster uptake of the more expensive, uncemented Hip Replacement in England, which ran against the clinical guidance. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. The willingness to relocate to another country: the impact of cultural similarity, destination safety, and financial incentive.

    Science.gov (United States)

    Wagner, Michael R; Westaby, James D

    2009-08-01

    Because of increased concerns about terrorism around the globe, international organizations are very interested in understanding how safety and cultural issues impact their employees' willingness to relocate abroad. This has been especially true for international companies based in the United States, given the recent salience of US activities around the world. Additionally, questions remain regarding the efficacy of financial incentives to motivate individuals' willingness to relocate when the destination may be dangerous. Therefore, the factors impacting willingness to relocate from the US to another country were examined experimentally in this study. Based upon theory and research in social and organizational psychology, it was hypothesized that cultural similarity, destination safety, and financial incentives would have direct effects on individuals' willingness to accept relocation offers. It was also predicted that cultural similarity and destination safety would moderate the effects of incentives upon willingness to relocate. The study used a 2 × 2 × 3 between-subjects design manipulating destination similarity (similar, different), destination safety (safe, dangerous), and bonus for relocating (0% bonus, 20% bonus, 40% bonus). Results from 196 participants at a university in the northeastern part of the US revealed that financial incentives and safety perceptions directly impacted willingness to relocate. In line with moderator predictions, financial incentives had a stronger effect on willingness to relocate when the destination was culturally different from the United States than when it was similar. Against expectations, there was no interaction between financial incentives and safety. Destination safety perceptions were relatively strong determinants of willingness to relocate.

  16. Case Studies on the Effectiveness of State Financial Incentives for Renewable Energy

    Energy Technology Data Exchange (ETDEWEB)

    None

    2002-09-01

    September 2002 · NREL/SR-620-32819 Case Studies on the Effectiveness of State Financial Incentives for Renewable Energy S. Gouchoe, V. Everette, and R. Haynes North Carolina State University Raleigh, North Carolina National Renewable Energy Laboratory 1617 Cole Boulevard Golden, Colorado 80401-3393 NREL is a U.S. Department of Energy Laboratory Operated by Midwest Research Institute · Battelle · Bechtel Contract No. DE-AC36-99-GO10337 September 2002 · NREL/SR-620-32819Case Studies on the Effecti

  17. Environmental assessment for the electric and hybrid vehicle demonstration project, performance standards and financial incentives

    Energy Technology Data Exchange (ETDEWEB)

    LaBelle, S. J.

    1978-10-01

    The assessment is concerned with the impacts of the demonstration of electric and hybrid vehicles acquired to fulfill certain requirements of the Electric and Hybrid Vehicle Research, Development, and Demonstration Act, PL 94-413 as amended. The financial incentives programs and vehicle performance standards associated with the demonstration are also covered. Not included is an assessment of the long term effects of EHV commercialization and of the research and development program being carried out simultaneously with the demonstration, also in response to PL 94-413. These federal actions will be included in a programmatic environmental assessment scheduled for completion in FY 79.

  18. Compliance Performance: Effects of a Provider Incentive Program and Coding Compliance Plan

    National Research Council Canada - National Science Library

    Tudela, Joseph A

    2004-01-01

    ...) and select attributes and experience/training variables. For BAMC's provider incentive program, analysis reveals statistical significance for record compliance rates with data dated measures, F(underscored)(1,103)= 4.74, p(underscored) = .03...

  19. Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment.

    Science.gov (United States)

    Adams, Jean; Bateman, Belinda; Becker, Frauke; Cresswell, Tricia; Flynn, Darren; McNaughton, Rebekah; Oluboyede, Yemi; Robalino, Shannon; Ternent, Laura; Sood, Benjamin Gardner; Michie, Susan; Shucksmith, Janet; Sniehotta, Falko F; Wigham, Sarah

    2015-11-01

    Uptake of preschool vaccinations is less than optimal. Financial incentives and quasi-mandatory policies (restricting access to child care or educational settings to fully vaccinated children) have been used to increase uptake internationally, but not in the UK. To provide evidence on the effectiveness, acceptability and economic costs and consequences of parental financial incentives and quasi-mandatory schemes for increasing the uptake of preschool vaccinations. Systematic review, qualitative study and discrete choice experiment (DCE) with questionnaire. Community, health and education settings in England. Qualitative study - parents and carers of preschool children, health and educational professionals. DCE - parents and carers of preschool children identified as 'at high risk' and 'not at high risk' of incompletely vaccinating their children. Qualitative study - focus groups and individual interviews. DCE - online questionnaire. The review included studies exploring the effectiveness, acceptability or economic costs and consequences of interventions that offered contingent rewards or penalties with real material value for preschool vaccinations, or quasi-mandatory schemes that restricted access to 'universal' services, compared with usual care or no intervention. Electronic database, reference and citation searches were conducted. Systematic review - there was insufficient evidence to conclude that the interventions considered are effective. There was some evidence that the quasi-mandatory interventions were acceptable. There was insufficient evidence to draw conclusions on economic costs and consequences. Qualitative study - there was little appetite for parental financial incentives. Quasi-mandatory schemes were more acceptable. Optimising current services was consistently preferred to the interventions proposed. DCE and questionnaire - universal parental financial incentives were preferred to quasi-mandatory interventions, which were preferred to targeted

  20. When do financial incentives reduce intrinsic motivation? comparing behaviors studied in psychological and economic literatures.

    Science.gov (United States)

    Promberger, Marianne; Marteau, Theresa M

    2013-09-01

    To review existing evidence on the potential of incentives to undermine or "crowd out" intrinsic motivation, in order to establish whether and when it predicts financial incentives to crowd out motivation for health-related behaviors. We conducted a conceptual analysis to compare definitions and operationalizations of the effect, and reviewed existing evidence to identify potential moderators of the effect. In the psychological literature, we find strong evidence for an undermining effect of tangible rewards on intrinsic motivation for simple tasks when motivation manifest in behavior is initially high. In the economic literature, evidence for undermining effects exists for a broader variety of behaviors, in settings that involve a conflict of interest between parties. By contrast, for health related behaviors, baseline levels of incentivized behaviors are usually low, and only a subset involve an interpersonal conflict of interest. Correspondingly, we find no evidence for crowding out of incentivized health behaviors. The existing evidence does not warrant a priori predictions that an undermining effect would be found for health-related behaviors. Health-related behaviors and incentives schemes differ greatly in moderating characteristics, which should be the focus of future research. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  1. When Do Financial Incentives Reduce Intrinsic Motivation? Comparing Behaviors Studied in Psychological and Economic Literatures

    Science.gov (United States)

    2013-01-01

    Objective: To review existing evidence on the potential of incentives to undermine or “crowd out” intrinsic motivation, in order to establish whether and when it predicts financial incentives to crowd out motivation for health-related behaviors. Method: We conducted a conceptual analysis to compare definitions and operationalizations of the effect, and reviewed existing evidence to identify potential moderators of the effect. Results: In the psychological literature, we find strong evidence for an undermining effect of tangible rewards on intrinsic motivation for simple tasks when motivation manifest in behavior is initially high. In the economic literature, evidence for undermining effects exists for a broader variety of behaviors, in settings that involve a conflict of interest between parties. By contrast, for health related behaviors, baseline levels of incentivized behaviors are usually low, and only a subset involve an interpersonal conflict of interest. Correspondingly, we find no evidence for crowding out of incentivized health behaviors. Conclusion: The existing evidence does not warrant a priori predictions that an undermining effect would be found for health-related behaviors. Health-related behaviors and incentives schemes differ greatly in moderating characteristics, which should be the focus of future research. PMID:24001245

  2. Financial incentives to discontinue long-term benzodiazepine use: a discrete choice experiment investigating patient preferences and willingness to participate

    OpenAIRE

    Marti, J; Bachhuber, M; Feingold, J; Meads, D; Richards, M; Hennessy, S.

    2017-01-01

    OBJECTIVES: Investigate the acceptability of financial incentives for initiating a medically supervised benzodiazepine discontinuation programme among people with long-term benzodiazepine use and to identify programme features that influence willingness to participate. METHODS: We conducted a discrete choice experiment in which we presented a variety of incentive-based programs to a sample of older adults with long-term benzodiazepine use identified using the outpatient electronic health reco...

  3. Financial incentives to discontinue long-term benzodiazepine use: a discrete choice experiment investigating patient preferences and willingness to participate.

    Science.gov (United States)

    Marti, Joachim; Bachhuber, Marcus; Feingold, Jordyn; Meads, David; Richards, Michael; Hennessy, Sean

    2017-10-06

    Investigate the acceptability of financial incentives for initiating a medically supervised benzodiazepine discontinuation programme among people with long-term benzodiazepine use and to identify programme features that influence willingness to participate. We conducted a discrete choice experiment in which we presented a variety of incentive-based programs to a sample of older adults with long-term benzodiazepine use identified using the outpatient electronic health record of a university-owned health system. We studied four programme variables: incentive amount for initiating the programme, incentive amount for successful benzodiazepine discontinuation, lottery versus certain payment and whether partial payment was given for dose reduction. Respondents reported their willingness to participate in the programmes and additional information was collected on demographics, history of use and anxiety symptoms. The overall response rate was 28.4%. Among the 126 respondents, all four programme variables influenced stated preferences. Respondents strongly preferred guaranteed cash-based incentives as opposed to a lottery, and the dollar amount of both the starting and conditional incentives had a substantial impact on choice. Willingness to participate increased with the amount of conditional incentive. Programme participation also varied by gender, duration of use and income. Participation in an incentive-based benzodiazepine discontinuation programme might be relatively low, but is modifiable by programme variables including incentive amounts. These results will be helpful to inform the design of future trials of benzodiazepine discontinuation programmes. Further research is needed to assess the financial viability and potential cost-effectiveness of such economic incentives. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Motivation for participating in a weight loss program and financial incentives: an analysis from a randomized trial.

    Science.gov (United States)

    Crane, Melissa M; Tate, Deborah F; Finkelstein, Eric A; Linnan, Laura A

    2012-01-01

    This analysis investigated if changes in autonomous or controlled motivation for participation in a weight loss program differed between individuals offered a financial incentive for weight loss compared to individuals not offered an incentive. Additionally, the same relationships were tested among those who lost weight and either received or did not receive an incentive. This analysis used data from a year-long randomized worksite weight loss program that randomly assigned employees in each worksite to either a low-intensity weight loss program or the same program plus small financial incentives for weight loss ($5.00 per percentage of initial weight lost). There were no differences in changes between groups on motivation during the study, however, increases in autonomous motivation were consistently associated with greater weight losses. This suggests that the small incentives used in this program did not lead to increases in controlled motivation nor did they undermine autonomous motivation. Future studies are needed to evaluate the magnitude and timing of incentives to more fully understand the relationship between incentives and motivation.

  5. Motivation for Participating in a Weight Loss Program and Financial Incentives: An Analysis from a Randomized Trial

    Directory of Open Access Journals (Sweden)

    Melissa M. Crane

    2012-01-01

    Full Text Available This analysis investigated if changes in autonomous or controlled motivation for participation in a weight loss program differed between individuals offered a financial incentive for weight loss compared to individuals not offered an incentive. Additionally, the same relationships were tested among those who lost weight and either received or did not receive an incentive. This analysis used data from a year-long randomized worksite weight loss program that randomly assigned employees in each worksite to either a low-intensity weight loss program or the same program plus small financial incentives for weight loss ($5.00 per percentage of initial weight lost. There were no differences in changes between groups on motivation during the study, however, increases in autonomous motivation were consistently associated with greater weight losses. This suggests that the small incentives used in this program did not lead to increases in controlled motivation nor did they undermine autonomous motivation. Future studies are needed to evaluate the magnitude and timing of incentives to more fully understand the relationship between incentives and motivation.

  6. Motivation for Participating in a Weight Loss Program and Financial Incentives: An Analysis from a Randomized Trial

    Science.gov (United States)

    Crane, Melissa M.; Tate, Deborah F.; Finkelstein, Eric A.; Linnan, Laura A.

    2012-01-01

    This analysis investigated if changes in autonomous or controlled motivation for participation in a weight loss program differed between individuals offered a financial incentive for weight loss compared to individuals not offered an incentive. Additionally, the same relationships were tested among those who lost weight and either received or did not receive an incentive. This analysis used data from a year-long randomized worksite weight loss program that randomly assigned employees in each worksite to either a low-intensity weight loss program or the same program plus small financial incentives for weight loss ($5.00 per percentage of initial weight lost). There were no differences in changes between groups on motivation during the study, however, increases in autonomous motivation were consistently associated with greater weight losses. This suggests that the small incentives used in this program did not lead to increases in controlled motivation nor did they undermine autonomous motivation. Future studies are needed to evaluate the magnitude and timing of incentives to more fully understand the relationship between incentives and motivation. PMID:22577524

  7. The effectiveness of financial incentives for smoking cessation during pregnancy: is it from being paid or from the extra aid?

    Directory of Open Access Journals (Sweden)

    Mantzari Eleni

    2012-04-01

    Full Text Available Abstract Background Financial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women's experiences of trying to stop smoking, within and outside of a financial incentives scheme. Methods Thirty-six (n = 36 UK-based pregnant smokers (n = 36, offered standard NHS Stop-Smoking Services, of whom twenty (n = 20 were enrolled in a financial incentives scheme for smoking cessation (n = 20 and sixteen (n = 16 were not, were interviewed about (i their motivation to stop smoking, and (ii the factors they perceived as influencing their quitting efforts. Framework Analysis was used to analyse the data. Results Women in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts. Conclusion Women participating in a financial incentives scheme to stop smoking reported greater engagement with the Stop-Smoking Services, from which they described receiving more help in quitting than women who were not part of the scheme. These results highlight the complexity of financial incentives schemes and the intricacies surrounding the ways in which they operate to affect smoking cessation. These might involve influencing individuals' motivation and self-regulation, changing engagement with

  8. The effectiveness of financial incentives for smoking cessation during pregnancy: is it from being paid or from the extra aid?

    Science.gov (United States)

    Mantzari, Eleni; Vogt, Florian; Marteau, Theresa M

    2012-04-02

    Financial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women’s experiences of trying to stop smoking, within and outside of a financial incentives scheme. Thirty-six (n = 36) UK-based pregnant smokers (n = 36), offered standard NHS Stop-Smoking Services, of whom twenty (n = 20) were enrolled in a financial incentives scheme for smoking cessation (n = 20) and sixteen (n = 16) were not, were interviewed about (i) their motivation to stop smoking, and (ii) the factors they perceived as influencing their quitting efforts. Framework Analysis was used to analyse the data. Women in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts. Women participating in a financial incentives scheme to stop smoking reported greater engagement with the Stop-Smoking Services, from which they described receiving more help in quitting than women who were not part of the scheme. These results highlight the complexity of financial incentives schemes and the intricacies surrounding the ways in which they operate to affect smoking cessation. These might involve influencing individuals’ motivation and self-regulation, changing engagement with and provision of support services, or a combination of

  9. Effect of Financial Incentives on Breastfeeding: A Cluster Randomized Clinical Trial.

    Science.gov (United States)

    Relton, Clare; Strong, Mark; Thomas, Kate J; Whelan, Barbara; Walters, Stephen J; Burrows, Julia; Scott, Elaine; Viksveen, Petter; Johnson, Maxine; Baston, Helen; Fox-Rushby, Julia; Anokye, Nana; Umney, Darren; Renfrew, Mary J

    2018-02-05

    Although breastfeeding has a positive effect on an infant's health and development, the prevalence is low in many communities. The effect of financial incentives to improve breastfeeding prevalence is unknown. To assess the effect of an area-level financial incentive for breastfeeding on breastfeeding prevalence at 6 to 8 weeks post partum. The Nourishing Start for Health (NOSH) trial, a cluster randomized trial with 6 to 8 weeks follow-up, was conducted between April 1, 2015, and March 31, 2016, in 92 electoral ward areas in England with baseline breastfeeding prevalence at 6 to 8 weeks post partum less than 40%. A total of 10 010 mother-infant dyads resident in the 92 study electoral ward areas where the infant's estimated or actual birth date fell between February 18, 2015, and February 17, 2016, were included. Areas were randomized to the incentive plus usual care (n = 46) (5398 mother-infant dyads) or to usual care alone (n = 46) (4612 mother-infant dyads). Usual care was delivered by clinicians (mainly midwives, health visitors) in a variety of maternity, neonatal, and infant feeding services, all of which were implementing the UNICEF UK Baby Friendly Initiative standards. Shopping vouchers worth £40 (US$50) were offered to mothers 5 times based on infant age (2 days, 10 days, 6-8 weeks, 3 months, 6 months), conditional on the infant receiving any breast milk. The primary outcome was electoral ward area-level 6- to 8-week breastfeeding period prevalence, as assessed by clinicians at the routine 6- to 8-week postnatal check visit. Secondary outcomes were area-level period prevalence for breastfeeding initiation and for exclusive breastfeeding at 6 to 8 weeks. In the intervention (5398 mother-infant dyads) and control (4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government

  10. Review of financial incentive, low-income, elderly and multifamily residential conservation programs

    Energy Technology Data Exchange (ETDEWEB)

    Berry, L.; Hubbard, M.; White, D.

    1986-09-01

    This report describes thirty-nine utility-sponsored residential conservation programs for four types of markets. The program types considered are: (1) financial incentive programs for the general residential market, (2) programs for low-income households, (3) programs for the elderly, and (4) programs for the multifamily market. Each program description contains information on incentive terms, eligibility, conservation measures, program history, design and marketing, and the utility/agency motivation for operating the program. The names, addresses and phone numbers of contact persons also are included. Two methods were used to select the programs to be described. First, nominations of successful programs of each type were solicited from experts on residential energy conservation. Second, managers of the programs on this initial list were asked to describe their programs and to suggest other successful programs that should be included in the sample. Because of the selection process used, this report covers mainly the best known and most frequently studied programs that are aimed at the four market types.

  11. A "nudge" at all? The jury is still out on financial health incentives.

    Science.gov (United States)

    Mitchell, Marc; Faulkner, Guy

    2012-01-01

    A comprehensive, multi-level approach to curb chronic disease-related costs in Canada is needed. One target for intervention is the economic domain. The emergence of user financial incentives (UFI) in public health policy as well as their broad implementation in corporate settings has stimulated a growing but limited body of research in this area. The authors'position is that the jury is still out on the question of their effectiveness in sustaining long-term health behaviour change, given the nature of the UFI that have been designed and delivered to date--that is, UFI with limited theoretical and contextual consideration. It is their contention that manipulating UFI design features (there are seven core features with a range of attributes) to exploit contextual (e.g., personal income) and theoretical (e.g., self-efficacy) factors may optimize UFI effectiveness over the long term. Although UFI are not the solution, they might very well be apart.

  12. Take the Money and Run: The Challenges of Designing and Evaluating Financial Incentives in Healthcare; Comment on “Paying for Performance in Healthcare Organisations”

    Directory of Open Access Journals (Sweden)

    Russell Mannion

    2014-02-01

    Full Text Available Many countries are turning their attention to the use of explicit financial incentives to drive desired improvements in healthcare performance. However, we have only a weak evidence-base to inform policy in this area. The research challenge is to generate robust evidence on what financial incentives work, under what circumstances, for whom and with what intended and unintended consequences.

  13. Take the money and run: the challenges of designing and evaluating financial incentives in healthcare; Comment on "Paying for performance in healthcare organisations".

    Science.gov (United States)

    Mannion, Russell

    2014-02-01

    Many countries are turning their attention to the use of explicit financial incentives to drive desired improvements in healthcare performance. However, we have only a weak evidence-base to inform policy in this area. The research challenge is to generate robust evidence on what financial incentives work, under what circumstances, for whom and with what intended and unintended consequences.

  14. Take the Money and Run: The Challenges of Designing and Evaluating Financial Incentives in Healthcare; Comment on “Paying for Performance in Healthcare Organisations”

    OpenAIRE

    Russell Mannion

    2014-01-01

    Many countries are turning their attention to the use of explicit financial incentives to drive desired improvements in healthcare performance. However, we have only a weak evidence-base to inform policy in this area. The research challenge is to generate robust evidence on what financial incentives work, under what circumstances, for whom and with what intended and unintended consequences.

  15. Effects of Performance-Based Financial Incentives on Work Performance: A Study of Technical-Level Employees in the Private Sector in Sri Lanka

    Science.gov (United States)

    Wickramasinghe, Vathsala; Dabere, Sampath

    2012-01-01

    The objective of the study is to investigate the effect of performance-based financial incentives on work performance. The study hypothesized that the design features of performance-based financial incentive schemes themselves may influence individuals' work performance. For the study, survey methodology was used and 93 technical-level employees…

  16. Measuring and Facilitating Client Engagement with Financial Incentives: Implications for Improving Clinical Outcomes in a Mental Health Setting.

    Science.gov (United States)

    Kotwicki, Raymond J; Balzer, Alexandra M; Harvey, Philip D

    2017-07-01

    Significant numbers of individuals with severe mental illnesses are difficult to engage in treatment services, presenting challenges for care. To be able to assess the relationship between engagement and discharge outcomes, we modified the "Milestones of Recovery Scale". This scale was modified for content to match the current clinical setting, evaluated for inter-rater reliability after modification in a sample of 233 cases receiving psychiatric rehabilitation, and then was administered to 423 additional psychiatric rehabilitation clients over a 24-month study period. In an effort to determine whether provision of financial incentives lead to sustained increases in client engagement, a cut off for client eligibility for financial incentives was evaluated on the basis of the reliability study and the course of engagement was related to receipt of this incentive and successful completion of treatment in a new sample of 423 patients. Of this sample, 78 % received an initial financial incentive during treatment (were initially engaged), and 93.3 % of that subgroup sustained this level of engagement it over their entire course of treatment. Of the 22 % of cases not receiving an initial incentive, only 5.4 % improved in their engagement to levels required for the incentive. Longitudinal analysis demonstrated that individuals who maintained or increased their level of engagement over time were more likely to complete treatment in accordance with planned treatment goals. The initial engagement and the course of engagement in treatment predicted successful completion, but incentives did not lead to increased engagement in initially poorly engaged patients. These data are interpreted in terms of the likely success of extrinsic rewards to increase engagement in mental health services.

  17. Effect of Non Financial Incentives on Job Satisfaction of Teachers in Public Secondary Schools--Survey of Kisii Sub County

    Science.gov (United States)

    Sabina, Asiago Lenah; Okibo, Walter; Nyang'au, Andrew; Ondima, Cleophas

    2015-01-01

    Job satisfaction is a major challenge among employees in many organizations. The purpose of this research project is to assess the effect of non-financial incentives on job satisfaction of teachers in public secondary schools of Kisii Sub County in the Republic of Kenya. The specific objectives for the study include: to assess the effect of…

  18. A systematic review of financial incentives given in the healthcare setting; do they effectively improve physical activity levels?

    NARCIS (Netherlands)

    Molema, Claudia C M; Wendel-Vos, G C Wanda; Puijk, Lisanne; Jensen, Jørgen Dejgaard; Schuit, A Jantine; de Wit, G Ardine

    2016-01-01

    BACKGROUND: According to current physical activity guidelines, a substantial percentage of the population in high-income countries is inactive, and inactivity is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The

  19. A systematic review of financial incentives given in the healthcare setting : Do they effectively improve physical activity levels?

    NARCIS (Netherlands)

    Molema, C.C.M.; Wendel-Vos, W.; Puijk, L.; Jensen, J.D.; Schuit, A.J.; de Wit, G.A.

    2016-01-01

    Background According to current physical activity guidelines, a substantial percentage of the population in high-income countries is inactive, and inactivity is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The

  20. Quit4U: The Effectiveness of Combining Behavioural Support, Pharmacotherapy and Financial Incentives to Support Smoking Cessation

    Science.gov (United States)

    Ormston, R.; van der Pol, M.; Ludbrook, A.; McConville, S.; Amos, A.

    2015-01-01

    The "quit4u" stop smoking service (SSS) was developed by National Health Service (NHS) Tayside for smokers in deprived areas of Dundee (UK). quit4u combined behavioural support and pharmacotherapy with financial incentives for each week that participants remained quit. A quasi-experimental study was undertaken with smokers using quit4u…

  1. A Mixed-Methods Randomized Controlled Trial of Financial Incentives and Peer Networks to Promote Walking among Older Adults

    Science.gov (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

    2014-01-01

    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…

  2. The impact of removing financial incentives from clinical quality indicators : longitudinal analysis of four Kaiser Permanente indicators

    NARCIS (Netherlands)

    Lester, H.; Schmittdiel, J.; Selby, J.; Fireman, B.; Campbell, S.M.; Lee, J.; Whippy, A.; Madvig, P.

    2010-01-01

    OBJECTIVE: To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. DESIGN: Longitudinal analysis. SETTING: 35 medical facilities of Kaiser Permanente Northern California,

  3. What factors influence the effectiveness of financial incentives on long-term natural resource management practice change?

    Directory of Open Access Journals (Sweden)

    Emma Swann

    2016-12-01

    Full Text Available Financial incentives are used by natural resource management organisations to encourage landholders to adopt sustainable practices where the outcomes on a farm scale may be negative or marginal. There is a growing body of research aimed at understanding why landholders do or do not agree to participate in financial incentive programs, however research that considers when and how financial incentives work to bring about long-term behaviour change is relatively immature. The purpose of this review is to answer the question ‘What factors influence the effectiveness of financial incentives on long-term natural resource management practice change?’ In synthesising the evidence, it was found that there are numerous characteristics of the practice change itself, along with the program design and implementation, which are important to understand long-term behaviour change. These include whether inexpensive maintenance or long-term funding is available; whether the changes are relatively simple to sustain; whether the program involves structural changes; whether there is land use rigidity; and whether the changes have resulting environmental benefits that are highly observable. Additionally, it is advisable for programs that use financial incentives to include the following program features: ongoing extension support and a focus on building relationship and trust; flexibility in how the practice change is applied; active landholder involvement from planning to evaluation; and contract length that is appropriate for the complexity of the NRM practice. These characteristics can be used to guide policy makers in their natural resource management investment decisions. There is a clear need for greatly increased monitoring and evaluation of existing programs, both during the program and after its conclusion, in order to more fully understand its long-term impacts and ultimate effectiveness. Finally, landholders undertaking a practice change generally

  4. Financial incentives, quality improvement programs, and the adoption of clinical information technology.

    Science.gov (United States)

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

    2009-04-01

    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.

  5. Legal and financial methods for reducing low emission sources: Options for incentives

    Energy Technology Data Exchange (ETDEWEB)

    Samitowski, W. [Office of Economic and Legal Advisors POLINVEST Ltd., Cracow (Poland)

    1995-12-31

    There are two types of the so-called low emission sources in Cracow: over 1,000 local boiler houses and several thousand solid fuel-fired stoves. The accomplishment of each of 5 sub-projects offered under the American-Polish program entails solving the technical, financial, legal and public relations-related problems. The elimination of the low emission source requires, therefore, a joint effort of the following pairs: (a) local authorities, (b) investors, (c) owners and users of low emission sources, and (d) inhabitants involved in particular projects. The results of the studies developed by POLINVEST indicate that the accomplishment of the projects for the elimination of low emission sources will require financial incentives. Bearing in mind the today`s resources available from the community budget, this process may last as long as a dozen or so years. The task of the authorities of Cracow City is making a long-range operational strategy enabling reduction of low emission sources in Cracow.

  6. Financial incentive policies at workplace cafeterias for preventing obesity--a systematic review and meta-analysis (Protocol).

    Science.gov (United States)

    Sawada, Kimi; Ota, Erika; Shahrook, Sadequa; Mori, Rintaro

    2014-10-28

    Various studies are currently investigating ways to prevent lifestyle-related diseases and obesity among workers through interventions using incentive strategies, including price discounts for low-fat snacks and sugar-free beverages at workplace cafeterias or vending machines, and the provision of a free salad bar in cafeterias. Rather than assessing individual or group interventions, we will focus on the effectiveness of nutrition education programs at the population level, which primarily incorporate financial incentive strategies to prevent obesity. This paper describes the protocol of a systematic review that will examine the effectiveness of financial incentive programs at company cafeterias in improving dietary habits, nutrient intake, and obesity prevention. We will conduct searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO. Interventions will be assessed using data from randomized control trials (RCTs) and cluster RCTs. However, if few such trials exist, we will include quasi-RCTs. We will exclude controlled before-and-after studies and crossover RCTs. We will assess food-based interventions that include financial incentive strategies (discount strategies or social marketing) for workplace cafeterias, vending machines, and kiosks. Two authors will independently review studies for inclusion and will resolve differences by discussion and, if required, through consultation with a third author. We will assess the risk of bias of included studies according to the Cochrane Collaboration's "risk of bias" tool. The purpose of this paper is to outline the study protocol for a systematic review and meta-analysis that will investigate the effectiveness of population-level, incentive-focused interventions at the workplace cafeteria that aim to promote and prevent obesity. This review will give an important overview of the available evidence about the effectiveness of incentive-based environmental interventions to

  7. Financial incentive policies at workplace cafeterias for preventing obesity—a systematic review and meta-analysis (Protocol)

    Science.gov (United States)

    2014-01-01

    Background Various studies are currently investigating ways to prevent lifestyle-related diseases and obesity among workers through interventions using incentive strategies, including price discounts for low-fat snacks and sugar-free beverages at workplace cafeterias or vending machines, and the provision of a free salad bar in cafeterias. Rather than assessing individual or group interventions, we will focus on the effectiveness of nutrition education programs at the population level, which primarily incorporate financial incentive strategies to prevent obesity. This paper describes the protocol of a systematic review that will examine the effectiveness of financial incentive programs at company cafeterias in improving dietary habits, nutrient intake, and obesity prevention. Methods/design We will conduct searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO. Interventions will be assessed using data from randomized control trials (RCTs) and cluster RCTs. However, if few such trials exist, we will include quasi-RCTs. We will exclude controlled before-and-after studies and crossover RCTs. We will assess food-based interventions that include financial incentive strategies (discount strategies or social marketing) for workplace cafeterias, vending machines, and kiosks. Two authors will independently review studies for inclusion and will resolve differences by discussion and, if required, through consultation with a third author. We will assess the risk of bias of included studies according to the Cochrane Collaboration’s “risk of bias” tool. Discussion The purpose of this paper is to outline the study protocol for a systematic review and meta-analysis that will investigate the effectiveness of population-level, incentive-focused interventions at the workplace cafeteria that aim to promote and prevent obesity. This review will give an important overview of the available evidence about the effectiveness of

  8. Personal financial incentives in health promotion: where do they fit in an ethic of autonomy?

    National Research Council Canada - National Science Library

    Ashcroft, Richard E

    2011-01-01

    Aim  This paper reviews the ethical controversy concerning the use of monetary incentives in health promotion, focussing specifically on the arguments relating to the impact on personal autonomy of such incentives. Background...

  9. Effect of a novel financial incentive program on operating room efficiency.

    Science.gov (United States)

    Scalea, Thomas M; Carco, Darlene; Reece, Melissa; Fouche, Yvette L; Pollak, Andrew N; Nagarkatti, Sushruta S

    2014-09-01

    Operating room (OR) turnaround times (TATs) and on-time first-case starts (FCSs) are commonly used measures of OR efficiency. Prolonged TATs and late FCSs occur frequently at academic medical centers. To test the hypothesis that establishing a financial incentive program (FIP) for OR teams would improve efficiency, leading to decreased TATs and improved on-time FCSs. Prospective study to evaluate the effect of an FIP on OR efficiency between March 1, 2013, and December 31, 2013, at a freestanding academic trauma hospital. Participants were all OR team members and included anesthesiologists, certified registered nurse anesthetists, nurses, and technicians. Operating room efficiency awareness education was conducted before FIP implementation beginning in February 2013. Each eligible OR team member achieving a TAT of 60 minutes or less or an on-time FCS was awarded 1 point. Reports listing individual performances were posted. Pay bonuses were awarded for achieving 1 of 3 progressive point totals in any month. Outcomeswere TAT, whichwas defined as “wheels out” to “wheels in,” and on-time FCS, which was defined as “wheels in” within 6 minutes of the scheduled start time. Before FIP implementation, the mean TAT varied between 77 and 83 minutes, with only 18%to 26%of TATs being 60 minutes or less; on-time FCSs averaged 29% to 34%. After FIP implementation, on-time FCSs improved from 31% to 64%(P < .001), and TATs of 60 minutes or less increased from 24%to 52%(P < .001). The cost of a 2-month FIP was $8340. We saved 13 minutes per TAT, for an estimated savings of $177 000.We estimate an additional savings of $33 000 for on-time FCSs, for a total hospital savings of $210 000. A novel FIP improved OR efficiency. Given the small amount of money involved, it seems unlikely that financial incentives were solely responsible. Effectively communicating the importance of TATs and on-time FCSs and publishing individual results more likely increased staff awareness

  10. The effect of financial incentives on top of behavioral support on quit rates in tobacco smoking employees: study protocol of a cluster-randomized trial.

    Science.gov (United States)

    van den Brand, F A; Nagelhout, G E; Winkens, B; Evers, S M A A; Kotz, D; Chavannes, N H; van Schayck, C P

    2016-10-06

    Stimulating successful tobacco cessation among employees has multiple benefits. Employees who quit tobacco are healthier, more productive, less absent from work, and longer employable than employees who continue to use tobacco. Despite the evidence for these benefits of tobacco cessation, a successful method to stimulate employees to quit tobacco is lacking. The aim of this study is to evaluate whether adding a financial incentive to behavioral support (compared with no additional incentive) is effective and cost-effective in increasing abstinence rates in tobacco smoking employees participating in a smoking cessation group training. In this cluster-randomized trial employees in the intervention and control group both participate in a smoking cessation group training consisting of seven weekly counseling sessions of ninety minutes each. In addition to the training, employees in the intervention group receive a voucher as an incentive for being abstinent from smoking at the end of the training (€50), after three months (€50), after six months (€50), and after one year (€200). The control group does not receive any incentive. The primary outcome is carbon monoxide validated 12-month continuous abstinence from smoking (Russel's standard). Additionally, an economic evaluation is performed from a societal and an employer perspective. The present paper describes the methods and design of this cluster-randomized trial in detail. We hypothesize that the financial incentive for abstinence in the form of vouchers increases abstinence rates over and above the group training. The results of this study can provide important recommendations for enhancement of employee tobacco cessation. Dutch Trial Register: NTR5657 . First received 27-01-2016.

  11. The effect of financial incentives on top of behavioral support on quit rates in tobacco smoking employees: study protocol of a cluster-randomized trial

    Directory of Open Access Journals (Sweden)

    F. A. van den Brand

    2016-10-01

    Full Text Available Abstract Background Stimulating successful tobacco cessation among employees has multiple benefits. Employees who quit tobacco are healthier, more productive, less absent from work, and longer employable than employees who continue to use tobacco. Despite the evidence for these benefits of tobacco cessation, a successful method to stimulate employees to quit tobacco is lacking. The aim of this study is to evaluate whether adding a financial incentive to behavioral support (compared with no additional incentive is effective and cost-effective in increasing abstinence rates in tobacco smoking employees participating in a smoking cessation group training. Methods/design In this cluster-randomized trial employees in the intervention and control group both participate in a smoking cessation group training consisting of seven weekly counseling sessions of ninety minutes each. In addition to the training, employees in the intervention group receive a voucher as an incentive for being abstinent from smoking at the end of the training (€50, after three months (€50, after six months (€50, and after one year (€200. The control group does not receive any incentive. The primary outcome is carbon monoxide validated 12-month continuous abstinence from smoking (Russel’s standard. Additionally, an economic evaluation is performed from a societal and an employer perspective. Discussion The present paper describes the methods and design of this cluster-randomized trial in detail. We hypothesize that the financial incentive for abstinence in the form of vouchers increases abstinence rates over and above the group training. The results of this study can provide important recommendations for enhancement of employee tobacco cessation. Trial registration Dutch Trial Register: NTR5657 . First received 27-01-2016.

  12. Customer satisfaction surveys: Methodological recommendations for financial service providers

    Directory of Open Access Journals (Sweden)

    Đorđić Marko

    2010-01-01

    Full Text Available This methodological article investigates practical challenges that emerge when conducting customer satisfaction surveys (CSS for financial service providers such as banks, insurance or leasing companies, and so forth. It displays methodological recommendations in reference with: (a survey design, (b sampling, (c survey method, (d questionnaire design, and (e data acquisition. Article provides appropriate explanations that usage of: two-stage survey design, SRS method, large samples, and rigorous fieldwork preparation can enhance the overall quality of CSS in financial services. Proposed methodological recommendations can primarily be applied to the primary quantitative marketing research in retail financial services. However, majority of them can be successfully applied when conducting primary quantitative marketing research in corporate financial services as well. .

  13. Financial incentives for lumbar surgery: a critical analysis of physician reimbursement for decompression and fusion procedures.

    Science.gov (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

    2008-08-01

    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.

  14. Financial Incentives for Chronic Disease Management: Results and Limitations of 2 Randomized Clinical Trials With New York Medicaid Patients.

    Science.gov (United States)

    VanEpps, Eric M; Troxel, Andrea B; Villamil, Elizabeth; Saulsgiver, Kathryn A; Zhu, Jingsan; Chin, Jo-Yu; Matson, Jacqueline; Anarella, Joseph; Roohan, Patrick; Gesten, Foster; Volpp, Kevin G

    2018-01-01

    To identify whether financial incentives promote improved disease management in Medicaid recipients diagnosed with hypertension or diabetes, respectively. Four-group, multicenter, randomized clinical trials. Between 2013 and 2016, New York State Medicaid managed care members diagnosed with hypertension (N = 920) or with diabetes (N = 959). Participants in each 6-month trial were randomly assigned to 1 of 4 arms: (1) process incentives-earned by attending primary care visits and/or receiving prescription medication refills, (2) outcome incentives-earned by reducing systolic blood pressure (hypertension) or hemoglobin A 1c (HbA 1c ; diabetes) levels, (3) combined process and outcome incentives, and (4) control (no incentives). Systolic blood pressure (hypertension) and HbA 1c (diabetes) levels, primary care visits, and medication prescription refills. Analysis and Results: At 6 months, there were no statistically significant differences between intervention arms and the control arm in the change in systolic blood pressure, P = .531. Similarly, there were no significant differences in blood glucose control (HbA 1c ) between the intervention arms and control after 6 months, P = .939. The majority of participants had acceptable systolic blood pressure (<140 mm Hg) or blood glucose (<8.0%) levels at baseline and throughout the study. Financial incentives-regardless of whether they were delivered based on disease-relevant outcomes, process activities, or a combination of the two-have a negligible impact on health outcomes for Medicaid recipients diagnosed with either hypertension or diabetes in 2 studies in which, among other design and operational limitations, the majority of recipients had relatively well-controlled diseases at the time of enrollment.

  15. Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming

    Science.gov (United States)

    Ierfino, Diana; Mantzari, Eleni; Hirst, Julie; Jones, Tina; Aveyard, Paul; Marteau, Theresa M

    2015-01-01

    Aims Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) ‘gaming’, i.e. false reporting of smoking status to enter the scheme or gain an incentive. Design Single-arm intervention study Setting Antenatal clinic and community Participants A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period. Measurements Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum. Findings Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers. Conclusions Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes. PMID:25727238

  16. Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming.

    Science.gov (United States)

    Ierfino, Diana; Mantzari, Eleni; Hirst, Julie; Jones, Tina; Aveyard, Paul; Marteau, Theresa M

    2015-04-01

    Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) 'gaming', i.e. false reporting of smoking status to enter the scheme or gain an incentive. Single-arm intervention study Antenatal clinic and community A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period. Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum. Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers. Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes. © 2015 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

  17. Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): a randomized controlled trial of a six month pedometer program with financial incentives.

    Science.gov (United States)

    Finkelstein, Eric A; Sahasranaman, Aarti; John, Geraldine; Haaland, Benjamin A; Bilger, Marcel; Sloan, Robert A; Nang, Ei Ei Khaing; Evenson, Kelly R

    2015-03-01

    Non-communicable diseases (NCDs) are emerging as the predominant global health challenge of this century. Physical inactivity is one of the primary risk factors for NCDs. Therefore, increasing physical activity levels is a public health imperative. The arrival of affordable wearable technologies, such as wireless pedometers, provides one strategy for encouraging walking. However, the effectiveness of these technologies in promoting sustained behavior change has not been established. Insights from economics suggest that incentives may be a useful strategy for increasing maintenance and effectiveness of behavior change interventions, including physical activity interventions that rely on wearable technologies. The aim of this trial is to test the effectiveness of a common wireless pedometer with or without one of two types of incentives (cash or donations to charity) for reaching weekly physical activity goals. We present here the design and baseline characteristics of participants of this four arm randomized controlled trial. 800 full-time employees (desk-bound office workers) belonging to 15 different worksites (on average, 53 (sd: 37) employees at each worksite) were successfully randomized to one of four study arms. If shown to be effective, wearable technologies in concert with financial incentives may provide a scalable and affordable health promotion strategy for governments and employers seeking to increase the physical activity levels of their constituents. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Financial Incentives Differentially Regulate Neural Processing of Positive and Negative Emotions during Value-Based Decision-Making

    Directory of Open Access Journals (Sweden)

    Anne M. Farrell

    2018-02-01

    Full Text Available Emotional and economic incentives often conflict in decision environments. To make economically desirable decisions then, deliberative neural processes must be engaged to regulate automatic emotional reactions. In this functional magnetic resonance imaging (fMRI study, we evaluated how fixed wage (FW incentives and performance-based (PB financial incentives, in which pay is proportional to outcome, differentially regulate positive and negative emotional reactions to hypothetical colleagues that conflicted with the economics of available alternatives. Neural activity from FW to PB incentive contexts decreased for positive emotional stimuli but increased for negative stimuli in middle temporal, insula, and medial prefrontal regions. In addition, PB incentives further induced greater responses to negative than positive emotional decisions in the frontal and anterior cingulate regions involved in emotion regulation. Greater response to positive than negative emotional features in these regions also correlated with lower frequencies of economically desirable choices. Our findings suggest that whereas positive emotion regulation involves a reduction of responses in valence representation regions, negative emotion regulation additionally engages brain regions for deliberative processing and signaling of incongruous events.

  19. Policy implementation and financial incentives for nurses in South Africa: a case study on the occupation-specific dispensation

    Directory of Open Access Journals (Sweden)

    Duane Blaauw

    2013-01-01

    Full Text Available Background: In 2007, the South African government introduced the occupation-specific dispensation (OSD, a financial incentive strategy, to attract, motivate, and retain health professionals in the public sector. Implementation commenced with the nursing sector, but there have been unintended negative consequences. Objective: First, to examine implementation of the OSD for nurses using Hogwood and Gunn's framework that outlines ‘perfect implementation’ pre-conditions. Second, to highlight the conditions for the successful implementation of financial incentives. Methods: A qualitative case study design using a combination of a document review and in-depth interviews with 42 key informants. Results: The study found that there were several implementation weaknesses. Only a few of the pre-conditions were met for OSD policy implementation. The information systems required for successful policy implementation, such as the public sector human resource data base and the South African Nursing Council register of specialised nurses were incomplete and inaccurate, thus undermining the process. Insufficient attention was paid to time and resources, dependency relationships, task specification, and communication and coordination. Conclusion: The implementation of financial incentives requires careful planning and management in order to avoid loss of morale and staff grievances.

  20. Do financial incentives for delivering health promotion counselling work? Analysis of smoking cessation activities stimulated by the quality and outcomes framework

    National Research Council Canada - National Science Library

    Coleman, Tim

    2010-01-01

    ... within this unique payment system is challenging. Financial incentives undoubtedly influence GPs' activities, however, those aimed at encouraging GPs' delivery of health promotion counselling may not always have the effects intended...

  1. 42 CFR 495.370 - Appeals process for a Medicaid provider receiving electronic health record incentive payments.

    Science.gov (United States)

    2010-10-01

    ... electronic health record incentive payments. 495.370 Section 495.370 Public Health CENTERS FOR MEDICARE... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.370 Appeals process for a Medicaid provider receiving electronic health record...

  2. The right incentives enable ocean sustainability successes and provide hope for the future.

    Science.gov (United States)

    Lubchenco, Jane; Cerny-Chipman, Elizabeth B; Reimer, Jessica N; Levin, Simon A

    2016-12-20

    Healthy ocean ecosystems are needed to sustain people and livelihoods and to achieve the United Nations Sustainable Development Goals. Using the ocean sustainably requires overcoming many formidable challenges: overfishing, climate change, ocean acidification, and pollution. Despite gloomy forecasts, there is reason for hope. New tools, practices, and partnerships are beginning to transform local fisheries, biodiversity conservation, and marine spatial planning. The challenge is to bring them to a global scale. We dissect recent successes using a complex adaptive-systems (CAS) framework, which acknowledges the interconnectedness of social and ecological systems. Understanding how policies and practices change the feedbacks in CASs by altering the behavior of different system components is critical for building robust, sustainable states with favorable emergent properties. Our review reveals that altering incentives-either economic or social norms, or both-can achieve positive outcomes. For example, introduction of well-designed rights-based or secure-access fisheries and ecosystem service accounting shifts economic incentives to align conservation and economic benefits. Modifying social norms can create conditions that incentivize a company, country, or individual to fish sustainably, curb illegal fishing, or create large marine reserves as steps to enhance reputation or self-image. In each example, the feedbacks between individual actors and emergent system properties were altered, triggering a transition from a vicious to a virtuous cycle. We suggest that evaluating conservation tools by their ability to align incentives of actors with broader goals of sustainability is an underused approach that can provide a pathway toward scaling sustainability successes. In short, getting incentives right matters.

  3. The Relationship of Financial Incentives and Consumers' Willingness to Disclose Information to eCommerce Marketers

    Science.gov (United States)

    Pourhosseini, Parissa

    2009-01-01

    In this study the problem examined was a lack of research based information on the degree to which incentives can be used to encourage consumers to volunteer private information. The purpose of this study was to determine if monetary incentives would be a beneficial means to increase consumers' involvement in eCommerce and thereby boost the growth…

  4. The Mechanisms of Financial Incentives and Credit Support of Small Business in the Global Economy

    Directory of Open Access Journals (Sweden)

    A. Ya. Mortaza

    2017-01-01

    Full Text Available Purpose: the aim of the article is to analyze the existing programs and technologies in the field of financial incentives and credit support of business, as well as justification of qualitatively new methodological tools in the study area for its adaptation in domestic practice. Subject of the article is relevant because it is devoted to description of sources of financial incentives and credit support to small businesses, which are currently the engine of the modern economy. In the first part of the article, an overview of the financial resources and types of funding sources of organizations and small- and medium-sized enterprises (SME in major developed European countries is provided. Also a description is provided of modern methods of creation of an innovative climate, support innovative ideas and internal business. The second part of the article describes the direction, forms of financing small and medium enterprises (SME in the major developed European countries, taking into account the peculiarities of the development and functioning. The possibility of using foreign experience in Russia is analyzed. The presented research topic is particularly relevant in connection to an increase in the role of sources of financing for small and medium-sized enterprises (SME. In current economic environment exists the need to address problem of financial support of small and medium-sized enterprises (SME, attraction of new sources of funding, as well as the development of bank credit loans. Processes of market transformation of small and medium-sized businesses have acquired a special importance in relation to the defining role of these enterprises in the system of provision of the economic security of the country. Methods: the methodological bases of this article are the economic and statistical analysis methods, regulatory documents in the field of economic security, publications in the field of economic and financial security, public

  5. Discerning Novel Value Chains in Financial Malware : On the Economic Incentives and Criminal Business Models in Financial Malware Schemes

    NARCIS (Netherlands)

    Wegberg, R.S. van; Klievink, A.J.; Eeten, M.J.G. van

    2017-01-01

    Fraud with online payment services is an ongoing problem, with significant financial-economic and societal impact. One of the main modus operandi is financial malware that compromises consumer and corporate devices, thereby potentially undermining the security of critical financial systems. Recent

  6. Discerning Novel Value Chains in Financial Malware : On the Economic Incentives and Criminal Business Models in Financial Malware Schemes

    NARCIS (Netherlands)

    van Wegberg, R.S.; Klievink, A.J.; van Eeten, M.J.G.

    Fraud with online payment services is an ongoing problem, with significant financial-economic and societal impact. One of the main modus operandi is financial malware that compromises consumer and corporate devices, thereby potentially undermining the security of critical financial systems.

  7. Discerning Novel Value Chains in Financial Malware : On the Economic Incentives and Criminal Business Models in Financial Malware Schemes

    NARCIS (Netherlands)

    van Wegberg, R.S.; Klievink, A.J.; van Eeten, M.J.G.

    2017-01-01

    Fraud with online payment services is an ongoing problem, with significant financial-economic and societal impact. One of the main modus operandi is financial malware that compromises consumer and corporate devices, thereby potentially undermining the security of critical financial systems.

  8. Derivative financial instruments and nonprofit health care providers.

    Science.gov (United States)

    Stewart, Louis J; Owhoso, Vincent

    2004-01-01

    This article examines the extent of derivative financial instrument use among US nonprofit health systems and the impact of these financial instruments on their cash flows, reported operating results, and financial risks. Our examination is conducted through a case study of New Jersey hospitals and health systems. We review the existing literature on interest rate derivative instruments and US hospitals and health systems. This literature describes the design of these derivative financial instruments and the theoretical benefits of their use by large health care provider organizations. Our contribution to the literature is to provide an empirical evaluation of derivative financial instruments usage among a geographically limited sample of US nonprofit health systems. We reviewed the audited financial statements of the 49 community hospitals and multi-hospital health systems operating in the state of New Jersey. We found that 8 percent of New Jersey's nonprofit health providers utilized interest rate derivatives with an aggregate principle value of $229 million. These derivative users combine interest rate swaps and caps to lower the effective interest costs of their long-term debt while limiting their exposure to future interest rate increases. In addition, while derivative assets and liabilities have an immaterial balance sheet impact, derivative related gains and losses are a material component of their reported operating results. We also found that derivative usage among these four health systems was responsible for generating positive cash flows in the range of 1 percent to 2 percent of their total 2001 cash flows from operations. As a result of our admittedly limited samples we conclude that interest rate swaps and caps are effective risk management tools. However, we also found that while these derivative financial instruments are useful hedges against the risks of issuing long-term financing instruments, they also expose derivative users to credit, contract

  9. Financial protection of patients through compensation of providers: the impact of Health Equity Funds in Cambodia.

    Science.gov (United States)

    Flores, Gabriela; Ir, Por; Men, Chean R; O'Donnell, Owen; van Doorslaer, Eddy

    2013-12-01

    Public providers have no financial incentive to respect their legal obligation to exempt the poor from user fees. Health Equity Funds (HEFs) aim to make exemptions effective by giving NGOs responsibility for assessing eligibility and compensating providers for lost revenue. We use the geographic spread of HEFs over time in Cambodia to identify their impact on out-of-pocket (OOP) payments. Among households with some OOP payment, HEFs reduce the amount paid by 35%, on average. The effect is larger for households that are poorer and mainly use public health care. Reimbursement of providers through a government operated scheme also reduces household OOP payments but the effect is not as well targeted on the poor. Both compensation models raise household non-medical consumption but have no impact on health-related debt. HEFs reduce the probability of primarily seeking care in the private sector. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives.

    Science.gov (United States)

    Bertone, Maria Paola; Witter, Sophie

    2015-07-28

    Human resources for health represent an essential component of health systems and play a key role to accelerate progress towards universal health coverage. Many countries in sub-Saharan Africa face challenges regarding the availability, distribution and performance of health workers, which could be in part addressed by providing effective financial incentives. Based on an overview of the existing literature, the paper highlights the gaps in the existing research in low-income countries exploring the different components of health workers' incomes. It then proposes a novel approach to the analysis of financial incentives and delineates a research agenda, which could contribute to shed light on this topic. The article finds that, while there is ample research that investigates separately each of the incomes health workers may earn (for example, salary, fee-for-service payments, informal incomes, "top-ups" and per diems, dual practice and non-health activities), there is a dearth of studies which look at the health workers' "complex remuneration", that is, the whole of the financial incentives available. Little research exists which analyses simultaneously all revenues of health workers, quantifies the overall remuneration and explores its complexity, its multiple components and their features, as well as the possible interaction between income components. However, such a comprehensive approach is essential to fully comprehend health workers' incentives, by investigating the causes (at individual and system level) of the fragmentation in the income structure and the variability in income levels, as well as the consequences of the "complex remuneration" on motivation and performance. This proposition has important policy implications in terms of devising effective incentive packages as it calls for an active consideration of the role that "complex remuneration" plays in determining recruitment, retention and motivation patterns, as well as, more broadly, the

  11. Effect of modest pay-for-performance financial incentive on time-to-discharge summary dictation among medical residents.

    Science.gov (United States)

    Wolk, Adam; Wang, Erwin; Horak, Bernard; Cloonan, Patricia; Adams, Michael; Moore, Eileen; Jaipaul, Chitra Komal; Brown, Gabrielle; Dasgupta, Dabanjan; Deluca, Danielle; Grossman, Mila

    2013-01-01

    Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents. Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees. Timely completion of discharge summaries is necessary for effective follow-up after hospitalization, and residents perform the majority of discharge summary dictations in academic medical centers. Medicine residents with the lowest average discharge-to-dictation time during their 1-month inpatient medicine ward rotation were rewarded with a $50 gift card. Discharge data were captured using an autopopulating electronic database. The average discharge-to-dictation time was reduced from 7.44 to 1.84 days, representing a 75.3% decrease. Almost 90% of discharge summary dictations were performed on the day of discharge. A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.

  12. Discerning Novel Value Chains in Financial Malware: On the Economic Incentives and Criminal Business Models in Financial Malware Schemes

    OpenAIRE

    van Wegberg, R.S.; Klievink, A.J.; Van Eeten, M.J.G.

    2017-01-01

    Fraud with online payment services is an ongoing problem, with significant financial-economic and societal impact. One of the main modus operandi is financial malware that compromises consumer and corporate devices, thereby potentially undermining the security of critical financial systems. Recent research into the underground economy has shown that cybercriminals are organised around highly specialised tasks, such as pay-per-install markets for infected machines, malware-as-a-service and mon...

  13. Financial Incentives to Restructure Coal Mining Industry. Comparative Case Study Romania and State of Michigan, U.S.

    Directory of Open Access Journals (Sweden)

    Roger HAMLIN

    2006-10-01

    Full Text Available Former coal mining sites have always raised environmental and economic challenges for the areas where they were located, especially for those communities that were highly dependent on the coal mining industry. The present paper will explore the factors leading to the decline of coal mining industry in Romania and State of Michigan, U.S., the social, economic and environmental impact that occurred after closing coal extractions and the approaches that the two states took to reconstruct the economy of the former mining areas. The paper attempts to make recommendations of financial incentives that can be used to foster the economic redevelopment of former coal mining sites in Romania.

  14. Incentives and regulation in banking

    NARCIS (Netherlands)

    Martynova, N.

    2015-01-01

    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

  15. FINANCIAL LITERACY, FINANCIAL EDUCATION AND ECONOMIC OUTCOMES.

    Science.gov (United States)

    Hastings, Justine S; Madrian, Brigitte C; Skimmyhorn, William L

    2013-05-01

    In this article we review the literature on financial literacy, financial education, and consumer financial outcomes. We consider how financial literacy is measured in the current literature, and examine how well the existing literature addresses whether financial education improves financial literacy or personal financial outcomes. We discuss the extent to which a competitive market provides incentives for firms to educate consumers or offer products that facilitate informed choice. We review the literature on alternative policies to improve financial outcomes, and compare the evidence to evidence on the efficacy and cost of financial education. Finally, we discuss directions for future research.

  16. Behavior analysts in the war on poverty: A review of the use of financial incentives to promote education and employment.

    Science.gov (United States)

    Holtyn, August F; Jarvis, Brantley P; Silverman, Kenneth

    2017-01-01

    Poverty is a pervasive risk factor underlying poor health. Many interventions that have sought to reduce health disparities associated with poverty have focused on improving health-related behaviors of low-income adults. Poverty itself could be targeted to improve health, but this approach would require programs that can consistently move poor individuals out of poverty. Governments and other organizations in the United States have tested a diverse range of antipoverty programs, generally on a large scale and in conjunction with welfare reform initiatives. This paper reviews antipoverty programs that used financial incentives to promote education and employment among welfare recipients and other low-income adults. The incentive-based, antipoverty programs had small or no effects on the target behaviors; they were implemented on large scales from the outset, without systematic development and evaluation of their components; and they did not apply principles of operant conditioning that have been shown to determine the effectiveness of incentive or reinforcement interventions. By applying basic principles of operant conditioning, behavior analysts could help address poverty and improve health through development of effective antipoverty programs. This paper describes a potential framework for a behavior-analytic antipoverty program, with the goal of illustrating that behavior analysts could be uniquely suited to make substantial contributions to the war on poverty. © 2017 Society for the Experimental Analysis of Behavior.

  17. National differences in incentive compensation practices : The differing roles of financial performance measurement in the United States and the Netherlands

    NARCIS (Netherlands)

    Jansen, E. Pieter; Merchant, Kenneth A.; Van der Stede, Wim A.

    This paper describes the findings of a study aimed at providing an international replication of a US-based study by Gibbs et al. [Gibbs, M., Merchant, K., Van der Stede, W., & Vargus, M. (2004). Determinants and effects of subjectivity in incentives. The Accounting Review, 79(2), 409-436; Gibbs, M.,

  18. Decision-making in general practice: the effect of financial incentives on the use of laboratory analyses.

    Science.gov (United States)

    Munkerud, Siri Fauli

    2012-04-01

    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.

  19. Birth weight differences between those offered financial voucher incentives for verified smoking cessation and control participants enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), employing an intuitive approach and a Complier Average Causal Effects (CACE) analysis.

    Science.gov (United States)

    McConnachie, Alex; Haig, Caroline; Sinclair, Lesley; Bauld, Linda; Tappin, David M

    2017-07-20

    The Cessation in Pregnancy Incentives Trial (CPIT), which offered financial incentives for smoking cessation during pregnancy showed a clinically and statistically significant improvement in cessation. However, infant birth weight was not seen to be affected. This study re-examines birth weight using an intuitive and a complier average causal effects (CACE) method to uncover important information missed by intention-to-treat analysis. CPIT offered financial incentives up to £400 to pregnant smokers to quit. With incentives, 68 women (23.1%) were confirmed non-smokers at primary outcome, compared to 25 (8.7%) without incentives, a difference of 14.3% (Fisher test, p birth weight gain with incentives is attributable only to potential quitters. We compared an intuitive approach to a CACE analysis. Mean birth weight of potential quitters in the incentives intervention group (who therefore quit) was 3338 g compared with potential quitters in the control group (who did not quit) 3193 g. The difference attributable to incentives, was 3338 - 3193 = 145 g (95% CI -617, +803). The mean difference in birth weight between the intervention and control groups was 21 g, and the difference in the proportion who managed to quit was 14.3%. Since the intervention consisted of the offer of incentives to quit smoking, the intervention was received by all women in the intervention group. However, "compliance" was successfully quitting with incentives, and the CACE analysis yielded an identical result, causal birth weight increase 21 g ÷ 0.143 = 145 g. Policy makers have great difficulty giving pregnant women money to stop smoking. This study indicates that a small clinically insignificant improvement in average birth weight is likely to hide an important clinically significant increase in infants born to pregnant smokers who want to stop but cannot achieve smoking cessation without the addition of financial voucher incentives. ISRCTN Registry, ISRCTN87508788

  20. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools

    Directory of Open Access Journals (Sweden)

    Imhoff Ingo

    2006-08-01

    Full Text Available Abstract Background There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya. Methods The study design entailed semi-structured qualitative interviews with doctors and nurses from public, private and NGO facilities in rural areas. The selection of health professionals was the result of a layered sampling process. In Benin 62 interviews with health professionals were carried out; in Kenya 37 were obtained. Results from individual interviews were backed up with information from focus group discussions. For further contextual information, interviews with civil servants in the Ministry of Health and at the district level were carried out. The interview material was coded and quantitative data was analysed with SPSS software. Results and discussion The study shows that health workers overall are strongly guided by their professional conscience and similar aspects related to professional ethos. In fact, many health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied human resources management (HRM tools. The paper also indicates that even some HRM tools that are applied may adversely affect the motivation of health workers. Conclusion The findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. Adequate HRM tools can uphold and strengthen the

  1. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools.

    Science.gov (United States)

    Mathauer, Inke; Imhoff, Ingo

    2006-08-29

    There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya. The study design entailed semi-structured qualitative interviews with doctors and nurses from public, private and NGO facilities in rural areas. The selection of health professionals was the result of a layered sampling process. In Benin 62 interviews with health professionals were carried out; in Kenya 37 were obtained. Results from individual interviews were backed up with information from focus group discussions. For further contextual information, interviews with civil servants in the Ministry of Health and at the district level were carried out. The interview material was coded and quantitative data was analysed with SPSS software. The study shows that health workers overall are strongly guided by their professional conscience and similar aspects related to professional ethos. In fact, many health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied human resources management (HRM) tools. The paper also indicates that even some HRM tools that are applied may adversely affect the motivation of health workers. The findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. Adequate HRM tools can uphold and strengthen the professional ethos of doctors and nurses. This entails acknowledging their

  2. Large performance incentives had the greatest impact on providers whose quality metrics were lowest at baseline.

    Science.gov (United States)

    Greene, Jessica; Hibbard, Judith H; Overton, Valerie

    2015-04-01

    This study examined the impact of Fairview Health Services' primary care provider compensation model, in which 40 percent of compensation was based on clinic-level quality outcomes. Fairview Health Services is a Pioneer accountable care organization in Minnesota. Using publicly reported performance data from 2010 and 2012, we found that Fairview's improvement in quality metrics was not greater than the improvement in other comparable Minnesota medical groups. An analysis of Fairview's administrative data found that the largest predictor of improvement over the first two years of the compensation model was primary care providers' baseline quality performance. Providers whose baseline performance was in the lowest tertile improved three times more, on average, across the three quality metrics studied than those in the middle tertile, and almost six times more than those in the top tertile. As a result, there was a narrowing of variation in performance across all primary care providers at Fairview and a narrowing of the gap in quality between providers who treated the highest-income patient panels and those who treated the lowest-income panels. The large quality incentive fell short of its overall quality improvement aim. However, the results suggest that payment reform may help narrow variation in primary care provider performance, which can translate into narrowing socioeconomic disparities. Project HOPE—The People-to-People Health Foundation, Inc.

  3. The Medicare Electronic Health Record Incentive Program: provider performance on core and menu measures.

    Science.gov (United States)

    Wright, Adam; Feblowitz, Joshua; Samal, Lipika; McCoy, Allison B; Sittig, Dean F

    2014-02-01

    To measure performance by eligible health care providers on CMS's meaningful use measures. Medicare Electronic Health Record Incentive Program Eligible Professionals Public Use File (PUF), which contains data on meaningful use attestations by 237,267 eligible providers through May 31, 2013. Cross-sectional analysis of the 15 core and 10 menu measures pertaining to use of EHR functions reported in the PUF. Providers in the dataset performed strongly on all core measures, with the most frequent response for each of the 15 measures being 90-100 percent compliance, even when the threshold for a particular measure was lower (e.g., 30 percent). PCPs had higher scores than specialists for computerized order entry, maintaining an active medication list, and documenting vital signs, while specialists had higher scores for maintaining a problem list, recording patient demographics and smoking status, and for providing patients with an after-visit summary. In fact, 90.2 percent of eligible providers claimed at least one exclusion, and half claimed two or more. Providers are successfully attesting to CMS's requirements, and often exceeding the thresholds required by CMS; however, some troubling patterns in exclusions are present. CMS should raise program requirements in future years. © Health Research and Educational Trust.

  4. In-Center Nutrition Practices of Clinics within a Large Hemodialysis Provider in the United States.

    Science.gov (United States)

    Benner, Debbie; Burgess, Mary; Stasios, Maria; Brosch, Becky; Wilund, Ken; Shen, Sa; Kistler, Brandon

    2016-05-06

    Eating during hemodialysis treatment remains a controversial topic. It is perceived that more restrictive practices in the United States contribute to poorer nutritional status and elevated mortality compared with some other parts of the world. However, in-center food practices in the United States have not been previously described. In 2011, we conducted a survey of clinic practices and clinician (dietitian, facility administrator, and medical director) opinions related to in-center food consumption within a large dialysis organization. After the initial survey, we provided clinicians with educational materials about eating during treatment. In 2014, we performed a follow-up survey. Differences in practices and opinions were analyzed using chi-squared tests and logistic regression. In 2011, 343 of 1199 clinics (28.6%) did not allow eating during treatment, 222 clinics (18.2%) did not allow drinking during treatment, and 19 clinics (1.6%) did not allow eating at the facility before or after treatment. In 2014, the proportion of clinics that did not allow eating during treatment had declined to 22.6% (321 of 1422 clinics), a significant shift in practice (Pnutritional status. Among clinicians, a higher percentage encouraged eating during treatment (53.1% versus 37.4%; P<0.05), and facility administrators and medical directors were less concerned about the seven reasons commonly cited for restricting eating during treatment in 2014 compared with 2011 (P<0.05 for all). We found that 28.6% and 22.6% of hemodialysis clinics within the United States restricted eating during treatment in 2011 and 2014, respectively, a rate more than double that found in an international cohort on which we previously published. However, practices and clinician opinions are shifting toward allowing patients to eat. Additional research is warranted to understand the effect that these practices have on patient outcomes and outline best practices. Copyright © 2016 by the American Society of

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

    Science.gov (United States)

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

    2013-04-01

    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. Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives.

    Science.gov (United States)

    Whellan, David J; Reed, Shelby D; Liao, Lawrence; Gould, Stuart D; O'connor, Christopher M; Schulman, Kevin A

    2007-01-15

    Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.

  7. Pilot Study to Test the Effectiveness of Different Financial Incentives to Improve Medication Adherence.

    Science.gov (United States)

    Garza, Kimberly B; Owensby, Justin K; Braxton Lloyd, Kimberly; Wood, Elizabeth A; Hansen, Richard A

    2016-01-01

    Medication nonadherence affects health care costs, morbidity, and mortality. Concepts from behavioral economics can guide the development of interventions to improve medication adherence. To measure the relative effectiveness of 2 behavioral economic-based incentive structures to improve medication adherence. This randomized controlled trial compared adherence among participants taking antihypertensive or antihyperlipidemic medications randomized to usual care (UC), guaranteed pay-out (GPO) incentives, or lottery incentives. Daily adherence was measured over a 90-day period using electronic caps (Medication Event Monitoring System [MEMS]). The GPO group received $30 up-front in a virtual account, with $0.50 deducted for each missed dose. Lottery group participants were eligible for a weekly $50 drawing, but only if they had taken their medication as prescribed all week. An electronic survey assessed self-reported adherence. Statistical analysis included descriptive statistics, paired t tests, ANOVA, and Pearson's correlations. In all, 36 participants were randomized (UC, n = 11; GPO, n = 14; lottery, n = 11). Mean percentage (±SD) of days adherent during the incentive period was highest in the lottery group (96% ± 5%), followed by the GPO group (94% ± 9%) and the UC group (94% ± 9%). There were no statistically significant differences among groups (P > 0.05). MEMS-measured adherence was not significantly correlated with a patient's self-reported adherence (P > 0.05) at baseline but was correlated at 90-day follow-up (P statistically significant differences in adherence were demonstrated in this small sample of highly adherent participants, larger studies in a more diverse population or with other medications might show otherwise. © The Author(s) 2015.

  8. Motivation and incentives of rural maternal and neonatal health care providers: a comparison of qualitative findings from Burkina Faso, Ghana and Tanzania.

    Science.gov (United States)

    Prytherch, Helen; Kagoné, Moubassira; Aninanya, Gifty A; Williams, John E; Kakoko, Deodatus C V; Leshabari, Melkidezek T; Yé, Maurice; Marx, Michael; Sauerborn, Rainer

    2013-04-25

    In Burkina Faso, Ghana and Tanzania strong efforts are being made to improve the quality of maternal and neonatal health (MNH) care. However, progress is impeded by challenges, especially in the area of human resources. All three countries are striving not only to scale up the number of available health staff, but also to improve performance by raising skill levels and enhancing provider motivation. In-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Interviews were held with 25 MNH providers, 8 facility and district managers, and 2 policy-makers in each country. Across the three countries some differences were found in the reasons why people became health workers. Commitment to remaining a health worker was generally high. The readiness to remain at a rural facility was far less, although in all settings there were some providers that were willing to stay. In Burkina Faso it appeared to be particularly difficult to recruit female MNH providers to rural areas. There were indications that MNH providers in all the settings sometimes failed to treat their patients well. This was shown to be interlinked with differences in how the term 'motivation' was understood, and in the views held about remuneration and the status of rural health work. Job satisfaction was shown to be quite high, and was particularly linked to community appreciation. With some important exceptions, there was a strong level of agreement regarding the financial and non-financial incentives that were suggested by these providers, but there were clear country preferences as to whether incentives should be for individuals or teams. Understandings of the terms and concepts pertaining to motivation differed between the three countries. The findings from Burkina Faso underline the importance of gender-sensitive health workforce planning. The training that all levels of MNH providers receive in

  9. Using a Financial Health Model to Provide Context for Financial Literacy Education Research: A Commentary

    Science.gov (United States)

    Huston, Sandra J.

    2015-01-01

    In the article, "Enhancing links between research and practice to improve consumer financial education and well-being" Billy J. Hensley, Director of Education at National Endowment for Financial Education® (NEFE®), outlines his perspective on the current relation between financial education and financial outcome (downstream financial…

  10. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach.

    Science.gov (United States)

    Agyepong, Irene A; Aryeetey, Geneieve C; Nonvignon, Justice; Asenso-Boadi, Francis; Dzikunu, Helen; Antwi, Edward; Ankrah, Daniel; Adjei-Acquah, Charles; Esena, Reuben; Aikins, Moses; Arhinful, Daniel K

    2014-08-05

    Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear

  11. DietBet: A Web-Based Program that Uses Social Gaming and Financial Incentives to Promote Weight Loss

    Science.gov (United States)

    Rosen, Jamie

    2014-01-01

    Background Web-based commercial weight loss programs are increasing in popularity. Despite their significant public health potential, there is limited research on the effectiveness of such programs. Objective The objective of our study was to examine weight losses produced by DietBet and explore whether baseline and engagement variables predict weight outcomes. Methods DietBet is a social gaming website that uses financial incentives and social influence to promote weight loss. Players bet money and join a game. All players have 4 weeks to lose 4% of their initial body weight. At enrollment, players can choose to share their participation on Facebook. During the game, players interact with one another and report their weight loss on the DietBet platform. At week 4, all players within each game who lose at least 4% of initial body weight are declared winners and split the pool of money bet at the start of the game. Official weigh-in procedures are used to verify weights at the start of the game and at the end. Results From December 2012 to July 2013, 39,387 players (84.04% female, 33,101/39,387; mean weight 87.8kg, SD 22.6kg) competed in 1934 games. The average amount bet was US $27 (SD US $22). A total of 65.63% (25,849/39,387) provided a verified weight at the end of the 4-week competition. The average intention-to-treat weight loss was 2.6% (SD 2.3%). Winners (n=17,171) won an average of US $59 (SD US $35) and lost 4.9% (SD 1.0%) of initial body weight, with 30.68% (5268/17,171) losing 5% or more of their initial weight. Betting more money at game entry, sharing on Facebook, completing more weigh-ins, and having more social interactions during the game predicted greater weight loss and greater likelihood of winning (Psweight loss clustered within games (Pweight outcomes. Conclusions DietBet, a social gaming website, reached nearly 40,000 individuals in just 7 months and produced excellent 4-week weight loss results. Given its reach and potential public health

  12. DietBet: A Web-Based Program that Uses Social Gaming and Financial Incentives to Promote Weight Loss.

    Science.gov (United States)

    Leahey, Tricia; Rosen, Jamie

    2014-02-07

    Web-based commercial weight loss programs are increasing in popularity. Despite their significant public health potential, there is limited research on the effectiveness of such programs. The objective of our study was to examine weight losses produced by DietBet and explore whether baseline and engagement variables predict weight outcomes. DietBet is a social gaming website that uses financial incentives and social influence to promote weight loss. Players bet money and join a game. All players have 4 weeks to lose 4% of their initial body weight. At enrollment, players can choose to share their participation on Facebook. During the game, players interact with one another and report their weight loss on the DietBet platform. At week 4, all players within each game who lose at least 4% of initial body weight are declared winners and split the pool of money bet at the start of the game. Official weigh-in procedures are used to verify weights at the start of the game and at the end. From December 2012 to July 2013, 39,387 players (84.04% female, 33,101/39,387; mean weight 87.8kg, SD 22.6kg) competed in 1934 games. The average amount bet was US $27 (SD US $22). A total of 65.63% (25,849/39,387) provided a verified weight at the end of the 4-week competition. The average intention-to-treat weight loss was 2.6% (SD 2.3%). Winners (n=17,171) won an average of US $59 (SD US $35) and lost 4.9% (SD 1.0%) of initial body weight, with 30.68% (5268/17,171) losing 5% or more of their initial weight. Betting more money at game entry, sharing on Facebook, completing more weigh-ins, and having more social interactions during the game predicted greater weight loss and greater likelihood of winning (Ps<.001). In addition, weight loss clustered within games (P<.001), suggesting that players influenced each others' weight outcomes. DietBet, a social gaming website, reached nearly 40,000 individuals in just 7 months and produced excellent 4-week weight loss results. Given its reach and

  13. Money for medication: a randomized controlled study on the effectiveness of financial incentives to improve medication adherence in patients with psychotic disorders.

    Science.gov (United States)

    Noordraven, Ernst L; Audier, Charlotte H; Staring, Anton B P; Wierdsma, Andre I; Blanken, Peter; van der Hoorn, Bas E A; Roijen, Leona Hakkaart-van; Mulder, Cornelis L

    2014-12-02

    Non-adherence with antipsychotic medication is a frequently occurring problem, particularly among patients with psychotic disorders. Prior research has generally shown encouraging results for interventions based on 'Contingency Management' (CM), in which desirable behaviour is encouraged by providing rewards contingent upon the behaviour. However, little is known about the application of CM on medication adherence in patients with psychotic disorders. An earlier pilot-study by our study group showed promising results in reducing admission days and increasing adherence. The current study is a randomized controlled trial concerning the effectiveness of a CM procedure called 'Money for Medication' (M4M), aimed at improving adherence with antipsychotic depot medication in psychotic disorder patients. Outpatients (n =168) with a psychotic disorder will be randomly assigned to either the experimental group (n =84), receiving a financial reward for each accepted antipsychotic medication depot, or the control group (n =84), receiving treatment as usual without financial rewards. Patients are included regardless of their previous adherence. The intervention has a duration of twelve months. During the subsequent six months follow-up, the effects of discontinuing the intervention on depot acceptance will be assessed. The primary goal of this study is to assess the effectiveness of providing financial incentives for improving adherence with antipsychotic depot medication (during and after the intervention). The primary outcome measure is the percentage of accepted depots in comparison to prescription. Secondary, we will consider alternative measures of medication acceptance, i.e. the longest period of uninterrupted depot acceptance and the time expired before depot is taken. Additionally, the effectiveness of the experimental intervention will be assessed in terms of psychosocial functioning, substance use, medication side-effects, quality of life, motivation, cost-utility and

  14. Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: Patients' and clinicians' perspectives after a 12-month randomized controlled trial

    NARCIS (Netherlands)

    E.L. Noordraven (Ernst); M.H.N. Schermer (Maartje); P. Blanken (Peter); C.L. Mulder (Niels); A.I. Wierdsma (André)

    2017-01-01

    textabstractBackground: A randomized controlled trial 'Money for Medication'(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication. This study assessed the attitudes and ethical considerations of patients and clinicians who participated in

  15. A labeling system as stepping-stone for financial incentives related to sustainable housing

    NARCIS (Netherlands)

    Hal, van J.D.M. (Anke)

    2007-01-01

    In 2004, the Dutch National Sustainable Building Center set up a research project to investigate the widespread belief that sustainable building is more expensive than standard building practice. The results disproved this assumption and demonstrated that sustainable building can be financially

  16. Incentive-based Financial Support Scheme for Immature Renewable Energy Systems

    DEFF Research Database (Denmark)

    Andersen, Morten Thøtt; Frigaard, Peter Bak

    2015-01-01

    Most of today’s renewable energy systems rely heavily on investments as well as public financial support. This support is often given by means of a higher sales price for each kWh produced, i.e. feed-in tariffs (FITs), green certificates or Renewable Obligation Certificates (ROCs), or by a fixed...

  17. 0-1 Test for Chaos in a Fractional Order Financial System with Investment Incentive

    Directory of Open Access Journals (Sweden)

    Baogui Xin

    2013-01-01

    weighted integral thought, the fractional order derivative's economics meaning is given. The 0-1 test algorithm and the improved Adams-Bashforth-Moulton predictor-corrector scheme are employed to detect numerically the chaos in the proposed fractional order financial system.

  18. Financial incentives improve recognition but not treatment of cardiovascular risk factors in severe mental illness.

    Directory of Open Access Journals (Sweden)

    Carol L Wilson

    Full Text Available Severe mental illness (SMI is associated with premature cardiovascular disease, prompting the UK primary care payment-for-performance system (Quality and Outcomes Framework, QOF to incentivise annual physical health reviews. This study aimed to assess the QOF's impact on detection and treatment of cardiovascular risk factors in people with SMI.A retrospective open cohort study of UK general practice was conducted between 1996 and 2014, using segmented logistic regression with 2004 and 2011 as break points, reflecting the introduction of relevant QOF incentives in these years. 67239 SMI cases and 359951 randomly-selected unmatched controls were extracted from the Clinical Practice Research Datalink (CPRD.There was strong evidence (p≤0.015 the 2004 QOF indicator (general health resulted in an immediate increase in recording of elevated cholesterol (odds ratio 1.37 (95% confidence interval 1.24 to 1.51; obesity (OR 1.21 (1.06 to 1.38; and hypertension (OR 1.19 (1.04 to 1.38 in the SMI group compared with the control group, which was sustained in subsequent years. Similar findings were found for diabetes, although the evidence was weaker (p = 0.059; OR 1.21 (0.99 to 1.49. There was evidence (p<0.001 of a further, but unsustained, increase in recording of elevated cholesterol and obesity in the SMI group following the 2011 QOF indicator (cardiovascular specific. There was no clear evidence that the QOF indicators affected the prescribing of lipid modifying medications or anti-diabetic medications.Incentivising general physical health review for SMI improves identification of cardiovascular risk factors, although the additional value of specifically incentivising cardiovascular risk factor assessment is unclear. However, incentives do not affect pharmacological management of these risks.

  19. Financial incentives improve recognition but not treatment of cardiovascular risk factors in severe mental illness.

    Science.gov (United States)

    Wilson, Carol L; Rhodes, Kirsty M; Payne, Rupert A

    2017-01-01

    Severe mental illness (SMI) is associated with premature cardiovascular disease, prompting the UK primary care payment-for-performance system (Quality and Outcomes Framework, QOF) to incentivise annual physical health reviews. This study aimed to assess the QOF's impact on detection and treatment of cardiovascular risk factors in people with SMI. A retrospective open cohort study of UK general practice was conducted between 1996 and 2014, using segmented logistic regression with 2004 and 2011 as break points, reflecting the introduction of relevant QOF incentives in these years. 67239 SMI cases and 359951 randomly-selected unmatched controls were extracted from the Clinical Practice Research Datalink (CPRD). There was strong evidence (p≤0.015) the 2004 QOF indicator (general health) resulted in an immediate increase in recording of elevated cholesterol (odds ratio 1.37 (95% confidence interval 1.24 to 1.51)); obesity (OR 1.21 (1.06 to 1.38)); and hypertension (OR 1.19 (1.04 to 1.38)) in the SMI group compared with the control group, which was sustained in subsequent years. Similar findings were found for diabetes, although the evidence was weaker (p = 0.059; OR 1.21 (0.99 to 1.49)). There was evidence (paffected the prescribing of lipid modifying medications or anti-diabetic medications. Incentivising general physical health review for SMI improves identification of cardiovascular risk factors, although the additional value of specifically incentivising cardiovascular risk factor assessment is unclear. However, incentives do not affect pharmacological management of these risks.

  20. Financial Incentives for Increasing Uptake of HPV Vaccinations: A Randomized Controlled Trial

    Science.gov (United States)

    2014-01-01

    Objective: Uptake of human papillomavirus (HPV) vaccinations by 17- to 18-year-old girls in England is below (incentives on uptake and completion of an HPV vaccination program, and (b) whether impacts are moderated by participants’ deprivation level. It also assesses the impact of incentives on decision quality to get vaccinated, as measured by attitudes toward the vaccination and knowledge of its consequences. Method: One thousand 16- to 18-year-old girls were invited to participate in an HPV vaccination program: 500 previously uninvited, and 500 unresponsive to previous invitations. Girls randomly received either a standard invitation letter or a letter including the offer of vouchers worth £45 (€56; $73) for undergoing 3 vaccinations. Girls attending their first vaccination appointment completed a questionnaire assessing decision quality to be vaccinated. Outcomes were uptake of the first and third vaccinations and decision quality. Results: The intervention increased uptake of the first (first-time invitees: 28.4% vs. 19.6%, odds ratio [OR] = 1.63, 95% confidence interval [CI; 1.08, 2.47]; previous nonattenders: 23.6% vs. 10.4%, OR = 2.65, 95% CI [1.61, 4.38]) and third (first-time invitees: 22.4% vs. 12%, OR = 2.15, 95% CI [1.32, 3.50]; previous nonattenders: 12.4% vs. 3%, OR = 4.28, 95% CI [1.92, 9.55]) vaccinations. Impacts were not moderated by deprivation level. Decision quality was unaffected by the intervention. Conclusions: Although the intervention increased completion of HPV vaccinations, uptake remained lower than the national target, which, in addition to cost effectiveness and acceptability issues, necessitates consideration of other ways of achieving it. PMID:25133822

  1. ABOUT THE MECHANISM OF FINANCIAL INCENTIVE FOR THE DEVELOPERS OF IT SYSTEMS

    Directory of Open Access Journals (Sweden)

    Alexey S. Dobrynin

    2015-01-01

    Full Text Available Improving the performance of the developers of hardware and software systems and IT systems it is inextricably linked with quality incentives. People are motivated to work and are able to achieve good results, focusing on decent remuneration. Non-rational approaches to remuneration are able to generate social problems and greatly reduce the overall efficiency of the organizational systems. Motivation mobile teams of IT developers and individuals engaged in the operational management of the project implementation is of paramount importance. The article examines the mechanisms for stimulating the synthesis development of IT systems based on the principle of coordinated control that allows you to bring together the interests of the customers and performers. It is expected that customers and performers interested in creating all the necessary conditions (investment, social, technological to obtain high-quality final product. The customer agrees with the developer on the approximate number of design iterations, each iteration of the composition, timing and budgets required to achieve the desired result. By means of evaluating the effectiveness of business results are metric tests, including functional and modular (unit tests, created in direct contact representatives of the customer and the developer. This mechanism should be used in mobile teams, in which the development is relatively short iterations with stepwise refinement of business requirements.

  2. The impact of an m-Health financial incentives program on the physical activity and diet of Australian truck drivers

    Directory of Open Access Journals (Sweden)

    Nicholas D. Gilson

    2017-05-01

    Full Text Available Abstract Background Chronic diseases are high in truck drivers and have been linked to work routines that promote inactivity and poor diets. This feasibility study examined the extent to which an m-Health financial incentives program facilitated physical activity and healthy dietary choices in Australian truck drivers. Methods Nineteen men (mean [SD] age = 47.5 [9.8] years; BMI = 31.2 [4.6] kg/m2 completed the 20-week program, and used an activity tracker and smartphone application (Jawbone UP™ to regulate small positive changes in occupational physical activity, and fruit, vegetable, saturated fat and processed/refined sugar food/beverage choices. Measures (baseline, end-program, 2-months follow-up; April–December 2014 were accelerometer-determined proportions of work time spent physically active, and a workday dietary questionnaire. Statistical (repeated measures ANOVA and thematic (interviews analyses assessed program impact. Results Non-significant increases in the mean proportions of work time spent physically active were found at end-program and follow-up (+1%; 7 mins/day. Fruit (p = 0.023 and vegetable (p = 0.024 consumption significantly increased by one serve/day at end-program. Non-significant improvements in saturated fat (5% and processed/refined sugar (1% food/beverage choices were found at end-program and follow-up. Overall, 65% (n = 11 of drivers demonstrated positive changes in physical activity, and at least one dietary choice (e.g. saturated fat at follow-up. Drivers found the financial incentives component of the program to be a less effective facilitator of change than the activity tracker and smartphone application, although this technology was easier to use for monitoring of physical activity than healthy dietary choices. Conclusions Not all drivers benefitted from the program. However, positive changes for different health behaviours were observed in the majority of participants. Outcomes from this

  3. Is there a financial incentive to immigrate? Examining of the health worker salary gap between India and popular destination countries.

    Science.gov (United States)

    George, Gavin; Rhodes, Bruce

    2017-10-19

    International migration is one of the factors resulting in the shortage of Human Resources for Health (HRH) in India. Literature suggests that migration is fuelled by the prospect of higher salaries available abroad. The extent of these salary differentials are unknown, and this study seeks to examine the salaries of selected HRH in India and four popular destination countries (United States of America, United Kingdom, Canada and the United Arab Emirates), whilst accounting for the in-country cost of living. This study will therefore determine truer financial incentives for Indian HRH to migrate abroad. A purchasing power parity (PPP) ratio is employed to equalise the international price of buying a representative basket of commonly bought goods (including food, entertainment, fuel and utilities). Using the PPP index, real differences in salaries are directly compared for selected work categories and different levels of work experience in the four respective countries. Nurses in the USA can earn up to 82.7% more than their Indian counterparts. Nurses in Canada and the UAE reveal more modest salary differentials, yet still significant better off by up to 28 and 20% respectively. Only nurses in the UK are potentially materially worse off than nurses working in India. We observe significant potential PPP gains of up to 57.4, 99.1 and 94.4% for medical doctors in the USA, Canada and the UAE respectively. Medical specialists potentially experience the greatest income disparities with anaesthetists potentially earning up to 600% more than their counterparts in India. Radiologists operating in the UK and general surgeons working in the USA can potentially earn more than double that of their counterparts working in India. We observe more modest positive or negligible PPP gains in other selected countries for health specialists. Even when considering the differences in the cost of living, the financial incentive for selected cadres of Indian HRH to seek work abroad remains

  4. The impact of an m-Health financial incentives program on the physical activity and diet of Australian truck drivers.

    Science.gov (United States)

    Gilson, Nicholas D; Pavey, Toby G; Wright, Olivia Rl; Vandelanotte, Corneel; Duncan, Mitch J; Gomersall, Sjaan; Trost, Stewart G; Brown, Wendy J

    2017-05-18

    Chronic diseases are high in truck drivers and have been linked to work routines that promote inactivity and poor diets. This feasibility study examined the extent to which an m-Health financial incentives program facilitated physical activity and healthy dietary choices in Australian truck drivers. Nineteen men (mean [SD] age = 47.5 [9.8] years; BMI = 31.2 [4.6] kg/m 2 ) completed the 20-week program, and used an activity tracker and smartphone application (Jawbone UP™) to regulate small positive changes in occupational physical activity, and fruit, vegetable, saturated fat and processed/refined sugar food/beverage choices. Measures (baseline, end-program, 2-months follow-up; April-December 2014) were accelerometer-determined proportions of work time spent physically active, and a workday dietary questionnaire. Statistical (repeated measures ANOVA) and thematic (interviews) analyses assessed program impact. Non-significant increases in the mean proportions of work time spent physically active were found at end-program and follow-up (+1%; 7 mins/day). Fruit (p = 0.023) and vegetable (p = 0.024) consumption significantly increased by one serve/day at end-program. Non-significant improvements in saturated fat (5%) and processed/refined sugar (1%) food/beverage choices were found at end-program and follow-up. Overall, 65% (n = 11) of drivers demonstrated positive changes in physical activity, and at least one dietary choice (e.g. saturated fat) at follow-up. Drivers found the financial incentives component of the program to be a less effective facilitator of change than the activity tracker and smartphone application, although this technology was easier to use for monitoring of physical activity than healthy dietary choices. Not all drivers benefitted from the program. However, positive changes for different health behaviours were observed in the majority of participants. Outcomes from this feasibility study inform future intervention development for

  5. Effectiveness of a financial incentive to physicians for timely follow-up after hospital discharge: a population-based time series analysis.

    Science.gov (United States)

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

    2017-10-02

    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.

  6. Cluster randomised controlled trial of a financial incentive for mothers to improve breast feeding in areas with low breastfeeding rates: the NOSH study protocol.

    Science.gov (United States)

    Relton, Clare; Strong, Mark; Renfrew, Mary J; Thomas, Kate; Burrows, Julia; Whelan, Barbara; Whitford, Heather M; Scott, Elaine; Fox-Rushby, Julia; Anoyke, Nana; Sanghera, Sabina; Johnson, Maxine; Easton, Sue; Walters, Stephen

    2016-04-11

    Breast feeding can promote positive long-term and short-term health outcomes in infant and mother. The UK has one of the lowest breastfeeding rates (duration and exclusivity) in the world, resulting in preventable morbidities and associated healthcare costs. Breastfeeding rates are also socially patterned, thereby potentially contributing to health inequalities. Financial incentives have been shown to have a positive effect on health behaviours in previously published studies. Based on data from earlier development and feasibility stages, a cluster (electoral ward) randomised trial with mixed-method process and content evaluation was designed. The 'Nourishing Start for Health' (NOSH) intervention comprises a financial incentive programme of up to 6 months duration, delivered by front-line healthcare professionals, in addition to existing breastfeeding support. The intervention aims to increase the prevalence and duration of breast feeding in wards with low breastfeeding rates. The comparator is usual care (no offer of NOSH intervention). Routine data on breastfeeding rates at 6-8 weeks will be collected for 92 clusters (electoral wards) on an estimated 10,833 births. This sample is calculated to provide 80% power in determining a 4% point difference in breastfeeding rates between groups. Content and process evaluation will include interviews with mothers, healthcare providers, funders and commissioners of infant feeding services. The economic analyses, using a healthcare provider's perspective, will be twofold, including a within-trial cost-effectiveness analysis and beyond-trial modelling of longer term expectations for cost-effectiveness. Results of economic analyses will be expressed as cost per percentage point change in cluster level in breastfeeding rates between trial arms. In addition, we will present difference in resource use impacts for a range of acute conditions in babies aged 0-6 months. Participating organisations Research and Governance

  7. Using educational outreach and a financial incentive to increase general practices' contribution to chlamydia screening in South-East London 2003-2011.

    Science.gov (United States)

    Kalwij, Sebastian; French, Sarah; Mugezi, Rumbi; Baraitser, Paula

    2012-09-18

    positivity rate was 3.9% in men and 5.3% in women. In 2003/04 13% tests in general practice (Lambeth) were from men, this increased to 25% in 2010/11. In Southwark this increased from 20% in 2003/04 to 27.6% in 2010/11. We compared the results with London and national data and showed significant differences between GP testing in Lambeth and Southwark, and GP testing in London and the rest of England. General practices can be important potential providers of chlamydia tests.With a combination of sustained support, financial incentives and feedback on performance, general practice may be able to test a large percentage of 15-24 year olds. General practice is also a potentially important provider of chlamydia tests to young men.

  8. 77 FR 65097 - Reimbursement to Financial Institutions for Providing Financial Records; Recordkeeping...

    Science.gov (United States)

    2012-10-25

    ... conform the citations and references to organizational changes adopted by the Director of the Financial... find regulatory requirements. With respect to the cross-references in Regulation S, 31 CFR 103.11 was... (Oct. 26, 2010). The Board is amending the cross-references in subpart B of its Regulation S to conform...

  9. California Energy Incentive Programs: An Annual Update on Key Energy Issues and Financial Opportunities for Federal Sites in California

    Energy Technology Data Exchange (ETDEWEB)

    None

    2011-12-01

    A spate of recently enacted energy legislation and associated program changes is providing numerous opportunities to help California federal energy managers cut costs and meet their renewables, energy efficiency and GHG emissions goals. In April 2011, Governor Jerry Brown approved the nation’s most ambitious renewable portfolio standard (RPS), which requires 33% of the state’s electricity to come from renewable energy sources by 2020. Policy changes that will support the RPS include expanded eligibility rules that fill previous gaps in incentives for certain sizes of on-site renewable energy systems. Program updates described in this document include: $200 million more in funding for California Solar Initiative rebates to commercial and industrial customers; an increase in the eligible system size for the Feed-In-Tariff (FIT) from 1.5MW to 3MW; and pending changes that may allow customer-side systems to sell tradable renewable energy credits (TRECs) to entities with RPS compliance obligations in California.

  10. Incentives for health.

    Science.gov (United States)

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

    2011-08-01

    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.

  11. Impact of a service provider incentive payment scheme on quality of reproductive and child-health services in Egypt.

    Science.gov (United States)

    Huntington, Dale; Zaky, Hassan H M; Shawky, Sherine; Fattah, Faten Abdel; El-Hadary, Eman

    2010-06-01

    A case-control, quasi-experimental study was designed (post-test only) to investigate the effect of a performance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. The results showed significant improvements in the quality of family-planning, antenatal care, and child-care services as reported by women seen in clinics where the incentive payment scheme was in operation as measured by various indicators, including both technical and inter-personal communication content. An analysis of characteristics of the service providers and clients found no significant or meaningful differences between the study groups, and the facilities of both the study groups were essentially the same. Some findings are suggestive of other influences on behaviours of the service providers not captured by the data-collection instruments of the study. Subsequent to this study, the payment scheme has been rolled out to other districts in Egypt.

  12. Solar workshops financial incentives

    Energy Technology Data Exchange (ETDEWEB)

    None

    1979-01-01

    Ten one-day workshops were held across the United States. Information in this workbook is compiled in conjunction with those workshops. The following discussions are included: solar as a fuel (history); why alternative fuels are being sought today; the need for conservation; advantages of solar energy; the potential of solar energy; why solar energy is not more widely used; a definition of solar; how solar can help meet energy demands; Federal policies and programs; what solar technologies exist today that can be effectively utilized (thermal applications, fuels from biomass, solar electric). Additional information is presented in three attachments: Energy-Conserving Methods; Domestic Policy Review of Solar Energy; and DOE Secretary's Annual Report to Congress-Solar Section. (MCW)

  13. A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace.

    Science.gov (United States)

    Dallat, Mary Anne T; Hunter, Ruth F; Tully, Mark A; Cairns, Karen J; Kee, Frank

    2013-10-10

    Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer's perspective. Employees used a 'loyalty card' to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates. The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds. The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer's perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable "business model" which

  14. Compliance Performance: Effects of a Provider Incentive Program and Coding Compliance Plan

    National Research Council Canada - National Science Library

    Tudela, Joseph A

    2004-01-01

    The purpose of this project is to study provider and coder related performance, i.e., provider compliance rate and coder productivity/accuracy rates and average dollar difference between coder and auditor, at Brooke Army Medical Center...

  15. It's all in the timing: Acceptability of a financial incentive intervention for linkage to HIV care in the HPTN 065 (TLC-Plus) study.

    Science.gov (United States)

    Shelus, Victoria; Taylor, Jamilah; Greene, Elizabeth; Stanton, Jill; Pack, Allison; Tolley, Elizabeth E; Branson, Bernard M; El-Sadr, Wafaa M; Pollydore, June; Gamble, Theresa

    2018-01-01

    The HPTN 065 (TLC-Plus) study tested the feasibility and effectiveness of using financial incentives (FIs) to increase linkage to care (L2C) among individuals with newly diagnosed HIV and those out of care in the Bronx, NY and Washington, DC. Qualitative data collection with a subset of participating patients and staff focused on experiences with and attitudes about the FI intervention. Semi-structured interviews were conducted with 15 patients and 14 site investigators. Four focus group discussions were conducted with a total of 15 staff members. The use of FIs for L2C was generally viewed favorably. Patients were grateful and benefited financially, but sites had some challenges implementing the program. Challenges included the timing and sensitive introduction of the intervention immediately after an HIV diagnosis, negative attitudes towards paying people for health behaviors, and the existence and strength of existing linkage programs. Future programs should consider optimal timing and presentation of FIs.

  16. Financial health and customer satisfaction in private health care providers in Brazil.

    Science.gov (United States)

    Schiozer, Rafael Felipe; Saito, Cristiana Checchia; Saito, Richard

    2011-11-01

    This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.

  17. Incentive Funding Meets Incentive-Based Budgeting: Can They Coexist?

    Science.gov (United States)

    Lang, Daniel W.

    2016-01-01

    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…

  18. Impact of gender and professional education on attitudes towards financial incentives for organ donation: results of a survey among 755 students of medicine and economics in Germany.

    Science.gov (United States)

    Inthorn, Julia; Wöhlke, Sabine; Schmidt, Fabian; Schicktanz, Silke

    2014-07-05

    There is an ongoing expert debate with regard to financial incentives in order to increase organ supply. However, there is a lacuna of empirical studies on whether citizens would actually support financial incentives for organ donation. Between October 2008 and February 2009 a quantitative survey was conducted among German students of medicine and economics to gain insights into their point of view regarding living and deceased organ donation and different forms of commercialization (n = 755). The average (passive) willingness to donate is 63.5% among medical students and 50.0% among students of economics (p = 0.001), while only 24.1% of the respondents were actually holding an organ donor card. 11.3% of students of economics had signed a donor card, however, the number is significantly higher among students of medicine (31.9%, p economics (p = 0.034). Despite a generally positive view on organ donation the respondents refuse to consent to commercialization, but are in favor of removing disincentives or are in favor of indirect models of reward.

  19. Not fully charged: Welfare effects of tax incentives for employer-provided electric cars

    NARCIS (Netherlands)

    Dimitropoulos, A.; van Ommeren, J.N.; Koster, P.R.; Rietveld, P.

    2016-01-01

    More than 15 million cars are provided as fringe benefits by employers in Europe. The company car market is the driving force of changes in European car fleets and one of the main channels for the penetration of low emission vehicles. Policies in support of low emission vehicles through this channel

  20. What might the English NHS learn about quality from Tuscany? Moving from financial and bureaucratic incentives towards 'social' drivers

    NARCIS (Netherlands)

    Brown, P.; Vainieri, M.; Bonini, A.; Nuti, S.; Calnan, M.

    2012-01-01

    Governance systems which are based on assumptions of purposive-rational action have received significant criticism. For example recent quality and performance frameworks of the English NHS have tended towards incentives and sanctions, and have been critiqued in terms of both the logic on which they

  1. Providing Quality Therapeutics in Switzerland: Role of the Stakeholders and Recent Incentives for Further Improvements.

    Science.gov (United States)

    Besson, Marie; Samer, Caroline; Rollason, Victoria; Dayer, Pierre; Desmeules, Jules

    2015-07-01

    Quality therapeutics play an important role in Switzerland's health care and economy. Switzerland holds a key position in the world of research and development, as well as in drug production. Recently, new emphasis has been placed on promoting clinical research and maintaining Switzerland's position as a center of excellence in the field. Recent revisions to the law regarding medical trials in human research allow for better allocation of regulatory resources and simplified procedures for drugs already authorized in Switzerland. The country has its own regulatory agency, the Swiss Agency for Therapeutic Products (Swissmedic), which is a public institution of the Swiss government. Swissmedic is responsible for ensuring safety in medicines, particularly regarding authorizations and market surveillance in the sector of medicinal products and medical devices. Although the centralized authorization procedure of the European Union for medicines does not apply to Switzerland, there are mutual recognition mechanisms between the Swiss medicine regulatory authority and the European Medicines Agency. Swissmedic is also in charge of postmarketing safety and oversees the national pharmacovigilance center, which collaborates closely with the World Health Organization center in Uppsala. In addition, university hospital-based clinical pharmacologists, who are involved in basic science and clinical research, regulatory affairs, ethics committees, and pharmacovigilance, promote quality therapeutics. This article discusses the role of the various stakeholders and the recent efforts made to provide a better allocation of resources aimed at further improving quality therapeutics in Switzerland. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

  2. The Marketing-Finance Interface Towards Financial Services: with Special Reference to New Services Provided by Futures Exchanges

    NARCIS (Netherlands)

    Pennings, J.M.E.; Wetzels, M.G.M.; Meulenberg, M.T.G.

    1999-01-01

    The financial services industry is one of the fastest growing service industries. The financial services industry includes financial derivatives markets such as options and futures markets. In order to ensure survival, firms providing financial services show a rapid product innovation. However, for

  3. 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...

  4. Application of 'Process management' methodology in providing financial services of PE 'Post Serbia'

    Directory of Open Access Journals (Sweden)

    Kujačić Momčilo D.

    2014-01-01

    Full Text Available The paper describes application of the methodology 'Process management', in providing of financial services at the post office counter hall. An overview of the methodology is given, as one of the most commonly used qualitative methodology, whereby Process management's technics are described , those can better meet user needs and market demands, as well as to find more effectively way to resist current competition in the postal service market. One of the main problem that pointed out is a long waiting time in the counter hall during providing financial services, which leads to the formation of queue lines, and thus to customer dissatisfaction. According that, paper points steps that should be taken during provide of financial services in a postal network unit for providing services to customers by optimizing user time waiting in line and increasing the satisfaction of all participants in that process.

  5. Carbon credits: source of financial incentives to construction of SHPs; Creditos de carbono: fonte de incentivo financeiro para construcao de PCHs

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Fernando Weigert; Pedroso, Andreia [ADD Engenharia, Consultoria e Participacoes Ltda., Curitiba, PR (Brazil)], E-mail: machado@addconsultoria.com

    2011-07-15

    At the last renewable energy auction performed in 2010, it was hired nearly 2.000 MW of wind power by the average energy price of R$ 130,00/MWh and only 130 MW of Small Hydro Power - SHP by the average price of R$ 142,00/MWh. After this event, claims from executives of SHP sector in order to acquire more incentives from Federal Government have been further constant. Although there is different incentives to install wind powers and SHPs, what can be seen in practice is that besides this discussion, incentives as carbon credits, which can mean 3% till 5% of enterprise's annual revenues, increasing its competitiveness in face other energy sources, have been despised or badly managed. In the ONU context, SHPs are considered renewable energy sources and each MWh produced by the plant can be converted in carbon credits. In order to receive the carbon credits effectively, the SHP must develop a special project called PDD and approve it at ONU. This project should be performed close the beginning of the plant construction otherwise it is not eligible whether postponed. The specific objectives of this paper are to show the current scenario of development of carbon credits projects for SHP in Brazil, the steps to approve a carbon credit project, how to calculate the amount of carbon credits for a SHP, the most important conditions that should be verified, a case to demonstrate the potential of financial return that there is in this source of resources and opportunities available. (author)

  6. Requesting a unique personal identifier or providing a souvenir incentive did not affect overall consent to health record linkage: evidence from an RCT nested within a cohort.

    Science.gov (United States)

    Ni, Michael Y; Li, Tom K; Hui, Rex W H; McDowell, Ian; Leung, Gabriel M

    2017-04-01

    It is unclear if unique personal identifiers should be requested from participants for health record linkage: this permits high-quality data linkage but at the potential cost of lower consent rates due to privacy concerns. Drawing from a sampling frame based on the FAMILY Cohort, using a 2 × 2 factorial design, we randomly assigned 1,200 participants to (1) request for Hong Kong Identity Card number (HKID) or no request and (2) receiving a souvenir incentive (valued at USD4) or no incentive. The primary outcome was consent to health record linkage. We also investigated associations between demographics, health status, and postal reminders with consent. Overall, we received signed consent forms from 33.3% (95% confidence interval [CI] 30.6-36.0%) of respondents. We did not find an overall effect of requesting HKID (-4.3%, 95% CI -9.8% to 1.2%) or offering souvenir incentives (2.4%, 95% CI -3.1% to 7.9%) on consent to linkage. In subgroup analyses, requesting HKID significantly reduced consent among adults aged 18-44 years (odds ratio [OR] 0.53, 95% CI 0.30-0.94, compared to no request). Souvenir incentives increased consent among women (OR 1.55, 95% CI 1.13-2.11, compared to no souvenirs). Requesting a unique personal identifier or providing a souvenir incentive did not affect overall consent to health record linkage. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. PROVIDING MORALE, WELFARE, AND RECREATION FUNDS AS INCENTIVES TO SAVE - ENDING THE END OF YEAR SPENDING FRENZY

    Science.gov (United States)

    2015-10-25

    Carryover Money in Oklahoma State Agencies." Public Budgeting & Finance 26, no. 3 (Fall 2006): 46-64. Business Source Complete, EBSCOhost (accessed...Premier, EBSCOhost (accessed September 11, 2015). Hurley W. J., Jack Brimberg & Brent Fisher, “Use It or Lose It: On the Incentives to Spend

  8. Financial incentives for improving adherence to maintenance treatment in patients with psychotic disorders (Money for Medication): a multicentre, open-label, randomised controlled trial.

    Science.gov (United States)

    Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony F T; Staring, Anton B P; Mulder, Cornelis L

    2017-03-01

    Provision of financial incentives is a promising intervention for improving adherence in patients taking antipsychotic medication. We aimed to assess the effectiveness of this intervention for improving adherence to antipsychotic depot medication in patients with psychotic disorders, irrespective of their previous compliance. We did this multicentre, open-label, randomised controlled trial at three mental health-care institutions in secondary psychiatric care services in the Netherlands. Eligible patients were aged 18-65 years, had been diagnosed with schizophrenia or another psychotic disorder, had been prescribed antipsychotic depot medication or had an indication to start using depot medication, and were participating in outpatient treatment. Patients were randomly assigned (1:1), via computer-generated randomisation with a block size of four, to receive 12 months of either treatment as usual plus a financial reward for each depot of medication received (€30 per month if fully compliant; intervention group) or treatment as usual alone (control group). Randomisation was stratified by treatment site and suspected prognostic factors: sex, comorbid substance-use disorder (absent vs present), and compliance with antipsychotic medication in the 4 months before baseline (improving adherence to antipsychotic depot medication among patients with psychotic disorders. Further research is needed to study the long-term effects of this intervention. Dual Diagnosis Center. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Reforestation tax incentives under the American jobs creation act of 2004

    Science.gov (United States)

    Thomas J. Straka; John L. Greene

    2007-01-01

    The American jobs creation act of 2004 made significant changes in the reforestation tax incentives available to private forest owners. Owners can now deduct outright reforestation costs up to $10,000 per year for each qualifying timber property and amortize any additional amount over 8 tax years. to assess the financial benefit the new incentives provide to forest...

  10. 28 CFR 58.25 - Qualifications for approval as providers of a personal financial management instructional course.

    Science.gov (United States)

    2010-07-01

    ... of a personal financial management instructional course. 58.25 Section 58.25 Judicial Administration... Qualifications for approval as providers of a personal financial management instructional course. (a) Definition... personal financial management instructional course must be in compliance with all applicable laws and...

  11. 25 CFR 20.102 - What is the Bureau's policy in providing financial assistance and social services under this part?

    Science.gov (United States)

    2010-04-01

    ..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Definitions... this part to eligible Indians when comparable financial assistance or social services are either not... 25 Indians 1 2010-04-01 2010-04-01 false What is the Bureau's policy in providing financial...

  12. Opportunity costs and financial incentives for Hispanic youth participating in a family-based HIV and substance use preventive intervention.

    Science.gov (United States)

    McCollister, Kathryn E; Freitas, Derek M; Prado, Guillermo; Pantin, Hilda

    2014-02-01

    This paper presents results from a pilot study of the synergies between the opportunity costs incurred by research participants, participant compensation, and program attendance in a family-based substance use and HIV preventive intervention for Hispanic adolescents in Miami-Dade County, Florida. To estimate parent/caretaker cost per session and cost for the duration of the intervention, we administered the Caretaker Drug Abuse Treatment Cost Analysis Program to a random sample of 34 families who participated in a recent clinical trial of Familias Unidas. The total opportunity cost per parent/caretaker was under $40 per group session, under $30 per family session, and just over $570 for the duration of the intervention. Participants were compensated between $40 and $50 per session and attended more than 79% of family and group sessions. Parents and caretakers incurred a cost of approximately $30-40 per intervention session for which they were adequately compensated. Attendance was very good overall for this group (>79%) and significantly higher than attendance in a comparable uncompensated study group from another recent Familias Unidas trial that targeted similar youth. Findings suggest that incentives should be considered important for future implementations of Familias Unidas and similar family-based interventions that target minority and low-SES populations.

  13. Improving uptake and use of malaria rapid diagnostic tests in the context of artemisinin drug resistance containment in eastern Myanmar: an evaluation of incentive schemes among informal private healthcare providers.

    Science.gov (United States)

    Aung, Tin; White, Christopher; Montagu, Dominic; McFarland, Willi; Hlaing, Thaung; Khin, Hnin Su Su; San, Aung Kyaw; Briegleb, Christina; Chen, Ingrid; Sudhinaraset, May

    2015-03-06

    As efforts to contain artemisinin resistance and eliminate Plasmodium falciparum intensify, the accurate diagnosis and prompt effective treatment of malaria are increasingly needed in Myanmar and the Greater Mekong Sub-region (GMS). Rapid diagnostic tests (RDTs) have been shown to be safe, feasible, and effective at promoting appropriate treatment for suspected malaria, which are of particular importance to drug resistance containment. The informal private sector is often the first point of care for fever cases in malaria endemic areas across Myanmar and the GMS, but there is little published information about informal private provider practices, quality of service provision, or potential to contribute to malaria control and elimination efforts. This study tested different incentives to increase RDT use and improve the quality of care among informal private healthcare providers in Myanmar. The study randomized six townships in the Mon and Shan states of rural Myanmar into three intervention arms: 1) RDT price subsidies, 2) price subsidies with product-related financial incentives, and 3) price subsidies with intensified information, education and counselling (IEC). The study assessed the uptake of RDT use in the communities by cross-sectional surveys of 3,150 households at baseline and six months post-intervention (6,400 households total, 832 fever cases). The study also used mystery clients among 171 providers to assess quality of service provision across intervention arms. The pilot intervention trained over 600 informal private healthcare providers. The study found a price subsidy with intensified IEC, resulted in the highest uptake of RDTs in the community, as compared to subsidies alone or merchandise-related financial incentives. Moreover, intensified IEC led to improvements in the quality of care, with mystery client surveys showing almost double the number of correct treatment following diagnostic test results as compared to a simple subsidy. Results show

  14. Incentives to participate in clinical trials: practical and ethical considerations.

    Science.gov (United States)

    Bernstein, Steven L; Feldman, James

    2015-09-01

    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. How does the pharmaceutical industry influence prescription? A qualitative study of provider payment incentives and drug remunerations in hospitals in Shanghai.

    Science.gov (United States)

    Yang, Wei

    2016-10-01

    Over-prescription has become one major problem in China's health care sector. Incorporating interview data from hospitals in Shanghai, this paper provided empirical evidence on how the process of over-prescription was carried out in day-to-day clinical settings, and demonstrates various mechanisms that allow over-prescription to continue vigorously in the context of the Chinese health care system. In particular, this study identified four levels of incentives that over-prescription was carried out: hospital, medical department, doctors and pharmaceutical companies. Due to the insufficient funding from the government and rising operational costs, hospitals had to rely on the sales of drugs and provision of medical services to survive. This funding pressure then transferred to specific revenue targets for medical departments. A combination of incentives, including drug remunerations, bonus system, low pay and high workloads motivated over-prescription at doctor level. At pharmaceutical company level, high profits of pharmaceuticals products as well as lack of emphasis on efficacy of drugs led to under-table payments and illicit drug remunerations. The study argued that the way that the Chinese health care system operates was based on the profit-seeking principle rather than on fulfilling its social functions, and called for a systematic reform of provider incentives to eradicating the problem of over-prescription.

  16. Financial Incentives Alone Versus Incentivized Partner Support for Promoting Smoking Cessation During Pregnancy and Postpartum: Protocol for a Non-Randomized Single-Blinded Study.

    Science.gov (United States)

    Frandsen, Mai; Thow, Megan; Ferguson, Stuart G

    2017-10-31

    Smoking tobacco remains the most significant modifiable cause of adverse pregnancy outcomes and contributor to ongoing maternal and infant ill-health. Pregnancy for many is a time of heightened health focus, with the primary motivation being the well-being of the unborn child. Yet, many women continue to smoke throughout their pregnancy. Despite this heightened motivation and known health risks, interventions to date have not effectively curbed the rate of smoking during pregnancy and they remain as high as rates among the general population. One promising strategy has been to incentivize these women to quit. However, incentives-based studies have not shown or reported long-term efficacy. Here, we present the protocol of a trial exploring the effect of incentivized partner support on pre- and postpartum smoking cessation. The aim of this study is to determine whether providing incentives to both the expectant mother and her support person in promoting short- and long-term smoking cessation during pregnancy is more effective than incentives to the expectant mother alone. This protocol is designed as a non-randomized, single-blinded trial to determine the efficacy of incentivized partner support, compared to participant incentive only, in promoting smoking cessation during pregnancy and postpartum. All eligible pregnant women receiving antenatal care via the Tasmanian Health Service (Australia) will be invited to participate. Participants will be eligible for monthly quit-contingent shopping vouchers if they verify, via carbon monoxide breath sample, as being abstinent from smoking. Participating women will be eligible for vouchers until 6-months postpartum and will be followed up at 12-months postpartum. The recruitment phase of this study has concluded. Results are expected to be published by the end of 2018. This study protocol extends the current literature on incentivized smoking cessation interventions for pregnant women by assessing the influence of

  17. CONCEPTUAL BASES OF FORMING THE SYSTEM OF FINANCIAL AND ECONOMIC PROVIDING SOCIAL PROTECTION INVOLUNTARILY DISPLACED PERSONS WITH CLUSTER APPROACH

    Directory of Open Access Journals (Sweden)

    Svitlana Kropelnytska

    2017-08-01

    Full Text Available The article systematizes approaches to financial support and social adaptation of internally displaced persons (IDPs as well as their social protection, that is based on the analysis of legal framework, situation and sources of financial and social support to the EU member states of the IDPs in Ukraine and their social security. The study of the IDPs situation and the assessment of the required resources are based on a cluster approach, which defines optimal set of problem areas requiring priority social and financial support. This allowed to develop practical recommendations for the development of a comprehensive, transparent and unified policy of social protection through the development of a conceptual framework for the financial and economic provision of social protection IDPs, which will be the basic solution to the problems of social and financial provision forced migrants in Ukraine. Key words: forced migrants, internally displaced persons, cluster, social policy, social protection, social providing, financial providing.

  18. 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

  19. Aligning ambition and incentives

    DEFF Research Database (Denmark)

    Koch, Alexander; Peyrache, Eloïc

    2011-01-01

    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...

  20. Incentives for breastfeeding and for smoking cessation in pregnancy: an exploration of types and meanings.

    Science.gov (United States)

    Crossland, Nicola; Thomson, Gill; Morgan, Heather; Dombrowski, Stephan U; Hoddinott, Pat

    2015-03-01

    Financial or tangible incentives are a strategy for improving health behaviours. The mechanisms of action of incentives are complex and debated. Using a multidisciplinary integrated mixed methods study, with service-user collaboration throughout, we developed a typology of incentives and their meanings for initiating and sustaining smoking cessation in pregnancy and breastfeeding. The ultimate aim was to inform incentive intervention design by providing insights into incentive acceptability and mechanisms of action. Systematic evidence syntheses of incentive intervention studies for smoking cessation in pregnancy or breastfeeding identified incentive characteristics, which were developed into initial categories. Little published qualitative data on user perspectives and acceptability was available. Qualitative interviews and focus groups conducted in three UK regions with a diverse socio-demographic sample of 88 women and significant others from the target population, 53 service providers, 24 experts/decision makers, and conference attendees identified new potential incentives and providers, with and without experience of incentives. Identified incentives (published and emergent) were classified into eight categories: cash and shopping vouchers, maternal wellbeing, baby and pregnancy-related, behaviour-related, health-related, general utility, awards and certificates, and experiences. A typology was refined iteratively through concurrent data collection and thematic analysis to explore participants' understandings of 'incentives' and to compare and contrast meanings across types. Our typology can be understood in three dimensions: the degree of restriction, the extent to which each is hedonic and/or utilitarian, and whether each has solely monetary value versus monetary with added social value. The layers of autonomy, meanings and the social value of incentive types influence their acceptability and interact with structural, social, and personal factors. Dimensions

  1. Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system

    National Research Council Canada - National Science Library

    Shea, Christopher M; Reiter, Kristin L; Weaver, Mark A; McIntyre, Molly; Mose, Jason; Thornhill, Jonathan; Malone, Robb; Weiner, Bryan J

    2014-01-01

    Meaningful Use (MU) provides financial incentives for electronic health record (EHR) implementation. EHR implementation holds promise for improving healthcare delivery, but also requires substantial changes for providers and staff...

  2. Incentives and Big E Engagement.

    Science.gov (United States)

    Terry, Paul E

    2017-11-01

    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.

  3. Effect of Electronic Reminders, Financial Incentives, and Social Support on Outcomes After Myocardial Infarction: The HeartStrong Randomized Clinical Trial.

    Science.gov (United States)

    Volpp, Kevin G; Troxel, Andrea B; Mehta, Shivan J; Norton, Laurie; Zhu, Jingsan; Lim, Raymond; Wang, Wenli; Marcus, Noora; Terwiesch, Christian; Caldarella, Kristen; Levin, Tova; Relish, Mike; Negin, Nathan; Smith-McLallen, Aaron; Snyder, Richard; Spettell, Claire M; Drachman, Brian; Kolansky, Daniel; Asch, David A

    2017-08-01

    Adherence to medications prescribed after acute myocardial infarction (AMI) is low. Wireless technology and behavioral economic approaches have shown promise in improving health behaviors. To determine whether a system of medication reminders using financial incentives and social support delays subsequent vascular events in patients following AMI compared with usual care. Two-arm, randomized clinical trial with a 12-month intervention conducted from 2013 through 2016. Investigators were blinded to study group, but participants were not. Design was a health plan-intermediated intervention for members of several health plans. We recruited 1509 participants from 7179 contacted AMI survivors (insured with 5 large US insurers nationally or with Medicare fee-for-service at the University of Pennsylvania Health System). Patients aged 18 to 80 years were eligible if currently prescribed at least 2 of 4 study medications (statin, aspirin, β-blocker, antiplatelet agent), and were hospital inpatients for 1 to 180 days and discharged home with a principal diagnosis of AMI. Patients were randomized 2:1 to an intervention using electronic pill bottles combined with lottery incentives and social support for medication adherence (1003 patients), or to usual care (506 patients). Primary outcome was time to first vascular rehospitalization or death. Secondary outcomes were time to first all-cause rehospitalization, total number of repeated hospitalizations, medication adherence, and total medical costs. A total of 35.5% of participants were female (n = 536); mean (SD) age was 61.0 (10.3) years. There were no statistically significant differences between study arms in time to first rehospitalization for a vascular event or death (hazard ratio, 1.04; 95% CI, 0.71 to 1.52; P = .84), time to first all-cause rehospitalization (hazard ratio, 0.89; 95% CI, 0.73 to 1.09; P = .27), or total number of repeated hospitalizations (hazard ratio, 0.94; 95% CI, 0.60 to 1.48; P

  4. 45 CFR Appendix I to Part 617 - List of Age Distinctions Provided in Federal Statutes or Regulations Affecting Federal Financial...

    Science.gov (United States)

    2010-10-01

    ... Statutes or Regulations Affecting Federal Financial Assistance Administered by NSF I Appendix I to Part 617.... 617, App. I Appendix I to Part 617—List of Age Distinctions Provided in Federal Statutes or Regulations Affecting Federal Financial Assistance Administered by NSF I. Section 6 of Pub. L. 94-86, 42 U.S.C...

  5. 12 CFR 989.3 - Requirement to provide financial and other information to the Finance Board and the Office of...

    Science.gov (United States)

    2010-01-01

    ... information to the Finance Board and the Office of Finance. 989.3 Section 989.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD OFFICE OF FINANCE FINANCIAL STATEMENTS OF THE BANKS § 989.3 Requirement to provide financial and other information to the Finance Board and the Office of Finance. In order to facilitate the...

  6. Bridging the financial gap through providing contract services: a model for publicly funded clinical biobanks.

    Science.gov (United States)

    Kozlakidis, Zisis; Mant, Christine; Cason, John

    2012-08-01

    Biobanks offer translational researchers a novel method of obtaining clinical research materials, patient data, and relevant ethical and legal permissions. However, such tissue collections are expensive to establish and maintain. Current opinion is that such initiatives can only survive with core funding from Government or major funding bodies. Given the present climate of financial austerity, funding agencies may be tempted to invest in fast-return research projects rather than in maintaining tissue collections, whose benefits will only become apparent in much longer timescales. Thus, securing additional funding for biobanks could provide a valuable boost enabling an extension of core services. Here we suggest that using biobank expertise to offer contract services to clinicians and industry may be an alternative approach to obtaining such extra funding.

  7. Financial abuse of older people by a family member: a difficult terrain for service providers in Australia.

    Science.gov (United States)

    Adams, Valerie Margaret; Bagshaw, Dale; Wendt, Sarah; Zannettino, Lana

    2014-01-01

    Financial abuse by a family member is the most common form of abuse experienced by older Australians, and early intervention is required. National online surveys of 228 chief executive officers and 214 aged care service providers found that, while they were well placed to recognize financial abuse, it was often difficult to intervene successfully. Problems providers encountered included difficulties in detecting abuse, the need for consent before they could take action, the risk that the abusive family member would withdraw the client from the service, and a lack of resources to deal with the complexities inherent in situations of financial abuse.

  8. Salary administration as part of employee incentive system at industrial enterprises

    Directory of Open Access Journals (Sweden)

    Sagandykov Michail

    2017-01-01

    Full Text Available The article analyses the financial staff incentives at industrial enterprises. The paper concludes that the incentive system should be developed taking into account the developed staff motivation. The only efficient target of influence is the existing staff motivation components. A 3-element employee incentive framework for industrial enterprises is suggested. The article presents the critical analysis of the existing payroll systems of several industrial enterprises, elicits the common flaws of the incentive payments, and develops requirements for such systems. The paper also provides an industrial enterprise needs matrix and an incentive payment types matrix required to build up a rational monetary staff incentive system. These matrices can be adapted for any industrial enterprise with regard to its long-term objectives.

  9. 45 CFR 305.34 - Payment of incentives.

    Science.gov (United States)

    2010-10-01

    ... 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...

  10. The use of financial incentives to help improve health outcomes: is the quality and outcomes framework fit for purpose? A systematic review.

    Science.gov (United States)

    Langdown, Carwyn; Peckham, Stephen

    2014-06-01

    The quality and outcomes framework (QOF) is one of the world's largest pay-for-performance schemes, rewarding general practitioners for the quality of care they provide. This review examines the evidence on the efficacy of the scheme for improving health outcomes, its impact on non-incentivized activities and the robustness of the clinical targets adopted in the scheme. The review was conducted using six electronic databases, six sources of grey literature and bibliography searches from relevant publications. Studies were identified using a comprehensive search strategy based on MeSH terms and keyword searches. A total of 21,543 references were identified of which 32 met the eligibility criteria with 11 studies selected for the review. Findings provide strong evidence that the QOF initially improved health outcomes for a limited number of conditions but subsequently fell to the pre-existing trend. There was limited impact on non-incentivized activities with adverse effects for some sub-population groups. The QOF has limited impact on improving health outcomes due to its focus on process-based indicators and the indicators' ceiling thresholds. Further research is required to strengthen the quality of evidence available on the QOF's impact on population health to ensure that the incentive scheme is both clinically and cost-effective. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. EQUILIBRIUM ANALYSIS OF FINANCIAL COMPANY BASED ON INFORMATION PROVIDED BY THE BALANCE SHEET

    Directory of Open Access Journals (Sweden)

    Ștefăniță ȘUȘU

    2014-06-01

    Full Text Available This article highlights the importance of indicators (as net working capital, working capital requirements and net cash by means of which it is considered in the context of financial balances capitalization information released by the balance sheet of an entity tourist profile. Theoretical concepts presented in a logical sequence are combined with the practical example transposed Turism Covasna company. The results of the analysis are interpreted while trying to formulate solutions to the economic and financial viability of the entity.

  12. Peace Incentives

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.

    2015-01-01

    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....

  13. Incentive contracts for development projects

    Science.gov (United States)

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

    2012-09-01

    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.

  14. The adoption of residential solar photovoltaic systems in the presence of a financial incentive: A case study of consumer experiences with the Renewable Energy Standard Offer Program in Ontario (Canada)

    Science.gov (United States)

    Adachi, Christopher William Junji

    2009-12-01

    Traditionally, high initial capital costs and lengthy payback periods have been identified as the most significant barriers that limit the diffusion of solar photovoltaic (PV) systems. In response, the Ontario Government, through the Ontario Power Authority (OPA), introduced the Renewable Energy Standard Offer Program (RESOP) in November, 2006. The RESOP offers owners of solar PV systems with a generation capacity under 10MW a 20 year contract to sell electricity back to the grid at a guaranteed rate of $0.42/kWh. While it is the intent of incentive programs such as the RESOP to begin to lower financial barriers in order to increase the uptake of solar PV systems, there is no guarantee that the level of participation will in fact rise. The "on-the-ground" manner in which consumers interact with such an incentive program ultimately determines its effectiveness. The purpose of this thesis is to analyze the relationship between the RESOP and solar PV system consumers. To act on this purpose, the experiences of current RESOP participants are presented, wherein the factors that are either hindering or promoting utilization of the RESOP and the adoption of solar PV systems are identified. This thesis was conducted in three phases--a literature review, preliminary key informant interviews, and primary RESOP participant interviews--with each phase informing the scope and design of the subsequent stage. First, a literature survey was completed to identify and to understand the potential drivers and barriers to the adoption of a solar PV system from the perspective of a consumer. Second, nine key informant interviews were completed to gain further understanding regarding the specific intricacies of the drivers and barriers in the case of Ontario, as well as the overall adoption system in the province. These interviews were conducted between July and September, 2008. Third, interviews with 24 RESOP participants were conducted; they constitute the primary data set. These

  15. A haemovigilance team provides both significant financial and quality benefits in a University Hospital.

    Science.gov (United States)

    Decadt, Ine; Costermans, Els; Van de Poel, Maai; Kesteloot, Katrien; Devos, Timothy

    2017-04-01

    Haemovigilance is the process of surveillance of blood transfusion procedures including unexpected hazards and reactions during the transfusion pathway in both donors and recipients. The haemovigilance team aims to increase blood transfusion safety and to decrease both morbidity and mortality in donors and recipients. The team collects data about transfusion reactions and incidents, instructs the involved health workers and assures the tracing of blood components. The haemovigilance team at the University Hospitals Leuven has played a pioneering role in the development of haemovigilance in Belgium Although the literature about safety and quality improvements by haemovigilance systems is abundant, there are no published data available measuring their financial impact in a hospital. Therefore, we studied the costs and returns of the haemovigilance team at the University Hospitals Leuven. This study has a descriptive explorative design. Research of the current costs and returns of the haemovigilance team were based upon data from the Medical Administration of the hospital. Data were analyzed descriptively. The haemovigilance team of the University Hospitals Leuven is financially viable: the direct costs are covered by the annual financial support of the National Public Health Service. The indirect returns come from two important tasks of the haemovigilance team itself: correction of the electronic registration of administered blood component and improvement of the return of conform preserved blood components to the blood bank. Besides safety and quality improvement, which are obviously their main goals, the haemovigilance team also implies a financial benefit for the hospital. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. A study of incentives to support and promote public health accreditation.

    Science.gov (United States)

    Thielen, Lee; Leff, Marilyn; Corso, Liza; Monteiro, Erinn; Fisher, Jessica Solomon; Pearsol, Jim

    2014-01-01

    Accreditation of public health agencies through the Public Health Accreditation Board is voluntary. Incentives that encourage agencies to apply for accreditation have been suggested as important factors in facilitating participation by state and local agencies. The project describes both current and potential incentives that are available at the federal, state, and local levels. Thirty-nine key informants from local, state, tribal, federal, and academic settings were interviewed from March through May 2012. Through open-ended interviews, respondents were asked about incentives that were currently in use in their settings and incentives they thought would help encourage participation in Public Health Accreditation Board accreditation. Incentives currently in use by public health agencies based on interviews include (1) financial support, (2) legal mandates, (3) technical assistance, (4) peer support workgroups, and (5) state agencies serving as role models by seeking accreditation themselves. Key informants noted that state agencies are playing valuable and diverse roles in providing incentives for accreditation within their own states. Key informants also identified the Centers for Disease Control and Prevention and other players, such as private foundations, public health institutes, national and state associations, and academia as providing both technical and financial assistance to support accreditation efforts. State, tribal, local, and federal agencies, as well as related organizations can play an important role by providing incentives to move agencies toward accreditation.

  17. Application service provider (ASP) financial models for off-site PACS archiving

    Science.gov (United States)

    Ratib, Osman M.; Liu, Brent J.; McCoy, J. Michael; Enzmann, Dieter R.

    2003-05-01

    For the replacement of its legacy Picture Archiving and Communication Systems (approx. annual workload of 300,000 procedures), UCLA Medical Center has evaluated and adopted an off-site data-warehousing solution based on an ASP financial with a one-time single payment per study archived. Different financial models for long-term data archive services were compared to the traditional capital/operational costs of on-site digital archives. Total cost of ownership (TCO), including direct and indirect expenses and savings, were compared for each model. Financial parameters were considered: logistic/operational advantages and disadvantages of ASP models versus traditional archiving systems. Our initial analysis demonstrated that the traditional linear ASP business model for data storage was unsuitable for large institutions. The overall cost markedly exceeds the TCO of an in-house archive infrastructure (when support and maintenance costs are included.) We demonstrated, however, that non-linear ASP pricing models can be cost-effective alternatives for large-scale data storage, particularly if they are based on a scalable off-site data-warehousing service and the prices are adapted to the specific size of a given institution. The added value of ASP is that it does not require iterative data migrations from legacy media to new storage media at regular intervals.

  18. The Promise of Tailoring Incentives for Healthy Behaviors.

    Science.gov (United States)

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

    2016-01-01

    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.

  19. Incentives for smoking cessation.

    Science.gov (United States)

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

    2015-05-18

    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

  20. Behavioural economics: Cash incentives avert deforestation

    Science.gov (United States)

    Cárdenas, Juan Camilo

    2017-10-01

    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.

  1. Nationwide expansion of a financial incentive program on fruit and vegetable purchases among Supplemental Nutrition Assistance Program participants: A cost-effectiveness analysis.

    Science.gov (United States)

    An, Ruopeng

    2015-12-01

    High prices remain a formidable barrier for many people, especially those of low socioeconomic status, to adopt a healthier diet. The Food, Conservation, and Energy Act of 2008 mandated the U.S. Department of Agriculture (USDA) to conduct a pilot study to assess the impact of making fruits and vegetables more affordable for households in the Supplemental Nutrition Assistance Program (SNAP). Based on the USDA final report of the Healthy Incentives Pilot (HIP), a large-scale randomized trial in 2011-2012 that provided 30% rebate on targeted fruits and vegetables to 7500 study participants enrolled in the SNAP, we constructed a decision model to evaluate the cost-effectiveness of an expansion of the HIP to all SNAP households nationwide. The estimated life-time per capita costs of the HIP to the Federal government is $1323 in 2012 U.S. dollars, and the average gains in quality-adjusted life expectancy to a SNAP participant is 0.082 quality-adjusted life year (QALY), resulting in an incremental cost-effectiveness ratio (ICER) of $16,172 per QALY gained. Sensitivity analysis using Monte Carlo simulations indicates a 94.4% and 99.6% probability that the estimated ICER would be lower than the cost-effective threshold of $50,000 and $100,000 per QALY gained, respectively. Moreover, the estimated ICER of the HIP expansion tends to be competitive in comparison to other interventions that aimed at promoting fruit/vegetable intake among adult population. Findings from this study suggest that a nationwide expansion of the HIP is likely to nudge SNAP households towards purchasing and consuming more targeted fruits and vegetables. However, diet behavior modification is proportional to price change. When people's actual eating behaviors and what dietary guidelines recommend differ by several folds, even a 30% rebate closes just a small fraction of that gap and has limited beneficial impact on participants' weight management, disease prevention, and health-related quality of life

  2. Incentives, health promotion and equality.

    Science.gov (United States)

    Voigt, Kristin

    2012-07-01

    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.

  3. Using Incentives

    Science.gov (United States)

    Seymour, Kathryn

    2012-01-01

    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…

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

    Directory of Open Access Journals (Sweden)

    Isamu Okada

    2015-05-01

    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.

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

    Science.gov (United States)

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

    2015-05-01

    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.

  6. Incentives for demand-side management

    Energy Technology Data Exchange (ETDEWEB)

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

    1992-01-01

    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.

  7. Incentives for demand-side management

    Energy Technology Data Exchange (ETDEWEB)

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

    1992-01-01

    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.

  8. "A Financial Crisis Manual Causes, Consequences, and Lessons of the Financial Crisis"

    OpenAIRE

    Ben Beachy

    2012-01-01

    On the fifth anniversary of the beginning of the Great Recession, there is still no consensus on the lessons to be gleaned from the lingering crisis. What provoked the largest financial and economic collapse in decades? While the housing bubble and subprime mortgage lending boom provide clear proximate causes, skewed financial sector incentives, errant economic assumptions, and inequitable socioeconomic structures laid the groundwork for crisis. The complex web of underlying factors extends f...

  9. Community pediatric hospitalists providing care in the emergency department: an analysis of physician productivity and financial performance.

    Science.gov (United States)

    Dudas, Robert A; Monroe, David; McColligan Borger, Melissa

    2011-11-01

    Community hospital pediatric inpatient programs are being threatened by current financial and demographic trends. We describe a model of care and report on the financial implications associated with combining emergency department (ED) and inpatient care of pediatric patients. We determine whether this type of model could generate sufficient revenue to support physician salaries for continuous in-house coverage in community hospitals. Financial productivity and selected performance indicators were obtained from a retrospective review of registration and billing records. Data were obtained from 2 community-based pediatric hospitalist programs, which are part of a single health system and included care delivered in the ED and inpatient settings during a 1-year period from July 1, 2008, to July 1, 2009. Together, the combined programs were able to generate 6079 total relative value units and collections of $244,828 annually per full-time equivalent (FTE). Salary, benefits, and practice expenses totaled $235,674 per FTE. Thus, combined daily revenues exceeded expenses and provided 104% of physician salary, benefits, and practice expenses. However, 1 program generated a net profit of $329,715 ($40,706 per FTE), whereas the other recorded a loss of $207,969 ($39,994 per FTE). Emergency department throughput times and left-without-being-seen rates at both programs were comparable to national benchmarks. Incorporating ED care into a pediatric hospitalist program can be an effective strategy to maintain the financial viability of pediatric services at community hospitals with low inpatient volumes that seek to provide 24-hour pediatric staffing.

  10. Designing PV Incentive Programs to Promote Performance: A Reviewof Current Practice

    Energy Technology Data Exchange (ETDEWEB)

    Barbose, Galen; Wiser, Ryan; Bolinger, Mark

    2007-06-01

    Increasing levels of financial support for customer-sited photovoltaic (PV) systems, provided through publicly-funded incentive programs, has heightened concerns about the long-term performance of these systems. Given the barriers that customers face to ensuring that their PV systems perform well, and the responsibility that PV incentive programs bear to ensure that public funds are prudently spent, these programs should, and often do, play a critical role in ensuring that PV systems receiving incentives perform well. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approaches to encouraging PV system performance used by 32 prominent PV incentive programs in the U.S. We identify eight general strategies or groups of related strategies that these programs have used to address performance issues, and highlight important differences in the implementation of these strategies among programs.

  11. 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...

  12. The role of micro health insurance in providing financial risk protection in developing countries- a systematic review

    Directory of Open Access Journals (Sweden)

    Shifa Salman Habib

    2016-03-01

    Full Text Available Abstract Background Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. Methods We conducted a systematic search for published literature using the search terms “Community based health insurance AND developing countries”, “Micro health insurance AND developing countries”, “Mutual health insurance AND developing countries”, “mutual OR micro OR community based health insurance” “Health insurance AND impact AND poor” “Health insurance AND financial protection” and “mutual health organizations” on three databases, Pubmed, Google Scholar and Science Direct (Elsevier. Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. Results Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa. Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure

  13. The role of micro health insurance in providing financial risk protection in developing countries--a systematic review.

    Science.gov (United States)

    Habib, Shifa Salman; Perveen, Shagufta; Khuwaja, Hussain Maqbool Ahmed

    2016-03-22

    Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. We conducted a systematic search for published literature using the search terms "Community based health insurance AND developing countries", "Micro health insurance AND developing countries", "Mutual health insurance AND developing countries", "mutual OR micro OR community based health insurance" "Health insurance AND impact AND poor" "Health insurance AND financial protection" and "mutual health organizations" on three databases, Pubmed, Google Scholar and Science Direct (Elsevier). Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa). Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure, household borrowings and poverty. MHI also had a positive safeguarding effect on

  14. Providing care to people on social assistance: how dentists in Montreal, Canada, respond to organisational, biomedical, and financial challenges.

    Science.gov (United States)

    Bedos, Christophe; Loignon, Christine; Landry, Anne; Richard, Lucie; Allison, Paul J

    2014-10-10

    Dentists report facing difficulties and experiencing frustrations with people on social assistance, one of the social groups with the most dental needs. Scientists ignore how they deal with these difficulties and whether they are able to overcome them. Our objective was to understand how dentists deal with critical issues encountered with people on social assistance. We conducted in-depth, semi-structured interviews with 33 dentists practicing in Montreal, Canada. The interview guides included questions on dentists' experiences with people on social assistance and potential strategies developed for this group of people. Analyses consisted of interview debriefing, transcript coding, and data interpretation. Dentists described strategies to resolve three critical issues: missed appointments (organisational issue); difficulty in performing non-covered treatments (biomedical issue); and low government fees (financial issue). With respect to missed appointments, dentists developed strategies to maximise attendance, such as motivating their patients, and to minimise the impact of non-attendance, like booking two people at the same time. With respect to biomedical and financial issues, dentists did not find any satisfactory solutions and considered that it was the government's duty to resolve them. Overall, dentists seem reluctant to exclude people on social assistance but develop solutions that may discriminate against them. The efforts and failures experienced by dentists with people on social assistance should encourage us to rethink how dental services are provided and financed.

  15. A review of case studies evaluating economic incentives to promote occupational safety and health.

    Science.gov (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

    2010-06-01

    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

  16. A time series analysis of the effects of financial incentives and mandatory clinical applications as interventions to improve spontaneous adverse drug reaction reporting by hospital medical staff in China.

    Science.gov (United States)

    Chang, Feng; Xi, Yue; Zhao, Jie; Zhang, Xiaojian; Lu, Yun

    2017-12-01

    Spontaneous reporting of adverse drug reactions (ADRs) in hospitals is often under-reported, which may lead to problems in patient management. This study was aimed to assess the effectiveness of a financial intervention based on a fine and a bonus for improving spontaneous reporting of ADRs by physicians in a hospital setting. This study was conducted at the First Affiliated Hospital of Zhengzhou University (China). Starting in 2009, a bonus of 20 RMB (Chinese currency) was given for each spontaneous ADR report, and a fine of 50 RMB was given for any withheld ADR report. A time series analysis using autoregressive integrated moving average models was performed to assess the changes in the total number of spontaneous ADR reports between the preintervention period (2006-2008) and during the first (2009-2011) and second (2012-2014) intervention periods. The median number of reported ADRs per year increased from 29 (range 27-72) in the preintervention period to 277 (range 199-284) in the first intervention period and to 666 in the second (range 644-691). The monthly number of reported ADRs was stable during the 3 periods: 3.56 ± 3.60/month (95% confidence interval (CI), 2.42-4.75) during the preintervention period, 21 ± 13/month (95% CI, 16.97-25.80) in the first intervention period, and 56 ± 20/month (95% CI, 48.81-62.17) in the second intervention period. A financial incentive and ADR management regulations had a significant effect on the increase of reported ADRs. © 2017 John Wiley & Sons, Ltd.

  17. A Study of Financial Services provided by Foreign Financial Institutions (FFIs) Operating in India consistently during the period 2003-04 to 2012-13 with reference to India’s Foreign Trade.

    OpenAIRE

    Edurkar, Ashok; Chougule, Dr.Dattatrya G.

    2016-01-01

    Both domestic and foreign trade needs financial services at each and every step of the business cycle. This role is carried out by both domestic as well as Foreign Financial Institutions (FFIs). This paper aims to take a review of financial services provided by FFIs operating in India based on four major hypothesis. For this research study, 24 FFIs operating in India consistently as per “Profile of Banks” published by RBI, out of the universe consisting of 43 FFIs and 43 representative office...

  18. Economic potential of agroforestry and forestry in the lower Mississippi Alluvial Valley with incentive programs and carbon payments

    Science.gov (United States)

    Gregory E. Frey; D. Evan Mercer; Frederick W. Cubbage; Robert C. Abt

    2011-01-01

    Conversion of bottomland hardwood forests in the Lower Mississippi Alluvial Valley (LMAV) to agricultural land has caused a loss of ecosystem services. The primary approaches to reverse this have been the Wetlands Reserve Program and the Conservation Reserve Program, which provide financial incentives to landowners to reforest. However, other forest production regimes...

  19. Financial statements

    International Development Research Centre (IDRC) Digital Library (Canada)

    2017-06-21

    Jun 21, 2017 ... This Management's Discussion and Analysis (MD&A) provides a narrative discussion of the financial results and operational changes for the financial year ended on. 31 March 2017. This discussion should be read with the. Financial Statements and accompanying notes provided on pages 51 to 67, which ...

  20. Incentives and performance governance of research organizations

    CERN Document Server

    Wollersheim, Jutta; Ringelhan, Stefanie; Osterloh, Margit

    2015-01-01

    ​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.

  1. Does a local financial incentive scheme reduce inequalities in the delivery of clinical care in a socially deprived community? A longitudinal data analysis.

    Science.gov (United States)

    Glidewell, Liz; West, Robert; Hackett, Julia E C; Carder, Paul; Doran, Tim; Foy, Robbie

    2015-05-14

    osteoporosis risk). For one indicator the deprivation-achievement gap reduced over time (repeat prednisolone prescription (OR 1.01; 1.01,1.01). Larger practices and those serving more affluent areas earned more income per patient than smaller practices and those serving more deprived areas (t = -3.99; p =0.0001). Any gaps in achievement between practices were modest but mostly sustained or widened over the duration of the scheme. Given that financial rewards may not reflect the amount of work undertaken by practices serving more deprived patients, future pay-for-performance schemes also need to address fairness of rewards in relation to workload.

  2. [Increased financial risks for health insurers: a challenge for providers of mental health care in the Netherlands].

    Science.gov (United States)

    Daansen, P J; van Schilt, J

    2014-01-01

    As from 2014 Dutch health insurance companies will bear the full financial risk for their clients in mental health care. Over the next years the existing risk settlement shared between insurance companies will gradually be brought to a close. Municipalities and the Ministry of Justice are already responsible for or will soon become responsible for financing health care for adolescents, patients with severe psychiatric disorders and forensic psychiatric patients. As a result, the health insurance companies are beginning to impose ever stricter conditions regarding the care 'product' they are 'buying'. To study the possible consequences, for mental health care institutions, of the increased risk to be borne by health care insurers. Use was made of relevant marketing literature and literature relating to mental health care. Studies of Dutch mental health care literature indicate that in the future the purchasing procedure will no longer consider the immediate treatment outcome as the sole performance indicator but will also take into account additional factors such as long-term improvements in patients' health, customer satisfaction and degree of patient participation, patient empowerment and autonomy. In formulating the details of their health products and business strategies, health care providers will now have to take into account not only the efficacy of the treatment they provide but also the purchasing policy and strategy of the health insurance companies.

  3. Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff.

    Science.gov (United States)

    McNaughton, Rebekah Jayne; Adams, Jean; Shucksmith, Janet

    2016-04-27

    Since the 1990 s strenuous attempts have been made to rebuild trust in childhood immunisations. This study aimed to understand if financial incentives (FI) or quasi-mandatory schemes (QMS), e.g. mandating immunisations for entry to universal services such as day care or school, might be acceptable interventions to increase immunisations uptake for preschool children. Parents and carers of preschool children (n=91); health and other professionals (n=18); and those responsible for developing and commissioning immunisation services (n=6) took part in the study. Qualitative methods were employed to explore the acceptability of FI/QMS with stakeholders. Framework analysis was used to develop a coding framework that was applied to the whole dataset. Interpretations of the emergent themes were verified between researchers and presented to the project's Parent Reference Group to ensure coherence and relevance. (1) FI: parents and professionals felt introducing FI was inappropriate. It was acknowledged FI may encourage families living in disadvantage to prioritise immunisation, but unintended consequences could outweigh any advantage. FI essentially changes behaviour into a cash transaction which many equated to bribery that could inadvertently create inequalities. (2) QMS: parents and professionals highlighted the positives of introducing QMS, stating it felt natural, fair and less likely to create inequality. Despite QMS' potential to positively impact on uptake there were concerns about the implementation and workability of such schemes. FI for preschool immunisation may not be acceptable, within a UK context. Introducing FI could have detrimental effects on uptake if it were associated with bribery and coercion. Quasi-mandatory schemes, mandating immunisation for universal service entry, was the most acceptable option and could contribute to the normalising of immunisation. Future work would be needed to assess how this could be successfully implemented and if it did

  4. Creating New Economic Incentives for Repurposing Generic Drugs for Unsolved Diseases Using Social Finance.

    Science.gov (United States)

    Bloom, Bruce E

    2015-12-01

    Repurposing research improves patient lives by taking drugs approved for one disease and clinically testing them to create a treatment for a different disease. Repurposing drugs that are generic, inexpensive, and widely available and that can be taken in their current dosage and formulation in the new indication provide a quick, affordable, and effective way to create "new" treatments. However, generic drug repurposing often provides no profit potential, and so there is no economic incentive for industry to pursue this, and philanthropy and government funds are often insufficient. One way to create new economic incentive for the repurposing of generic drugs is through social finance. This perspective describes how social finance can create a new economic incentive by using a social impact bond, or similar financial structure, to repay for-profit investors who fund the repurposing research from the proceeds of healthcare cost reductions generated when these affordable, effective, and widely available repurposed therapies improve healthcare outcomes.

  5. Health Gains and Financial Protection Provided by the Ethiopian Mental Health Strategy: an Extended Cost-Effectiveness Analysis.

    Science.gov (United States)

    Johansson, Kjell Arne; Strand, Kirsten Bjerkreim; Fekadu, Abebaw; Chisholm, Dan

    2017-04-01

    Mental and neurological (MN) health care has long been neglected in low-income settings. This paper estimates health and non-health impacts of fully publicly financed care for selected key interventions in the National Mental Health Strategy in Ethiopia for depression, bipolar disorder, schizophrenia and epilepsy. A methodology of extended cost-effectiveness analysis (ECEA) is applied to MN health care in Ethiopia. The impact of providing a package of selected MN interventions free of charge in Ethiopia is estimated for: epilepsy (75% coverage, phenobarbital), depression (30% coverage, fluoxetine, cognitive therapy and proactive case management), bipolar affective disorder (50% coverage, valproate and psychosocial therapy) and schizophrenia (75% coverage, haloperidol plus psychosocial treatment). Multiple outcomes are estimated and disaggregated across wealth quintiles: (1) healthy-life-years (HALYs) gained; (2) household out-of-pocket (OOP) expenditures averted; (3) expected financial risk protection (FRP); and (4) productivity impact. The MN package is expected to cost US$177 million and gain 155,000 HALYs (epilepsy US$37m and 64,500 HALYs; depression US$65m and 61,300 HALYs; bipolar disorder US$44m and 20,300 HALYs; and schizophrenia US$31m and 8,900 HALYs) annually. The health benefits would be concentrated among the poorest groups for all interventions. Universal public finance averts little household OOP expenditures and provides minimal FRP because of the low current utilization of these MN services in Ethiopia. In addition, economic benefits of US$ 51 million annually are expected from depression treatment in Ethiopia as a result of productivity gains, equivalent to 78% of the investment cost. The total MN package in Ethiopia is estimated to cost equivalent to US$1.8 per capita and yields large progressive health benefits. The expected productivity gain is substantially higher than the expected FRP. The ECEA approach seems to fit well with the current

  6. Health Gains and Financial Protection Provided by the Ethiopian Mental Health Strategy: an Extended Cost-Effectiveness Analysis

    Science.gov (United States)

    Strand, Kirsten Bjerkreim; Fekadu, Abebaw; Chisholm, Dan

    2017-01-01

    Abstract Background: Mental and neurological (MN) health care has long been neglected in low-income settings. This paper estimates health and non-health impacts of fully publicly financed care for selected key interventions in the National Mental Health Strategy in Ethiopia for depression, bipolar disorder, schizophrenia and epilepsy. Methods: A methodology of extended cost-effectiveness analysis (ECEA) is applied to MN health care in Ethiopia. The impact of providing a package of selected MN interventions free of charge in Ethiopia is estimated for: epilepsy (75% coverage, phenobarbital), depression (30% coverage, fluoxetine, cognitive therapy and proactive case management), bipolar affective disorder (50% coverage, valproate and psychosocial therapy) and schizophrenia (75% coverage, haloperidol plus psychosocial treatment). Multiple outcomes are estimated and disaggregated across wealth quintiles: (1) healthy-life-years (HALYs) gained; (2) household out-of-pocket (OOP) expenditures averted; (3) expected financial risk protection (FRP); and (4) productivity impact. Results: The MN package is expected to cost US$177 million and gain 155,000 HALYs (epilepsy US$37m and 64,500 HALYs; depression US$65m and 61,300 HALYs; bipolar disorder US$44m and 20,300 HALYs; and schizophrenia US$31m and 8,900 HALYs) annually. The health benefits would be concentrated among the poorest groups for all interventions. Universal public finance averts little household OOP expenditures and provides minimal FRP because of the low current utilization of these MN services in Ethiopia. In addition, economic benefits of US$ 51 million annually are expected from depression treatment in Ethiopia as a result of productivity gains, equivalent to 78% of the investment cost. Conclusions: The total MN package in Ethiopia is estimated to cost equivalent to US$1.8 per capita and yields large progressive health benefits. The expected productivity gain is substantially higher than the expected FRP. The

  7. The US Financial Crisis

    DEFF Research Database (Denmark)

    Campbell, John L.

    2011-01-01

    for each other's shortcomings rather than reinforce each other's incentives. This paper uses evidence from the US financial crisis of 2008 to adjudicate this debate. It argues that different types of institutional complementarities are necessary in combination to ensure market stability and successful......Many comparative political economists hold that market performance depends on the presence of institutional complementarities. Some argue that when institutions reinforce similar incentives markets work best. Others disagree and argue that for markets to function well institutions must compensate...

  8. Financial Motivation Undermines Maintenance in an Intensive Diet and Activity Intervention

    Directory of Open Access Journals (Sweden)

    Arlen C. Moller

    2012-01-01

    Full Text Available Financial incentives are widely used in health behavior interventions. However, self-determination theory posits that emphasizing financial incentives can have negative consequences if experienced as controlling. Feeling controlled into performing a behavior tends to reduce enjoyment and undermine maintenance after financial contingencies are removed (the undermining effect. We assessed participants’ context-specific financial motivation to participate in the Make Better Choices trial—a trial testing four different strategies for improving four health risk behaviors: low fruit and vegetable intake, high saturated fat intake, low physical activity, and high sedentary screen time. The primary outcome was overall healthy lifestyle change; weight loss was a secondary outcome. Financial incentives were contingent upon meeting behavior goals for 3 weeks and became contingent upon merely providing data during the 4.5-month maintenance period. Financial motivation for participation was assessed at baseline using a 7-item scale (=.97. Across conditions, a main effect of financial motivation predicted a steeper rate of weight regained during the maintenance period, (165=2.15, =.04. Furthermore, financial motivation and gender interacted significantly in predicting maintenance of healthy diet and activity changes, (160=2.42, =.016, such that financial motivation had a more deleterious influence among men. Implications for practice and future research on incentivized lifestyle and weight interventions are discussed.

  9. Financial motivation undermines maintenance in an intensive diet and activity intervention.

    Science.gov (United States)

    Moller, Arlen C; McFadden, H Gene; Hedeker, Donald; Spring, Bonnie

    2012-01-01

    Financial incentives are widely used in health behavior interventions. However, self-determination theory posits that emphasizing financial incentives can have negative consequences if experienced as controlling. Feeling controlled into performing a behavior tends to reduce enjoyment and undermine maintenance after financial contingencies are removed (the undermining effect). We assessed participants' context-specific financial motivation to participate in the Make Better Choices trial-a trial testing four different strategies for improving four health risk behaviors: low fruit and vegetable intake, high saturated fat intake, low physical activity, and high sedentary screen time. The primary outcome was overall healthy lifestyle change; weight loss was a secondary outcome. Financial incentives were contingent upon meeting behavior goals for 3 weeks and became contingent upon merely providing data during the 4.5-month maintenance period. Financial motivation for participation was assessed at baseline using a 7-item scale (α = .97). Across conditions, a main effect of financial motivation predicted a steeper rate of weight regained during the maintenance period, t(165) = 2.15, P = .04. Furthermore, financial motivation and gender interacted significantly in predicting maintenance of healthy diet and activity changes, t(160) = 2.42, P = .016, such that financial motivation had a more deleterious influence among men. Implications for practice and future research on incentivized lifestyle and weight interventions are discussed.

  10. Incentives and Insurance in International Financial Markets.

    Science.gov (United States)

    1984-06-01

    resource flows to the Comunist World resulting from Western trade policy, and of the extent to which these transfers may directly or indirectly affect...off a bad loan. The delinquent loans still carried as assets on the books of the EXIN Bank include loans made to Cuba and China prior to the incumbency

  11. Effects of Strategy Training and Incentives on Students' Performance, Confidence, and Calibration

    Science.gov (United States)

    Gutierrez, Antonio P.; Schraw, Gregory

    2015-01-01

    This study examined the effect of strategy instruction and incentives on performance, confidence, and calibration accuracy. Individuals (N = 107) in randomly assigned treatment groups received a multicomponent strategy instruction intervention, financial incentives for high performance, or both. The authors predicted that incentives would improve…

  12. Not all incentives wash out the warm glow: the case of blood donation revisited

    OpenAIRE

    Costa-Font, J.; Jofre-Bonet, M.; Yen, S.

    2012-01-01

    The issue of the nature of the altruism inherent in blood donation and the perverse effects of financial rewards for blood and/or organ donation has been recently revisited in the economic literature with limited consensus. As Titmuss (1970) famously pointed out, providing monetary incentives to blood donors may crowd out blood supply as purely altruistic donors may feel less inclined to donate if a reward is involved - in addition to having the effect of reducing blood quality. In this paper...

  13. Financial Statements Analysis

    OpenAIRE

    Tănase Alin-Eliodor

    2014-01-01

    This article focuses on analyzing of a consolidated financial statements of a hypothetically SME. The interpretation of the financial position and performances is based on the more than 40 financial key ratios computed by using financial data from consolidated income statement, consolidated financial position and cash flow. However additional data from notes to financial statements are provided.

  14. Regulatory Incentives and Disincentives for Utility Investments in Grid Modernization

    Energy Technology Data Exchange (ETDEWEB)

    Kihm, Steve [Seventhware, Madison, WI (United States); Beecher, Janice [Michigan State Univ., East Lansing, MI (United States). Inst. of Public Utilities; Lehr, Ronald L.

    2017-05-31

    Electric power is America's most capital-intensive industry, with more than $100 billion invested each year in energy infrastructure. Investment needs are likely to grow as electric utilities make power systems more reliable and resilient, deploy advanced digital technologies, and facilitate new services to meet some consumers' expectations for greater choice and control. But do current regulatory approaches provide the appropriate incentives for grid modernization investments? This report presents three perspectives: -Financial analyst Steve Kihm begins by explaining that any major investor-owned electric utility that wants to raise capital today can do so at a reasonable cost. The question is whether utility managers want to raise capital for grid modernization. Specifically, they look for investments that create the most value for their existing shareholders. In cases where grid modernization investments are not the best choice in terms of shareholder value, Kihm describes shareholder incentive mechanisms that regulators could consider to encourage such investments when they are in the public interest. -From an institutional perspective, Dr. Janice Beecher finds that the traditional rate-base/rate of return regulatory model provides powerful incentives for utilities to pursue investments, cost control, efficiency and even innovation, and it is well suited to the policy objectives of grid modernization. Prudence of grid modernization investments (fair returns) depends on careful evaluation of the specific asset, and any special incentives (bonus returns) should be used only if they promote economic efficiency consistent with the core goals of economic regulation. According to Beecher, realizing the promises of grid modernization depends on effective implementation of the traditional regulatory model and ratemaking tools to serve the public interest. -Conversely, former commissioner and clean energy consultant Ron Lehr says that rapid electric industry

  15. Using Effective Contractual Incentives to Obtain Superior Contractor Performance

    National Research Council Canada - National Science Library

    Venable, Timothy

    2000-01-01

    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. Small practices' experience with EHR, quality measurement, and incentives.

    Science.gov (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

    2013-11-01

    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.

  17. Major risks and financial guarantees provided by the State in France; Les risques majeurs et la garantie financiere de l'Etat en France

    Energy Technology Data Exchange (ETDEWEB)

    Brassard, Guy [92 - Boulogne-Billancourt, (France)

    2012-01-15

    France's system for indemnifying damage from natural catastrophe is exemplary, whether for floods, storms, or subsidence. However, France is not equipped with the financial capacity to deal with the damage resulting from an exceptional disaster, such as an earthquake on the Mediterranean coast, or a nuclear meltdown. Major catastrophes could be a significant risk to the financial stability of the State today, because the State is in fact the ultimate insurer of its citizens and its institutions. It would be wise to built up reserves in order to enhance the financial resources of the State and to provide a uniform guarantee covering major risks, whatever the cause of the damage may be. (author)

  18. The role of micro health insurance in providing financial risk protection in developing countries- a systematic review

    OpenAIRE

    Shifa Salman Habib; Shagufta Perveen; Hussain Maqbool Ahmed Khuwaja

    2016-01-01

    Abstract Background Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was co...

  19. The Original Management Incentive Schemes

    OpenAIRE

    Richard T. Holden

    2005-01-01

    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. State property tax incentives for promoting ecosystem goods and services from private forest land in the United States: a review and analysis

    Science.gov (United States)

    Michael A. Kilgore; Paul B. Ellefson; Travis J. Funk; Gregory E. Frey

    2017-01-01

    Financial incentives provided by State property tax programs are a means of promoting ecosystem services from private forest land. Identified by this 50-State 2015 review, categories of ecosystem services frequently promoted by such programs are open space and scenic resources, conservation of...

  1. Channeling consumers to preferred providers and the impact of status quo bias: does type of provider matter?

    Science.gov (United States)

    Boonen, Lieke H H M; Donkers, Bas; Schut, Frederik T

    2011-04-01

    To effectively bargain about the price and quality of health services, health insurers need to successfully channel their enrollees. Little is known about consumer sensitivity to different channeling incentives. In particular, the impact of status quo bias, which is expected to differ between different provider types, can play a large role in insurers' channeling ability. To examine consumer sensitivity to channeling strategies and to analyze the impact of status quo bias for different provider types. With a large-scale discrete choice experiment, we investigate the impact of channeling incentives on choices for pharmacies and general practitioners (GPs). Survey data were obtained among a representative Dutch household panel (n = 2,500). Negative financial incentives have a two to three times larger impact on provider choice than positive ones. Positive financial incentives have a relatively small impact on GP choice, while the impact of qualitative incentives is relatively large. Status quo bias has a large impact on provider choice, which is more prominent in the case of GPs than in the case of pharmacies. The large impact of the status quo bias makes channeling consumers away from their current providers a daunting task, particularly in the case of GPs. © Health Research and Educational Trust.

  2. Innovation in Workforce Incentives

    Science.gov (United States)

    2015-05-13

    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

  3. Survey of state approaches to solar energy incentives

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, S. B.

    1979-07-01

    A comprehensive survey is presented of state statutes designed to encourage the application of solar technology. A large majority of the states have enacted financial incentives designed to stimulate solar energy use. Commonly, these incentives include preferential property tax treatment of solar systems, and income tax benefits to solar users. There are a wide variety of other tax breaks as well, including excise and franchise tax incentives. Some states have recently developed loan or grant programs for solar installations. Other states have addressed aspects of real property and land-use planning law, which have served as barriers to either the installation of solar technology or access to sunlight. In addition to removing such obstacles as restrictive convenants and zoning limitations, the legislation of several states provides affirmative recognition of the potential of real property law to serve as a spur to solar development, through solar easements, planning and zoning, and public nuisance. A small number of states have legislated in the field of utility regulation, addressing important questions of (1) nondiscriminatory rates for utility backup to solar systems and public utility commissions, and (2) utility involvement in solar energy applicatons.

  4. The Mixed Nature of Incentives of Community Health Workers: Lessons from a Qualitative Study in Two Districts in India

    Directory of Open Access Journals (Sweden)

    Enisha eSarin

    2016-03-01

    Full Text Available Incentives play an important role in motivating community health workers (CHWs. In India, accredited social health activists (ASHAs are female CHWs who provide a range of services, including those specific to reproductive, maternal, neonatal, child, and adolescent health. Qualitative interviews were conducted with 49 ASHAs and one of their family members (husband, mother-in-law, sister-in-law, or son from Gurdarspur and Mewat districts to explore the role of family, community, and health system in supporting ASHAs in their work. Thematic analysis revealed that incentives were both empowering and a source of distress for ASHAs and their families. Earning income and contributing to the household’s financial wellbeing inspired a sense of financial independence and self-confidence for ASHAs, especially with respect to relations with their husbands and parents-in-law. In spite of the empowering effects of the incentives, they were a cause of distress. Low incentive rates relative to the level of effort required to complete ASHA responsibilities, compounded by irregular and incomplete payment, put pressure on families. ASHAs dedicated much of their time and own resources to perform their duties, drawing them away from their household responsibilities. Communication around incentives from supervisors may have led ASHAs to prioritize and promote those services that yielded higher incentives, as opposed to focusing on the most appropriate services for the client. ASHAs and their families maintained hope that their positions would eventually bring in a regular salary, which contributed to retention of ASHAs. Incentives, therefore, are both motivating and inspiring as well as a cause dissatisfaction among ASHAs and their families. Recommendations include revising the incentive scheme to be responsive to the time and effort required to complete tasks and the out-of-pocket costs incurred while working as an ASHA; improve communication to ASHAs on

  5. The Mixed Nature of Incentives for Community Health Workers: Lessons from a Qualitative Study in Two Districts in India

    Science.gov (United States)

    Sarin, Enisha; Lunsford, Sarah Smith; Sooden, Ankur; Rai, Sanjay; Livesley, Nigel

    2016-01-01

    Incentives play an important role in motivating community health workers (CHWs). In India, accredited social health activists (ASHAs) are female CHWs who provide a range of services, including those specific to reproductive, maternal, neonatal, child, and adolescent health. Qualitative interviews were conducted with 49 ASHAs and one of their family members (husband, mother-in-law, sister-in-law, or son) from Gurdaspur and Mewat districts to explore the role of family, community, and health system in supporting ASHAs in their work. Thematic analysis revealed that incentives were both empowering and a source of distress for ASHAs and their families. Earning income and contributing to the household’s financial wellbeing inspired a sense of financial independence and self-confidence for ASHAs, especially with respect to relations with their husbands and parents-in-law. In spite of the empowering effects of the incentives, they were a cause of distress. Low incentive rates relative to the level of effort required to complete ASHA responsibilities, compounded by irregular and incomplete payment, put pressure on families. ASHAs dedicated much of their time and own resources to perform their duties, drawing them away from their household responsibilities. Communication around incentives from supervisors may have led ASHAs to prioritize and promote those services that yielded higher incentives, as opposed to focusing on the most appropriate services for the client. ASHAs and their families maintained hope that their positions would eventually bring in a regular salary, which contributed to retention of ASHAs. Incentives, therefore, are both motivating and inspiring as well as a cause dissatisfaction among ASHAs and their families. Recommendations include revising the incentive scheme to be responsive to the time and effort required to complete tasks and the out-of-pocket costs incurred while working as an ASHA; improve communication to ASHAs on incentives and

  6. Donors and Founders on Charter School Boards and Their Impact on Financial and Academic Outcomes

    OpenAIRE

    Elif Sisli Ciamarra; Charisse Glosino

    2015-01-01

    This study provides the first systematic analysis of the composition of charter school governing boards. We assemble a dataset of charter school boards in Massachusetts between 2001 and 2013 and investigate the consequences of donor and founder representation on governing boards. We find that the presence of donors on the charter school boards is positively related to financial performance and attribute this result to the donors' strong monitoring incentives due to their financial stakes in t...

  7. RECRUITING NEW TEACHERS TO URBAN SCHOOL DISTRICTS: WHAT INCENTIVES

    Directory of Open Access Journals (Sweden)

    ANTHONY T. MILANOWSKI

    2009-08-01

    Full Text Available Many urban districts in the United States have difficulty attracting and retaining quality teachers, yet they are often themost in need of them. In response, U.S. states and districts are experimenting with financial incentives to attract andretain high-quality teachers in high-need, low-achieving, or hard-to-staff urban schools. However, relatively little isknown about how effective financial incentives are for recruiting new teachers to high-need urban schools. This researchexplores factors that are important to the job choices of teachers in training. Focus groups were held with students atthree universities, and a policy-capturing study was done using 64 job scenarios representing various levels of pay andworking conditions. Focus group results suggested that: a many pre-service teachers, even relatively late in their preparation,are not committed to a particular district and are willing to consider many possibilities, including high needschools; b although pay and benefits were attractive to the students, loan forgiveness and subsidies for further educationwere also attractive; and c small increments of additional salary did not appear as important or attractive as otherjob characteristics. The policy-capturing study showed that working conditions factors, especially principal support, hadmore influence on simulated job choice than pay level, implying that money might be better spent to attract, retain, ortrain better principals than to provide higher beginning salaries to teachers in schools with high-poverty or a high proportionof students of color.

  8. Incentives from Curriculum Tracking

    Science.gov (United States)

    Koerselman, Kristian

    2013-01-01

    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…

  9. Incentives and Earnings Growth

    DEFF Research Database (Denmark)

    Frederiksen, Anders

    2013-01-01

    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....

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

    Directory of Open Access Journals (Sweden)

    Eric Keuffel

    2017-07-01

    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

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

    Science.gov (United States)

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

    2016-10-29

    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

  12. EHR Incentive Programs - Data and Reports

    Data.gov (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...

  13. The importance of non-financial motivators to pharmaceutical sales ...

    African Journals Online (AJOL)

    financial incentives. As companies become increasingly cash-strapped, using non-financial motivators may be the solution. Self-administered questionnaires were completed by a sample of 100 pharmaceutical sales representatives from three ...

  14. The impact of facility audits, evaluation reports and incentives on motivation and supply management among family planning service providers: an interventional study in two districts in Maputo Province, Mozambique.

    Science.gov (United States)

    Vermandere, Heleen; Galle, Anna; Griffin, Sally; de Melo, Málica; Machaieie, Lino; Van Braeckel, Dirk; Degomme, Olivier

    2017-05-02

    Good progress is being made towards universal access to contraceptives, however stock-outs still jeopardize progress. A seldom considered but important building block in optimizing supply management is the degree to which health workers feel motivated and responsible for monitoring supply. We explored how and to what extent motivation can be improved, and the impact this can have on avoiding stock-outs. Fifteen health facilities in Maputo Province, Mozambique, were divided into 3 groups (2 intervention groups and 1 control), and 10 monthly audits were implemented in each of these 15 facilities to collect data through examination of stock cards and stock-counts of 6 contraceptives. Based on these audits, the 2 intervention groups received a monthly evaluation report reflecting the quality of their supply management. One of these 2 groups was also awarded material incentives conditional on their performance. A Wilcoxon-Mann Whitney test was used to detect differences between the groups in the average number of stocked-out centres, while changes over time were verified through applying a Friedman test. Additionally, staff motivation was measured through interviewing health care providers of all centres at baseline, and after 5 and 10 months. To detect differences between the groups and changes over time, a Kruskal Wallis and a Wilcoxon signed-rank test were applied, respectively. Motivation reported by providers (n = 55, n = 40 and n = 39 at baseline, 1st and 2nd follow-up respectively) was high in all groups, during all rounds, and did not change over time. Facilities in the intervention groups had better supply management results (including less stock-outs) during the entire intervention period compared with those in the control group, but the difference was only significant for the group receiving both material incentives and a monthly evaluation. However, our data also suggest that supply management also improved in control facilities, receiving

  15. CROSS-CULTURAL INCENTIVES FOR THE FDI

    Directory of Open Access Journals (Sweden)

    Dumitru ZAIȚ

    2014-06-01

    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

  16. Adoption of International Financial Accounting Reporting Standards ...

    African Journals Online (AJOL)

    This study examines the International Financial Accounting Reporting Standards adoption practices around the world and the way these practices are reflected in the financial statements of companies in different countries. It also examines the incentives/ motivations for the variations in the type of International Financial ...

  17. Saving mothers and newborns in communities: strengthening community midwives to provide high quality essential newborn and maternal care in Baluchistan, Pakistan in a financially sustainable manner.

    Science.gov (United States)

    Mumtaz, Zubia; Cutherell, Andrea; Bhatti, Afshan

    2014-04-06

    To address it's persistently high maternal mortality rate of 276/100,000 live births, the government of Pakistan created a new cadre of community based midwives (CMW). One expectation is that CMWs will improve access to maternal health services for underserved women. Recent research shows the CMWs have largely failed to establish midwifery practices, because CMW's lack of skills, both clinical and entrepreneurial and funds necessary to develop their practice infrastructure and logistics. Communities also lack trust in their competence to conduct safe births. To address these issues, the Saving Mothers and Newborn (SMNC) intervention will implement three key elements to support the CMWs to establish their private practices: (1) upgrade CMW clinical skills (2) provide business-skills training and small loans (3) generate demand for CMW services using cellular phone SMS technology and existing women's support groups. This 3-year project aims to investigate whether CMWs enrolled in this initiative are providing the essential maternal and newborn health care to women and children living in districts of Quetta, and Gwadar in a financially self-sustaining manner. Specifically the research will use quasi-experimental impact assessment to document whether the SMNC initiative is having an impact on CMW services uptake, financial analysis to assess if the initiative enabled CMWs to develop financially self-sustainable practices and observation methods to assess the quality of care the CMWs are providing. A key element of the SMNC initiative - the provision of business skills training and loans to establish private practices - is an innovative initiative in Pakistan and little is known about its effectiveness. This research will provide emperic evidence of the effectiveness of the intervention as well as contribute to the body of evidence around potential solutions to improve sustainable coverage of high impact Maternal, Neonatal and Child Health interventions in vulnerable

  18. Financial markets

    OpenAIRE

    Bibow, Jörg

    2011-01-01

    This paper provides a brief exposition of financial markets in Post Keynesian economics. Inspired by John Maynard Keynes's path-breaking insights into the role of liquidity and finance in "monetary production economies," Post Keynesian economics offers a refreshing alternative to mainstream (mis)conceptions in this area. We highlight the importance of liquidity-as provided by the financial system—to the proper functioning of real world economies under fundamental uncertainty, contrasting star...

  19. Extrinsic incentives and tax compliance

    OpenAIRE

    Sour, Laura; Gutiérrez Andrade, Miguel Ángel

    2011-01-01

    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.

  20. Designing PV Incentive Programs to Promote Performance: A Reviewof Current Practice in the U.S.

    Energy Technology Data Exchange (ETDEWEB)

    Barbose, Galen; Wiser, Ryan; Bolinger, Mark

    2006-10-06

    In the U.S., the increasing financial support for customer-sited photovoltaic (PV) systems provided through publicly-funded incentive programs has heightened concerns about the long-term performance of these systems. Given the barriers that customers face to ensuring that their PV systems perform well, and the responsibility that PV incentive programs bear to ensure that public funds are prudently spent, these programs should, and often do, play a critical role in addressing PV system performance. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approaches to encouraging PV system performance used by 32 prominent PV incentive programs in the U.S. We identify eight general strategies or groups of related strategies that these programs have used to address factors that affect performance, and describe key implementation details. Based on this review, we then offer recommendations for how PV incentive programs can be effectively designed to mitigate potential performance issues.

  1. Social benefits of financial investment support in energy conservation policy

    Energy Technology Data Exchange (ETDEWEB)

    Haugland, T. [ECON Centre for Economic Analysis, Oslo (Norway)

    1996-12-01

    Energy conservation became an important component of energy policy after the oil price increases in the 1970s. The authors refer to energy conservation as policy measures other than price and tax changes intended to improve the efficiency in end use of energy. From 1973 to 1985, more stringent technical standards, information and financial incentives contributed to a 20 percent drop in energy intensities in Organization Economic and Cooperative Developing (OECD) countries. However, high end use prices rather than conservation policies had the greatist effect. The author examines the costs and benefits of a Norwegian energy conservation program that provided financial support for investments in energy efficiency. 28 refs., 6 figs.

  2. A Neural Computational Model of Incentive Salience

    Science.gov (United States)

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

    2009-01-01

    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

  3. Essays in corporate finance and financial intermediation

    NARCIS (Netherlands)

    Kempf, Elisabeth

    2016-01-01

    This thesis consists of three chapters in corporate finance and financial intermediation. The first two chapters explore sources of incentives and learning for finance professionals. Specifically, the first chapter studies how the option to go work for an investment bank affects the incentives of

  4. Altruism, Conformism, and Incentives in the Workplace

    OpenAIRE

    Tichem, Jan

    2014-01-01

    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...

  5. 10 CFR Appendix C to Part 30 - Criteria Relating to Use of Financial Tests and Self Guarantees for Providing Reasonable...

    Science.gov (United States)

    2010-01-01

    ... least 10 times the total current decommissioning cost estimate for the total of all facilities or parts... Guarantees for Providing Reasonable Assurance of Funds for Decommissioning C Appendix C to Part 30 Energy NUCLEAR REGULATORY COMMISSION RULES OF GENERAL APPLICABILITY TO DOMESTIC LICENSING OF BYPRODUCT MATERIAL...

  6. Powerplant productivity improvements and regulatory incentives

    Energy Technology Data Exchange (ETDEWEB)

    Hardy, D; Brown, D

    1980-10-27

    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.

  7. Book Review: "Financial Therapy: 5 Steps Toward Financial Freedom

    OpenAIRE

    Megan McCoy; D. Bruce Ross

    2013-01-01

    Financial Therapy: 5 Steps Toward Financial Freedom and its accompanying workbook, Guide to Financial Therapy Forms and Handouts: 5 Steps Toward Financial Freedom, was created to provide an intervention model to help clients become more financially literate and protect them from financial predators.

  8. Book Review: "Financial Therapy: 5 Steps Toward Financial Freedom

    Directory of Open Access Journals (Sweden)

    Megan McCoy

    2013-08-01

    Full Text Available Financial Therapy: 5 Steps Toward Financial Freedom and its accompanying workbook, Guide to Financial Therapy Forms and Handouts: 5 Steps Toward Financial Freedom, was created to provide an intervention model to help clients become more financially literate and protect them from financial predators.

  9. Incentives to Repurpose Existing Drugs for Orphan Indications.

    Science.gov (United States)

    Kwok, Annette K; Koenigbauer, Fabian M

    2015-08-13

    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.

  10. Financialization and financial profit

    Directory of Open Access Journals (Sweden)

    Arturo Guillén

    2014-09-01

    Full Text Available This article starts from the critical review of the concept of financial capital. I consider it is necessary not to confuse this category with of financialization, which has acquired a certificate of naturalization from the rise of neoliberalism. Although financial monopoly-financial capital is the hegemonic segment of the bourgeoisie in the major capitalist countries, their dominance does not imply, a fortiori, financialization of economic activity, since it depends of the conditions of the process reproduction of capital. The emergence of joint stock companies modified the formation of the average rate of profit. The "promoter profit" becomes one of the main forms of income of monopoly-financial capital. It is postulated that financial profit is a kind of "extraordinary surplus-value" which is appropriated by monopoly-financial capital by means of the monopolistic control it exerts on the issue and circulation of fictitious capital.

  11. Differential dependence of Pavlovian incentive motivation and instrumental incentive learning processes on dopamine signaling

    Science.gov (United States)

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

    2011-01-01

    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

  12. Innumeracy and incentives

    Directory of Open Access Journals (Sweden)

    Donald Dale

    2007-08-01

    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.

  13. Cost incentives for doctors

    DEFF Research Database (Denmark)

    Schottmüller, Christoph

    2013-01-01

    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....

  14. Designing effective incentives for energy conservation in the public sector

    Science.gov (United States)

    Drezner, Jeffrey Alan

    Understanding why government officials behave in certain ways under particular circumstances is an important theme in political science. This research explores the design of policies and incentives targeted at public sector officials, in particular the use of market based policy tools in a non-market environment, and the influence of that organizational environment on the effectiveness of the policy. The research examines the case of Department of Defense (DoD) facility energy management. DoD energy policy includes a provision for the retention of savings generated by conservation activities: two-thirds of the savings is retained at the installation generating the savings, half to used for further investment in energy conservation, and half to be used for general morale, welfare, and recreation activities. This policy creates a financial incentive for installation energy managers to establish higher quality and more active conservation programs. A formal written survey of installation energy managers within DoD was conducted, providing data to test hypotheses regarding policy effectiveness and factors affecting policy implementation. Additionally, two detailed implementation case studies were conducted in order to gain further insights. Results suggest that policy design needs to account for the environment within which the policy will be implemented, particularly organizational culture and standard operating procedures. The retention of savings policy failed to achieve its intended outcome---retention of savings for re-investment in energy conservation---because the role required of the financial management community was outside its normal mode of operation and interests and the budget process for allocating resources did not include a mechanism for retention of savings. The policy design did not adequately address these start-up barriers to implementation. This analysis has shown that in order for retention of savings, or similar policies based on market

  15. Maximizing Energy Savings Reliability in BC Hydro Industrial Demand-side Management Programs: An Assessment of Performance Incentive Models

    Science.gov (United States)

    Gosman, Nathaniel

    For energy utilities faced with expanded jurisdictional energy efficiency requirements and pursuing demand-side management (DSM) incentive programs in the large industrial sector, performance incentive programs can be an effective means to maximize the reliability of planned energy savings. Performance incentive programs balance the objectives of high participation rates with persistent energy savings by: (1) providing financial incentives and resources to minimize constraints to investment in energy efficiency, and (2) requiring that incentive payments be dependent on measured energy savings over time. As BC Hydro increases its DSM initiatives to meet the Clean Energy Act objective to reduce at least 66 per cent of new electricity demand with DSM by 2020, the utility is faced with a higher level of DSM risk, or uncertainties that impact the costeffective acquisition of planned energy savings. For industrial DSM incentive programs, DSM risk can be broken down into project development and project performance risks. Development risk represents the project ramp-up phase and is the risk that planned energy savings do not materialize due to low customer response to program incentives. Performance risk represents the operational phase and is the risk that planned energy savings do not persist over the effective measure life. DSM project development and performance risks are, in turn, a result of industrial economic, technological and organizational conditions, or DSM risk factors. In the BC large industrial sector, and characteristic of large industrial sectors in general, these DSM risk factors include: (1) capital constraints to investment in energy efficiency, (2) commodity price volatility, (3) limited internal staffing resources to deploy towards energy efficiency, (4) variable load, process-based energy saving potential, and (5) a lack of organizational awareness of an operation's energy efficiency over time (energy performance). This research assessed the capacity

  16. Motivating employees through incentives: productive or a counterproductive strategy.

    Science.gov (United States)

    Qayum, Mehran; Sawal, Shefa Haider; Khan, Hassan Mehmood

    2014-05-01

    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.

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

    OpenAIRE

    Itoh, Hideshi

    1991-01-01

    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...

  18. Financial Participation of Employees in Lithuania

    DEFF Research Database (Denmark)

    Darskuviené, Valdoné; Hanisch, Stefan; Mygind, Niels

    2006-01-01

    Participation of employees in decision-making in Lithuanian companies has its roots in trade union movement as well as in the practice of managing companies under Soviet rule. After Lithuania regained independence, employee ownership was used to facilitate privatization. A notable success...... was establishment of a number of employee-owned companies that were formerly state-owned enterprises during the first stage of privatization. However, no stronger tradition of employee participation has evolved. Current legal regulation of participation of employees - financial participation, as well...... as participation in decision-making - is not well developed and does not provide for stronger incentives. The solution of current employment and social problems by the Government, ruling parties as well as social partners is not associated with a higher level of participation of employees. Financial participation...

  19. Nudge or not: can incentives change health behaviours?

    Science.gov (United States)

    Ries, Nola M

    2012-01-01

    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.

  20. 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)

    2014-10-01

    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).

  1. 42 CFR 417.479 - Requirements for physician incentive plans.

    Science.gov (United States)

    2010-10-01

    ... 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...

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

    African Journals Online (AJOL)

    ... and social media (58.2%) to entice voters. Financial aids were given to rural women prior and during elections by traditional institutions and security agents. The paper concludes that candidates and collaborators who used any forms of incentives to entice voters or influence the outcome of elections deserve prosecution.

  3. Health Workers' Incentives in South Sudan (IMCHA) | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The project team will examine non-financial incentives that will help improve the performance of community health workers. The study's first phase includes analyzing a qualitative evaluation of existing community health-worker programs in South Sudan and other BRAC-supported countries (Uganda, Sierra Leone, and ...

  4. Incentives to promote breastfeeding: a systematic review.

    Science.gov (United States)

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

    2015-03-01

    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.

  5. The Energy Economics of Financial Structuring for Renewable Energy Projects

    Science.gov (United States)

    Rana, Vishwajeet

    2011-12-01

    This dissertation focuses on the various financial structuring options for the renewable energy sector. The projects in this sector are capital-intensive to build but have relatively low operating costs in the long run when compared to traditional energy resources. The large initial capital requirements tend to discourage investors. To encourage renewable investments the government needs to provide financial incentives. Since these projects ultimately generate returns, the government's monetary incentives go to the sponsors and tax equity investors who build and operate such projects and invest capital in them. These incentives are usually in the form of ITCs, PTCs and accelerated depreciation benefits. Also, in some parts of the world, carbon credits are another form of incentive for the sponsors and equity investors to invest in such turnkey projects. The relative importance of these various considerations, however, differs from sponsor to sponsor, investor to investor and from project to project. This study focuses mainly on the US market, the federal tax benefits and incentives provided by the government. This study focuses on the energy economics that are used for project decision-making and parties involved in the transaction as: Project Developer/Sponsor, Tax equity investor, Debt investor, Energy buyer and Tax regulator. The study fulfils the knowledge gap in the decision making process that takes advantage of tax monetization in traditional after-tax analysis for renewable energy projects if the sponsors do not have the tax capacity to realize the total benefits of the project. A case-study for a wind farm, using newly emerging financial structures, validates the hypothesis that these renewable energy sources can meet energy industry economic criteria. The case study also helps to validate the following hypotheses: a) The greater a sponsor's tax appetite, the tower the sponsor's equity dilution. b) The use of leverage increases the cost of equity financing

  6. Water Conservation and Economic Incentives

    Science.gov (United States)

    Narayanan, M.

    2016-12-01

    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: http://www.nrdc.org/water/http://www.ecy.wa.gov/programs/wr/ws/wtrcnsv.htmlhttp://www.sscwd.org/tips.html

  7. Incentive Issues in Information Security Management

    Science.gov (United States)

    Lee, Chul Ho

    2012-01-01

    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…

  8. Psychology, economics and incentives.

    OpenAIRE

    Biel, P. R.

    2005-01-01

    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

    OpenAIRE

    Bénabou, Roland; Tirole, Jean

    2003-01-01

    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. Incentives to encourage participation in the national public health accreditation model: a systematic investigation.

    Science.gov (United States)

    Davis, Mary V; Cannon, Margaret M; Corso, Liza; Lenaway, Dennis; Baker, Edward L

    2009-09-01

    We sought to identify the incentives most likely to encourage voluntary participation in the national public health accreditation model. We reviewed existing incentives, held meetings with key informants, and conducted a survey of state and local public health agency representatives. The survey was sent to all state health departments and a sample of local health departments. Group-specific differences in survey responses were examined. Survey response rates were 51% among state health department representatives and 49% among local health department representatives. Both state health department and local health department respondents rated financial incentives for accredited agencies, financial incentives for agencies considering accreditation, and infrastructure and quality improvement as important incentives. State health department respondents also indicated that grant administration and grant application would encourage their participation in the national accreditation model, and local health department respondents also noted that technical assistance and training would encourage their participation. Incentives to encourage participation of state and local agencies in the national voluntary accreditation model should include financial support as well as support for agency infrastructure and quality improvements. Several initiatives are already under way to support agency infrastructure and quality improvement, but financial support incentives have yet to be developed.

  11. Incentive and insurance effects of income taxation

    DEFF Research Database (Denmark)

    Andersen, Torben M.

    2015-01-01

    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....

  12. Payment systems and incentives in primary care: implications of recent reforms in Estonia and Romania.

    Science.gov (United States)

    Dan, Sorin; Savi, Riin

    2015-01-01

    Since the early 1990s, major reform in healthcare has been adopted in former communist countries in Central and Eastern Europe. More than 20 years after, reform in healthcare still draws much interest from policy makers and academics alike. One of the dynamic components of reform has been the reform of payment systems in primary care. This article looks at recent developments in payment systems and financial incentives in Estonia and Romania. We conclude that finding the appropriate mix in paying and incentivizing primary care providers in a transitional context is no easy solution for healthcare policy makers who need to carefully weigh in the advantages and inherent problems of various payment arrangements. In a transitional, rapidly changing healthcare system and society, and a context of financial stringency, the theoretical effects of payment mechanisms may be more difficult to predict and manage than it is expected. Copyright © 2013 John Wiley & Sons, Ltd.

  13. Financial history and financial economics

    OpenAIRE

    Turner, John D.

    2014-01-01

    This essay looks at the bidirectional relationship between financial history and financial economics. It begins by giving a brief history of financial economics by outlining the main topics of interest to financial economists. It then documents and explains the increasing influence of financial economics upon financial history, and warns of the dangers of applying financial economics unthinkingly to the study of financial history. The essay proceeds to highlight the many insights that financi...

  14. The new requirements relating to going concern evaluation and disclosure provide a critical improvement to the financial statements taken as a whole

    Directory of Open Access Journals (Sweden)

    Achraf A. Seyam

    2016-03-01

    Full Text Available The going concern principle assumes that an entity will continue to exist into the future. This assumption implies that the entity will not be compelled to end their operations, liquidate their assets, or go into bankruptcy. It is an integral assumption in financial statements since it allows for the deferral of recognition of certain expenses until a period of time into the future, when the company is still assumed to exist. Members of management, as well as financial statement auditors, are required to identify signs that could indicate that an entity will not be able to continue their operations into the near future. Some of these signs include a trend of operating losses, loan defaults, legal proceedings against the entity and so forth. The Financial Accounting Standards Board (FASB updated the going concern guidelines so that issuers of financial statements are uniform in frequency and substance of going concern determination. Prior to the Accounting Standards Update, U.S. GAAP lacked sufficient guidance about management’s responsibility to evaluate whether there is substantial doubt of the entity’s ability to continue as going concern. In order to clarify the uncertainty, FASB issued a new financial reporting standard. This new reporting will be in effect for the annual period ending after December 15, 2016. The updated standard will require management to perform annual and interim assessments of an entity’s ability to continue as a going concern for one year from the date of financial statements issuance.

  15. [The evaluation of an incentive system for the primary care professionals of Mallorca].

    Science.gov (United States)

    Tamborero, G; Pomar, J M; Pareja, A; Pou, J; Llobera, J; Fuster, J

    1997-04-15

    To describe the assessment made by Mallorca's primary care professionals of the economic incentives system set up in 1994 and find their opinions of financial incentives and other motivating mechanisms. A descriptive, crossover study. Primary care in Mallorca (INSALUD of the Balearics). All the health professionals and ancillary workers (554) of Mallorca's 24 Health Centres. A self-filled questionnaire was used as a measuring instrument. There was a 74% reply rate. Their assessment of the incentives system used was that the distribution of the incentives was unjust and a cause of tension. However, expectations as to the amount received had been met to a reasonable extent. Self-management was a stronger motivating force than incentives (48.4% vs 13.6%). The incentives system used displayed certain faults (in distribution and the work atmosphere generated). However, decentralization was shown to be a powerful motivating force. Monitoring professionals' expectations and the fulfillment of them should be integrated into management habits.

  16. 78 FR 21116 - Superior Supplier Incentive Program

    Science.gov (United States)

    2013-04-09

    ... 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...

  17. 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...

  18. 75 FR 30007 - Teacher Incentive Fund

    Science.gov (United States)

    2010-05-28

    ... 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...

  19. Economic Incentives for Stormwater Control (ISBN9781439845608)

    Science.gov (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...

  20. Regional Incentives and Patient Cross-Border Mobility: Evidence from the Italian Experience

    Directory of Open Access Journals (Sweden)

    Elenka Brenna

    2015-06-01

    Full Text Available Background In recent years, accreditation of private hospitals followed by decentralisation of the Italian National Health Service (NHS into 21 regional health systems has provided a good empirical ground for investigating the Tiebout principle of “voting with their feet”. We examine the infra-regional trade-off between greater patient choice (due to an increase in hospital services supply and financial equilibrium, and we relate it to the significant phenomenon of Cross-Border Mobility (CBM between Italian regions. Focusing on the rules supervising the financial agreements between regional authorities and providers of hospital care, we find incentives for private accredited providers in attracting patient inflows. Methods The analysis is undertaken from an institutional, regulatory and empirical perspective. We select a sample of five regions with higher positive CBM balance and we examine regional regulations governing the contractual agreements between purchasers and providers of hospital care. According to this sample, we provide a statistical analysis of CBM and apply a Regional Attraction Ability Index (RAAI, aimed at testing patient preferences for private/public accredited providers. Results We find that this index is systematically higher for private providers, both in the case of distance/boundary patients and of excellence/general hospitals. Conclusion Conclusions address both financial issues regarding the coverage of regional healthcare systems and equity issues on patient healthcare access. They also raise concerns on the new European Union (EU directive inherent to patient mobility across Europe.

  1. Financial Markets and Compliance

    NARCIS (Netherlands)

    van de Laar, T.A.H.M.; Bleker, Sylvie; Houben, Raf

    2017-01-01

    This chapter will focus on the goals of financial market regulation through the rules of economics, the strategies financial regulation employs to achieve these goals and the insights this provides for the compliance profession. For an overview of the goals and strategies of financial regulation

  2. Offering Incentives from the Outside

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.

    2017-01-01

    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....

  3. Statewide program to promote institutional delivery in Gujarat, India: who participates and the degree of financial subsidy provided by the Chiranjeevi Yojana program.

    Science.gov (United States)

    Sidney, Kristi; Iyer, Veena; Vora, Kranti; Mavalankar, Dileep; De Costa, Ayesha

    2016-01-27

    The Chiranjeevi Yojana (CY) is a large public-private partnership program in Gujarat, India, under which the state pays private sector obstetricians to provide childbirth services to poor and tribal women. The CY was initiated statewide in 2007 because of the limited ability of the public health sector to provide emergency obstetric care and high out-of-pocket expenditures in the private sector (where most qualified obstetricians work), creating financial access barriers for poor women. Despite a million beneficiaries, there have been few reports studying CY, particularly the proportion of vulnerable women being covered, the expenditures they incur in connection with childbirth, and the level of subsidy provided to beneficiaries by the program. Cross-sectional facility based the survey of participants in three districts of Gujarat in 2012-2013. Women were interviewed to elicit sociodemographic characteristics, out-of-pocket expenditures, and CY program details. Descriptive statistics, chi square, and a multivariable logistic regression were performed. Of the 901 women surveyed in 129 facilities, 150 (16 %) were CY beneficiaries; 336 and 415 delivered in government and private facilities, respectively. Only 36 (24 %) of the 150 CY beneficiaries received a completely cashless delivery. Median out-of-pocket for vaginal/cesarean delivery among CY beneficiaries was $7/$71. The median degree of subsidy for women in CY who delivered vaginally/cesarean was 85/71 % compared to out-of-pocket expenditure of $44/$208 for vaginal/cesarean delivery paid by non-program beneficiaries in the private health sector. CY beneficiaries experienced a substantially subsidized childbirth compared to women who delivered in non-accredited private facilities. However, despite the government's efforts at increasing access to delivery services for poor women in the private sector, uptake was low and very few women experienced a cashless delivery. While the long-term focus remains on

  4. Why Financial Advice Cannot Substitute for Financial Literacy?

    OpenAIRE

    M. Debbich

    2015-01-01

    This paper examines the ability of financial advice provided by sellers of financial services to substitute for financial literacy of customers. I set up a simple theoretical model in which an informed financial advisor communicates with a less informed customer of financial services. Given the existence of a conflict of interest from the advisor's perspective, the model predicts that only well financially sophisticated customers receive relevant information from the advisor. This fact tends ...

  5. Financial Stability and Financial Inclusion

    OpenAIRE

    Peter J. Morgan; Victor Pontines

    2014-01-01

    Developing economies are seeking to promote financial inclusion, i.e., greater access to financial services for low-income households and firms, as part of their overall strategies for economic and financial development. This raises the question of whether financial stability and financial inclusion are, broadly speaking, substitutes or complements. In other words, does the move toward greater financial inclusion tend to increase or decrease financial stability? A number of studies have sugge...

  6. Financial History

    OpenAIRE

    Cassis, Y.; Cottrell, P. L

    2017-01-01

    The considerable renewal of interest in all aspects of financial history over recent years provided one motivation for this new venture. Yet, the foundations for our specialism, which draws from both History and the Social Sciences, especially economics, have been laid by many. Some would point to continuity in our interest from the publication in the 1930s of jubilee banking history volumes, such as those written for British institutions by Gregory, and by Crick and Wadsworth. Further schola...

  7. Transferring the financial risks of pharmaceutical benefits from a large health care provider in Argentina to a consortium of pharmaceutical companies

    Directory of Open Access Journals (Sweden)

    Cervellino Juan C.

    2003-01-01

    Full Text Available OBJECTIVE: The National Institute of Social Services for Retirees and Pensioners (NISSRP is a nationwide health care financing agency and service provider in Argentina. Among its services, the NISSRP provides outpatient drug coverage to more than 3.3 million beneficiaries, mainly senior citizens and disabled persons. In 1997, to help cope with its rising costs, the NISSRP agreed to transfer the risk for the cost of outpatient medications and cancer-treatment drugs to a consortium of pharmaceutical companies in exchange for a fixed monthly payment. The objective of this study was to determine the impact that this new approach had on three things: (1 the level of expenditures for the medicines that were included in the agreement, (2 the pattern of nonrational prescribing for NISSRP beneficiaries, and (3 this pattern's relationship with macroeconomic variables and the pattern of prescribing for Argentina as a whole. METHODS: We compared outpatient-medicine consumption in 1999 with consumption before the agreement went into effect. RESULTS: The actual amount that NISSRP beneficiaries spent out-of-pocket climbed from US$ 336.13 million in 1996 to US$ 473.36 million in 1999, an increase of almost 41%. The nominal amount "spent" by the NISSRP in 1999 was US$ 601.11 million, versus a real amount of US$ 374.75 million in 1996, an "increase" of 60% (that increase for the NISSRP was only theoretical since the agreement specified the fixed monthly amount that the NISSRP would have to pay to the pharmaceutical consortium. In contrast with the increased real spending by NISSRP beneficiaries, Argentina's economy remained stable over the assessed period, with the consumer price index even falling by 0.8%. We found high levels of nonrational drug use in the NISSRP system in both 1996 and 1999, indicating a serious ongoing problem. CONCLUSIONS: An agreement with pharmaceutical companies, like the one we have described, might add an element of financial

  8. Teacher Incentives and Student Achievement: Evidence from New York City Public Schools. NBER Working Paper No. 16850

    Science.gov (United States)

    Fryer, Roland G.

    2011-01-01

    Financial incentives for teachers to increase student performance is an increasingly popular education policy around the world. This paper describes a school-based randomized trial in over two-hundred New York City public schools designed to better understand the impact of teacher incentives on student achievement. I find no evidence that teacher…

  9. Changes in the relationship between nursing home financial performance and quality of care under public reporting.

    Science.gov (United States)

    Park, Jeongyoung; Werner, Rachel M

    2011-07-01

    The relationship between financial performance and quality of care in nursing homes is not well defined and prior work has been mixed. The recent focus on improving the quality of nursing homes through market-based incentives such as public reporting may have changed this relationship, as public reporting provides nursing homes with increased incentives to engage in quality-based competition. If quality improvement activities require substantial production costs, nursing home profitability may become a more important predictor of quality under public reporting. This study explores the relationship between financial performance and quality of care and test whether this relationship changes under public reporting. Using a 10-year (fiscal years 1997-2006) panel data set of 9444 skilled nursing facilities in the US, this study employs a facility fixed-effects with and without instrumental variables approach to test the effect of finances on quality improvement and correct for potential endogeneity. The results show that better financial performance, as reflected by the 1-year lagged total profit margin, is modestly associated with higher quality but only after public reporting is initiated. These findings have important policy implications as federal and state governments use market-based incentives to increase demand for high-quality care and induce providers to compete based on quality. Copyright © 2010 John Wiley & Sons, Ltd.

  10. Separating Real Incentives and Accountability

    NARCIS (Netherlands)

    F.M. Vieider (Ferdinand)

    2008-01-01

    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

  11. Incentives and moral hazard

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...

  12. Has incentive payment improved venous thrombo-embolism risk assessment and treatment of hospital in-patients?

    OpenAIRE

    Child, Sue; Sheaff, Rod; Boiko, Olga; Bateman, Alice; Gericke, Christian A

    2013-01-01

    This paper focuses on financial incentives rewarding successful implementation of guidelines in the UK National Health Service (NHS). In particular, it assesses the implementation of National Institute for Health and Clinical Excellence (NICE) venous thrombo-embolism (VTE) guidance in 2010 on the risk assessment and secondary prevention of VTE in hospital in-patients and the financial incentives driving successful implementation introduced by the Commissioning for Quality and Innovation for P...

  13. Using incentives to attract nurses to remote areas of Tanzania: a contingent valuation study.

    Science.gov (United States)

    Munga, Michael A; Torsvik, Gaute; Mæstad, Ottar

    2014-03-01

    This article analyses (1) how financial incentives (salary top-ups) and non-financial incentives (housing and education) affect nurses' willingness to work in remote areas of Tanzania and (2) how the magnitude of the incentives needed to attract health workers varies with the nurses' geographic origin and their intrinsic motivation. A contingent valuation method was used to elicit the location preferences of 362 nursing students. Without any interventions, 19% of the nurses were willing to work in remote places. With the provision of free housing, this share increased by 15 percentage points. Better education opportunities increased the share by 28 percentage points from the baseline. For a salary top-up to have the same effect as provision of free housing, the top-up needs to be between 80 and 100% of the base salary. Similarly, for salary top-ups to have the same effect as provision of better education opportunities, the top-up should be between 120 and 140%. Our study confirms results from previous research, that those with a strong intrinsic motivation to provide health care are more motivated to work in a remote location. A more surprising finding is that students of older age are more prepared to take a job in remote areas. Several studies have found that individuals who grew up in a remote area are more willing to work in such locations. A novel finding of our analysis is that only nursing students with a 'very' remote origin (i.e. those who grew up farther from a district centre than the suggested remote working place) express a higher willingness to take the remote job. Although we do control for nursing school effects, our results could be biased due to omitted variables capturing individual characteristics.

  14. Incentives to Repurpose Existing Drugs for Orphan Indications

    OpenAIRE

    Kwok, Annette K.; Koenigbauer, Fabian M.

    2015-01-01

    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...

  15. Incentive Use in Research: Protecting Vulnerable Populations from Exploitation

    Directory of Open Access Journals (Sweden)

    Haruna Muwonge

    2013-06-01

    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

  16. Managerial incentives and the efficiency of capital structure

    OpenAIRE

    Hughes, Joseph P.; Lang, William W.; Moon, Choon-Geol; Pagano, Michael S.

    2001-01-01

    We extend the literature on the effects of managerial entrenchment on capital structure to consider how safety-net subsidies and financial distress costs interact with managerial incentives to influence capital structure in U.S. commercial banking. Using cross-sectional data on publicly traded, highest-level U.S. bank holding companies, we find empirical evidence of Marcus' proposition (1984) that there are dichotomous strategies for value maximization—one involving relatively higher financia...

  17. Effect of financial relationships on the behaviors of health care professionals: a review of the evidence.

    Science.gov (United States)

    Robertson, Christopher; Rose, Susannah; Kesselheim, Aaron S

    2012-01-01

    This paper explores the empirical evidence regarding the impact financial relationships on the behavior of health care providers, specifically, physicians. We identify and synthesize peer-reviewed data addressing whether financial incentives are causally related to patient outcomes and health care costs. We cover three main areas where financial conflicts of interest arise and may have an observable relationship to health care practices: (1) physicians' roles as self-referrers, (2) insurance reimbursement schemes that create incentives for certain clinical choices over others, and (3) financial relationships between physicians and the drug and device industries. We found a well-developed scientific literature consisting of dozens of empirical studies, some that allow stronger causal inferences than others, but which altogether show that such financial conflicts of interests can, and sometimes do, impact physicians' clinical decisions. Further research is warranted to document the causal relationship of such changes on health outcomes and the cost of care, but the current base of evidence is sufficiently robust to motivate policy reform. © 2012 American Society of Law, Medicine & Ethics, Inc.

  18. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices. Final rule.

    Science.gov (United States)

    2017-08-14

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

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

    OpenAIRE

    Rosellon, Juan; Weigt, Hannes

    2008-01-01

    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...

  20. Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

    Science.gov (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

    2016-01-19

    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.

  1. O pagamento de incentivo financeiro para os funcionários como parte da política de qualificação da assistência de um hospital público, Volta Redonda, Rio de Janeiro, Brasil Financial incentives for employees as part of a policy to upgrade care in a public hospital in Volta Redonda, Rio de Janeiro State, Brazil

    Directory of Open Access Journals (Sweden)

    Luiz Carlos de Oliveira Cecilio

    2002-12-01

    Full Text Available Os autores apresentam e discutem seis anos de aplicação regular e contínua de uma política de avaliação institucional, com uso de incentivo financeiro, em um hospital público, no Município de Volta Redonda, Rio de Janeiro, como parte de seu processo de modernização gerencial. Trabalham com a idéia de que esse tipo de política implica uma cadeia concatenada de apostas: (1 a possibilidade de se viabilizarem recursos financeiros para o pagamento de gratificação; (2 a viabilidade de se construir uma planilha de avaliação sensível e operacionalizável; (3 a capacidade de criação de mecanismos gerenciais competentes para implementar a política de avaliação; (4 a conquista dos trabalhadores, em função da gratificação, para a política de qualificação do hospital e (5 o "não-desvirtuamento" da política de avaliação com o correr do tempo. O artigo faz uma discussão sobre o grau de "sucesso" de cada uma dessas apostas, buscando mostrar alguns ganhos obtidos, mas também apontando as dificuldades inerentes a esse tipo de política.The authors present and analyze six years of regular and steady application of an institutional evaluation policy based on financial incentives in a public hospital in Volta Redonda, Rio de Janeiro State, Brazil, as a part of the hospital's administrative modernization policy. This type of policy is considered implicitly capable of developing a sequence of strategic wagers: (1 release of financial resources for payment of bonuses; (2 creation of an operationally feasible and sensitive evaluation instrument; (3 creation of adequate management mechanisms to improve evaluation policy; (4 employee adherence to the hospital upgrading policy based on the bonus system; and (5 maintenance of the effects of evaluation policy over time. The article discusses the "degree of success" of each of these wagers in an attempt to portray possible gains throughout the process, while also identifying inherent

  2. The Effect of Incentives on Sustainable Behavior

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...

  3. Developing treatments for inborn errors: incentives available to the clinician.

    Science.gov (United States)

    Haffner, Marlene E

    2004-04-01

    Disorders resulting from inborn errors of metabolism (IEM) affect very small numbers of individuals. The entire population, however, of patients suffering the results of inherited metabolic disorders is large, and has been of increasing concern to patient groups and health care professionals in the United States as well as other countries throughout the world. The 1983 US Orphan Drug Act (ODA) serves to facilitate the development of drugs to treat rare diseases by providing several economic incentives. The sponsor of a product designated as an orphan by the Food & Drugs Administration (FDA) Office of Orphan Products Development (OPD) qualifies for tax credits on clinical trial expenses, the award of grant funding by FDA, through the OPD, and 7 years of marketing exclusivity for a designated drug, or biological product that receives FDA market approval. Orphan drug legislation in the US has benefited victims of IEM by encouraging development of drugs for metabolic deficiencies affecting populations that otherwise would be ignored. America's solution to the orphan drug problem has had worldwide impact. The success of this legislation was a factor leading to the 1993 orphan drug law in Japan; the 1997 implementation of a process whereby most FDA-approved orphan drugs and biological products will be similarly approved in Australia; and, in 1999, regulation on orphan medicinal products in the European Union (EU). Today, international support for rare disease research is providing stimulus and motivation to overcome the financial barriers and encourage development of treatment for very rare diseases throughout the world.

  4. Do Financial Constraints Moderate the Impact of Financing Decisions From Internal-financing Sources on Investment?

    Directory of Open Access Journals (Sweden)

    Andewi Rokhmawati

    2017-07-01

    Full Text Available To prevent investment growth in 2013 to 2015 from decreasing, the Industrial Ministry provided fiscal incentives to stimulate investment-growth. Nevertheless, the investment growth of manufacturing firms still declined. This condition indicated that fiscal stimulus might be ineffective to prevent investment-growth from declining. The decline of investment might be influenced by the increase of firm financial constraints to access a source of long term debts. This study aimed to examine the influence of financial constraints in moderating the effect of financing decisions from internal financing sources on investment. The population of the study was all listed-manufacturing firms in Indonesia from 2013 to 2015. Samples were chosen based on the availability of firms’ financial report covering the period of the study. The study concluded that financial constraints significantly weaken the effect of internal funding decision on investment. Unconstrained firms had a higher beta than constrained firms. Although unconstrained firms had an opportunity to choose their source of funding, they preferred to finance their investment from cash flows because the cost of debts might be much higher than the cost of equity.Hence, to help firms to finance their feasible investment opportunity, the government should not only provide tax incentives but also provide a low-interest loan.

  5. Designing PV Incentive Programs to Promote System Performance: AReview of Current Practice

    Energy Technology Data Exchange (ETDEWEB)

    Barbose, Galen; Wiser, Ryan; Bolinger, Mark

    2006-11-12

    rather than the rated capacity of the modules or system, are often suggested as one possible strategy. Somewhat less recognized are the many other program design options also available, each with its particular advantages and disadvantages. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approaches to encouraging PV system performance - including, but not limited to, PBIs - used by 32 prominent PV incentive programs in the U.S. (see Table 1).1 We focus specifically on programs that offer an explicit subsidy payment for customer-sited PV installations. PV support programs that offer other forms of financial support or that function primarily as a mechanism for purchasing renewable energy credits (RECs) through energy production-based payments are outside the scope of our review.2 The information presented herein is derived primarily from publicly available sources, including program websites and guidebooks, programs evaluations, and conference papers, as well as from a limited number of personal communications with program staff. The remainder of this report is organized as follows. The next section presents a simple conceptual framework for understanding the issues that affect PV system performance and provides an overview of the eight general strategies to encourage performance used among the programs reviewed in this report. The subsequent eight sections discuss in greater detail each of these program design strategies and describe how they have been implemented among the programs surveyed. Based on this review, we then offer a series of recommendations for how PV incentive programs can effectively promote PV system performance.

  6. Financial integration and financial development in transition economies: What happens during financial crises?

    Directory of Open Access Journals (Sweden)

    Igor Masten

    2011-12-01

    Full Text Available

    This paper provides an empirical analysis of the role of financial development and financial integration in the growth dynamics of transition countries. We focus on the role of financial integration in determining the impact of financial development on growth, distinguishing “normal times” from periods of financial crises. In addition to confirming the significant positive effect on growth exerted by financial development and financial integration, our estimates show that a higher degree of financial openness tends to reduce the contractionary effect of financial crises, by cushioning the effect on the domestic supply of credit. Consequently, the high reliance on international capital flows by transition countries does not necessarily increase their financial fragility. This implies that financial protectionism is a self-defeating policy, at least for transition countries.

  7. Where do we go from here Now that some utilities have won the incentive regulation war, many executives are wondering how they can manage the peace

    Energy Technology Data Exchange (ETDEWEB)

    Christensen, L.R.; Meitzen, M.E.; Schoech, P.E.

    1993-06-15

    Productivity is a measure of how efficiently a company uses its resources. The productivity budgeting model (PBM) is one tool that can aid management in the transition from cost-plus, rate-of-return regulation to the market-oriented, cost-control environment of incentive regulation. Most, if not all, utilities use some type of budgeting/forecasting process that provides the blueprint for future company activity. The PBM reveals the growth in total factor productivity (TFP) implied by a budget and, thus, provides a forecast of the company's future efficiency. The PBM can be used to guide resource usage, because it analyzes investment, labor force, and operating decisions from an economic efficiency perspective. In general, the model makes the budgeting process more relevant to the kind of decisions utility management must make for long-term success under incentive regulation. Furthermore, under many incentive regulation. Furthermore, under many incentive regulation plans (such as the FCC's price-cap plan), a company must meet or beat the productivity offset to increase its profitability. With PBM, the company can determine whether its proposed budget is on track and devise a plan to meet any offset. The PBM can also be used to track productivity using financial data from the period in question.

  8. Premier Hospital Quality Incentive Demonstration

    Data.gov (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...

  9. Increasing Army Retention Through Incentives

    National Research Council Canada - National Science Library

    Beerman, Kevin

    2006-01-01

    .... 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...

  10. Motivating employees through incentive programs.

    OpenAIRE

    Lai, Calista.

    2009-01-01

    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...

  11. On Manufacturing/Marketing Incentives

    OpenAIRE

    Evan L. Porteus; Seungjin Whang

    1991-01-01

    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 ...

  12. Exit Options in Corporate Finance: Liquidity versus Incentives

    OpenAIRE

    Aghion, Philippe; Bolton, Patrick; Tirole, Jean

    2004-01-01

    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...

  13. Promotions and Incentives: The Case of Multistage Elimination Tournaments

    OpenAIRE

    Altmann, Steffen; Falk, Armin; Wibral, Matthias

    2012-01-01

    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...

  14. Empirical studies of regulatory restructuring and incentives

    Science.gov (United States)

    Knittel, Christopher Roland

    gas is also an input into the generation of electricity. However because these firms are regulated, these differing incentives would only be acted upon if regulation is imperfect in some way. Chapter 2 analyzes these issues. In particular, I estimate equilibrium pricing and investment equations that capture the relative incentives of single and dual-product electricity firms. The results imply that both electricity prices and reliance on natural gas generation are higher in a dual-product setting, both suggesting that regulators respond to the relative incentives of electricity and natural gas firms. Chapter 3 analyzes electricity firm production incentives when regulated via performance based regulation. Although many electricity markets are currently considering adopting a competitive market for electricity generation, and still others have already done so, the vast majority of electricity markets remain tightly regulated. Within this traditional regulatory environment, the use of incentive regulation schemes in US electricity markets has grown during the past two decades. While every state has some program that it refers to as an incentive regulation program, these programs differ in both their goals and how they attempt to meet these goals. In this chapter, I discuss the wide array of programs that have been utilized to alter the incentives of US investor-owned utilities (IOUs). In addition, using stochastic frontier methods, I provide empirical analysis of the impact that a number of incentive regulation programs have on the efficiency of a large set of coal and natural gas generator units.

  15. Financial Education

    Directory of Open Access Journals (Sweden)

    Udo Reifner

    2010-08-01

    Full Text Available New, more or better financial education and financial literacy programmes should lead to improved financial capability, knowledge and outcomes. Yet we do not even know which terminology is most suitable for those projects who all intend to give an answer to a question which is less than clear. What is meant by the term “financial education”? Why did the “demand” for financial education suddenly increase? Have the numerous tasks which consumers in a modern society have to fulfill created this new field for financial education? Are their specific needs of financial markets which need adapted consumers as competent players? Or has the general level of education fallen? Would more ignorance on financial products perhaps increase the likelihood of these markets to care more about consumers? Do we truly need financial education at all and if so, as this article argues, what kind of financial education would respond to it? Based on five years of empirical research, on existing papers and curriculars for financial education and another five years of our own experiences with practical financial education in schools and with clients of debt advice agencies we would like to promote financial education as a form of consumer protection where consumers are seen collectively as the true masters of the economy.

  16. Re-examination of the effect of ownership structure on financial reporting: Evidence from share pledges in China

    Directory of Open Access Journals (Sweden)

    Zhizhong Huang

    2016-06-01

    Full Text Available In this paper, we present evidence that firms with concentrated ownership manage earnings when their large shareholders have an incentive to do so. The large shareholders of Chinese public firms often pledge their shares for loans. Before the split share reform in 2006, loan terms were based on the book value of the firm. Since then, the share price has become critical for share pledged loans. We postulate that the reform triggered large shareholders’ incentive to influence financial reports. Using a sample of non-state-owned enterprises, we test the effect of share pledges on earnings smoothing and how this effect changes after the reform. Our results suggest that share pledging firms smooth their earnings more than other firms, but these results are only found after the split share reform. Accordingly, our results provide more direct evidence on the effect of ownership concentration on financial reporting.

  17. Incentives of Health Care Expenditure

    Directory of Open Access Journals (Sweden)

    Eero Siljander

    2012-12-01

    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

  18. Essays in financial reporting, tax, and politics

    NARCIS (Netherlands)

    Janssen, W.H.P.

    2015-01-01

    This dissertation contains three essays on financial reporting, tax, and politics. The first essay explores whether the tax authority is able to generate spillover effects for auditors. The IRS can generate spillover effects for auditors, as a strong IRS increases manager’s incentives to comply with

  19. Financial expertise as an arms race

    NARCIS (Netherlands)

    Glode, V.; Green, R.C.; Lowery, R.

    2012-01-01

    We show that firms intermediating trade have incentives to overinvest in financial expertise. In our model, expertise improves firms’ ability to estimate value when trading a security. Expertise creates asymmetric information, which, under normal circumstances, works to the advantage of the expert

  20. Modeling Financial Incentives to Get the Unemployed Back to Work

    NARCIS (Netherlands)

    Boone, J.; van Ours, J.

    2006-01-01

    We model how unemployment benefit sanctions - benefit reductions that are imposed if unemployed do not comply with job search guidelines - affect unemployment. We find that benefit sanctions are more effective in reducing unemployment than an across-the-board reduction in the replacement rate, for a

  1. Entrepreneurship and financial incentives of return, risk, and skew

    NARCIS (Netherlands)

    Berkhout, P.; Hartog, J.; van Praag, M.

    2016-01-01

    We focus on the role of the opportunity cost in the choice for entrepreneurship in favor of wage employment, that is, the wages given up as an employee. We argue that just like outside observers, potential entrepreneurs will face great difficulty to predict their earnings from entrepreneurship. The

  2. Why financial incentives can destroy economically valuable biodiversity in Ethiopia

    NARCIS (Netherlands)

    Gatzweiler, F.; Reichhuber, A.; Hein, L.G.

    2007-01-01

    Ethiopian montane rainforests are economically valuable repositories of biodiversity, especially of wild Coffea arabica populations, and they are vanishing at accelerating rates. Our research results confirm theory which explains biodiversity loss by diverging private and social net benefits from

  3. STATE BENEFIT - INCENTIVE FOR SAVINGS AND INVESTMENTS

    Directory of Open Access Journals (Sweden)

    CLAUDIA ISAC

    2015-12-01

    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.

  4. The Potential of Using the Financial Instruments of Accumulation of the Fund for Modernization of Electroenergetics of Ukraine

    Directory of Open Access Journals (Sweden)

    Lukiashko Pavlo O.

    2017-08-01

    Full Text Available The article is aimed at substantiating the efficient financial instruments for the formation of of the fund of financial resources for modernization of electroenergetics of Ukraine and evaluating the potential impact of applying them. Results of an assessment of the prospects of attracting financial resources for modernization of the electroenergetic sector from outside Ukraine urge to look for the available inland possibilities for financing (depreciation fund of enterprises of the industry sector, means of the banking system, resources of private investors. The article proposes a financial instrument for attracting investments for each of the indicated sources and assesses the potential for their use. The carried out study suggests the ability of Ukraine to provide the initial stages of modernization of the electroenergetic sector by means of the domestic sources, which can further become a significant incentive for inflow of foreign investment.

  5. 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)

    2017-08-15

    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.

  6. Financial Education

    OpenAIRE

    Udo Reifner; Anne Schelhowe

    2010-01-01

    New, more or better financial education and financial literacy programmes should lead to improved financial capability, knowledge and outcomes. Yet we do not even know which terminology is most suitable for those projects who all intend to give an answer to a question which is less than clear. What is meant by the term “financial education”? Why did the “demand” for financial education suddenly increase? Have the numerous tasks which consumers in a modern society have to fulfill created this ...

  7. Financial Sector Assessment : Morocco

    OpenAIRE

    World Bank

    2003-01-01

    This Financial Sector Assessment (FSA) provides a summary of the policy priorities, and main findings intended to assist the Moroccan authorities in evaluating the country's financial system. It reviews the uneasy trade-off between concerns for stability, and development, suggesting Morocco's macroeconomic policies and practices as a whole tend to err more on the side of the concerns of pr...

  8. Financial Services Marketing.

    Science.gov (United States)

    Olson, Lucretia Maria

    This manual contains student assignments in the financial services area of the marketing process. The individualized competency-based materials are intended to enhance and supplement instruction or to provide the basis for a course of instruction by the teacher-coordinator. Information on skills needed in jobs in financial marketing is first…

  9. Financial arrangements for health systems in low-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Wiysonge, Charles S; Paulsen, Elizabeth; Lewin, Simon; Ciapponi, Agustín; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Oxman, Andrew D

    2017-09-11

    is uncertain whether they improve completion of treatment for active tuberculosis. Conditional cash transfer programmes probably lead to an increase in service utilisation (moderate-certainty evidence), but their effects on health outcomes are uncertain. Vouchers may improve health service utilisation (low-certainty evidence), but the effects on health outcomes are uncertain (very low-certainty evidence). Introducing a restrictive cap may decrease use of medicines for symptomatic conditions and overall use of medicines, may decrease insurers' expenditures on medicines (low-certainty evidence), and has uncertain effects on emergency department use, hospitalisations, and use of outpatient care (very low-certainty evidence). Reference pricing, maximum pricing, and index pricing for drugs have mixed effects on drug expenditures by patients and insurers as well as the use of brand and generic drugs. Provider incentives: the effects of provider incentives are uncertain (very low-certainty evidence), including: the effects of provider incentives on the quality of care provided by primary care physicians or outpatient referrals from primary to secondary care, incentives for recruiting and retaining health professionals to serve in remote areas, and the effects of pay-for-performance on provider performance, the utilisation of services, patient outcomes, or resource use in low-income countries. Research based on sound systematic review methods has evaluated numerous financial arrangements relevant to low-income countries, targeting different levels of the health systems and assessing diverse outcomes. However, included reviews rarely reported social outcomes, resource use, equity impacts, or undesirable effects. We also identified gaps in primary research because of uncertainty about applicability of the evidence to low-income countries. Financial arrangements for which the effects are uncertain include external funding (aid), caps and co-payments, pay-for-performance, and

  10. ICAF Financial Services Industry Study

    National Research Council Canada - National Science Library

    Allison, Douglas; Barry, Kevin; Beaver, Philip; Browne, Michael; Cubillos, Claudio; Hanger, Wallace; Kluchko, Luke; LaDue, Charles; McGhee, Michael; Mitsoff, Gregory

    2005-01-01

    .... The industry includes those firms that provide financial services to organizations or individuals, the government agencies that regulate the industry, and the markets that facilitate the exchange of financial assets...

  11. Financial Literacy Education for Women

    Science.gov (United States)

    Jarecke, Jodi; Taylor, Edward W.; Hira, Tahira K.

    2014-01-01

    Exploring the pedagogical approaches of four women's financial literacy education programs, this chapter provides an overview of trends and needs in financial education for women and offers pedagogical strategies for teaching women about finance.

  12. The financial accelerator effect: concept and challenges

    National Research Council Canada - National Science Library

    Bruno Coric

    2011-01-01

    .... We find that the financial accelerator effect, as it is known, provides a consistent, first principle based, theoretical framework for the analysis of the relationship between financial markets...

  13. Financial Literacy and Financial Behaviour

    NARCIS (Netherlands)

    Sayinzoga, Aussi; Bulte, Erwin H.; Lensink, Robert

    2016-01-01

    We organise a field experiment with smallholder farmers in Rwanda to measure the impact of financial literacy training on financial knowledge and behaviour. The training increased financial literacy of participants, changed their savings and borrowing behaviour and had a positive effect on the

  14. Optimal incentives for collective intelligence.

    Science.gov (United States)

    Mann, Richard P; Helbing, Dirk

    2017-05-16

    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.

  15. Financial Literacy, Retirement Planning and Household Wealth

    NARCIS (Netherlands)

    van Rooij, Maarten C. J.; Lusardi, Annamaria; Alessie, Rob J. M.

    Relying on comprehensive measures of financial knowledge, we provide evidence of a strong positive association between financial literacy and net worth, even after controlling for many determinants of wealth. We discuss two channels through which financial literacy might facilitate wealth

  16. Late Financial Distress Process Stages and Financial Ratios

    DEFF Research Database (Denmark)

    Sormunen, Nina; Laitinen, Teija

    2012-01-01

    according to the date of application for reorganization: the first group of businesses applied for reorganization between 1 and 182 days after the closing of accounts, and the second group between 183 and 365 days after that point. The study findings provide evidence that the financial distress process......The present study adds to our understanding and knowledge of financial distress predictions regarding the usefulness of financial ratios in the late stages of the financial distress process. The study contributes to previous research by generating information concerning: (1) the behavior...... and usefulness of single financial ratios in short-term financial distress prediction when the effect of each different financial distress process stage is considered; (2) the effects of recognition of the financial distress process stage on the financial distress prediction model. The time horizon...

  17. [Possibilities and limitations of results-based management, pay-for-performance and the redesign of incentives. 2008 SESPAS Report].

    Science.gov (United States)

    Peiró, Salvador; García-Altés, Anna

    2008-04-01

    The concept of pay-for-performance (P4P) encompasses different strategies that aim to stimulate health care quality improvement by remunerating healthcare providers according to their performance in specific measures of efficiency or quality. Although the effectiveness of P4P in improving quality of care is largely unknown, these systems are being widely adopted in the United Kingdom, the United States and other countries, including Spain. The elements of P4P design that are most decisive for the effectiveness of these schemes are as follows: 1) who should receive the incentives, how they should be paid, what should be rewarded, the need to incorporate risk adjustments (mainly if surrogate outcomes are used as indicators) and the need to bear organizational climate and the optimal combination of financial and non-financial incentives in mind. The most important limitations to consider are the following: 1) the exclusive focus on reducing subutilization; 2) the effect on equity; 3) the "magnifying glass" effect; 4) the validity of indicators; 5) the confusion between the recommendations of clinical guidelines and quality indicators; 6) "document engineering"; 7) paternalism; 8) the negative impact on professionalism and clinicians' internal motivation, and 9) the assumption that quality problems result from imperfect individual decisions rather than from an imperfect system.

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

    NARCIS (Netherlands)

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

    2011-01-01

    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

  19. FINANCIAL INSTRUMENTS FOR THE PROTECTION OF MOTHERS

    Directory of Open Access Journals (Sweden)

    ANA-PETRINA PĂUN

    2016-10-01

    Full Text Available The social policy of any state incorporates suitable financial tools that support parents and children. In this paper, we have presented the evolution of these forms of social protection, which have changed almost yearly over the past decade. The ones that I have considered particularly important are: the allowance for raising children up to 2 years or up to 3 years in the case of disabled children and the re-induction incentive. An important instrument of reintegration in the labour market, the re-induction incentive is presented in the main financial aspects and statistically speaking, I have analyzed its evolution in numbers and total value. In the second part of the thesis I have shown the social, legislative and financial aspects of the child raising allowance.

  20. When and why do university managers use publication incentive payments?

    DEFF Research Database (Denmark)

    Opstrup, Niels

    2017-01-01

    Pay-for-performance schemes have become a widespread management strategy in the public sector. However, not much is known about the rationales that trigger the adoption of performance-related pay provisions. This article examines managerial and organisational features of university departments in......’ and ‘non-believers’. Almost half expressed confidence in that publication incentive payments motivate researchers to perform better, not because of the monetary reward, but because of the positive feedback signalled by the pay supplement...... in Denmark that use publication incentive payments. Most often it is used when heads of department outside the humanities think it is a good idea to reward scholars financially for publications. In-depth analysis of the cases reveals, however, that department heads cannot only be divided between ‘believers...

  1. Implementing a comprehensive relative-value-based incentive plan in an academic family medicine department.

    Science.gov (United States)

    Cramer, J S; Ramalingam, S; Rosenthal, T C; Fox, C H

    2000-12-01

    The authors describe the implementation and first three years (1997-1999) of a department-wide incentive plan of the Department of Family Medicine at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. By using a consensus approach, a representative elected committee designed a clinical relative value unit (explained in detail) that could be translated to equally value and reward faculty efforts in patient care, education, and research and which allowed the department to avoid the imposition of a model that could have undervalued scholarship and teaching. By 1999, the plan's goal of eight patient-care-equivalent points per four-hour session had been exceeded for pure clinical care. Clearly, only a small financial incentive was necessary (in 1999, an incentive pool of 4% of providers' gross salary) to motivate the faculty to be more productive and to self-report their efforts. Long-term productivity for pure clinical care rose from 9.8 points per session in 1997 to 10.4 in 1999. Of the mean total of 3,980 points for the year 1999, the contribution from teaching was 1,146, or 29%, compared with 25% in 1997. For scholarship, the number of points was 775, or 20%, in 1999, compared with 11% in 1997. The authors describe modifications to the original plan (e.g., integration of quality measures) that the department's experience has fostered. Problems encountered included the lack of accurate and timely billing information from the associated teaching hospitals, the inherent problems of self-reported information, difficulties of gaining buy-in from the faculty, and inherent risks of a pay-for-performance approach. But the authors conclude that the plan is fulfilling its goal of effectively and fairly quantifying all areas of faculty effort, and is also helping the department to more effectively demonstrate clinical productivity in negotiations with teaching hospitals.

  2. Understanding and Integrating Local Perceptions of Trees and Forests into Incentives for Sustainable Landscape Management

    Science.gov (United States)

    Pfund, Jean-Laurent; Watts, John Daniel; Boissière, Manuel; Boucard, Amandine; Bullock, Renee Marie; Ekadinata, Andree; Dewi, Sonya; Feintrenie, Laurène; Levang, Patrice; Rantala, Salla; Sheil, Douglas; Sunderland, Terence Clarence Heethom; Urech, Zora Lea

    2011-08-01

    We examine five forested landscapes in Africa (Cameroon, Madagascar, and Tanzania) and Asia (Indonesia and Laos) at different stages of landscape change. In all five areas, forest cover (outside of protected areas) continues to decrease despite local people's recognition of the importance of forest products and services. After forest conversion, agroforestry systems and fallows provide multiple functions and valued products, and retain significant biodiversity. But there are indications that such land use is transitory, with gradual simplification and loss of complex agroforests and fallows as land use becomes increasingly individualistic and profit driven. In Indonesia and Tanzania, farmers favor monocultures (rubber and oil palm, and sugarcane, respectively) for their high financial returns, with these systems replacing existing complex agroforests. In the study sites in Madagascar and Laos, investments in agroforests and new crops remain rare, despite government attempts to eradicate swidden systems and their multifunctional fallows. We discuss approaches to assessing local values related to landscape cover and associated goods and services. We highlight discrepancies between individual and collective responses in characterizing land use tendencies, and discuss the effects of accessibility on land management. We conclude that a combination of social, economic, and spatially explicit assessment methods is necessary to inform land use planning. Furthermore, any efforts to modify current trends will require clear incentives, such as through carbon finance. We speculate on the nature of such incentive schemes and the possibility of rewarding the provision of ecosystem services at a landscape scale and in a socially equitable manner.

  3. Financial arbitrator

    OpenAIRE

    Jendrulková, Anna

    2014-01-01

    Financial Arbitrator The legislative introduction of the institute of Financial Arbitrator as the relevant authority for settling out-of-court disputes into Czech law is a relatively new phenomenon, and is related to the interests of consumer protection within the European Union. In particular, the interests of the European Union in this area are to reinforce consumer confidence in the financial market. Given the fact that the majority of consumer disputes are so-called petty disputes, and re...

  4. Financial arrangements for health systems in low-income countries: an overview of systematic reviews

    Science.gov (United States)

    Wiysonge, Charles S; Paulsen, Elizabeth; Lewin, Simon; Ciapponi, Agustín; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Oxman, Andrew D

    2017-01-01

    completion of tuberculosis prophylaxis, and it is uncertain whether they improve completion of treatment for active tuberculosis. Conditional cash transfer programmes probably lead to an increase in service utilisation (moderate-certainty evidence), but their effects on health outcomes are uncertain. Vouchers may improve health service utilisation (low-certainty evidence), but the effects on health outcomes are uncertain (very low-certainty evidence). Introducing a restrictive cap may decrease use of medicines for symptomatic conditions and overall use of medicines, may decrease insurers' expenditures on medicines (low-certainty evidence), and has uncertain effects on emergency department use, hospitalisations, and use of outpatient care (very low-certainty evidence). Reference pricing, maximum pricing, and index pricing for drugs have mixed effects on drug expenditures by patients and insurers as well as the use of brand and generic drugs. Provider incentives: the effects of provider incentives are uncertain (very low-certainty evidence), including: the effects of provider incentives on the quality of care provided by primary care physicians or outpatient referrals from primary to secondary care, incentives for recruiting and retaining health professionals to serve in remote areas, and the effects of pay-for-performance on provider performance, the utilisation of services, patient outcomes, or resource use in low-income countries. Authors' conclusions Research based on sound systematic review methods has evaluated numerous financial arrangements relevant to low-income countries, targeting different levels of the health systems and assessing diverse outcomes. However, included reviews rarely reported social outcomes, resource use, equity impacts, or undesirable effects. We also identified gaps in primary research because of uncertainty about applicability of the evidence to low-income countries. Financial arrangements for which the effects are uncertain include external

  5. Association of financial or professional conflict of interest to research outcomes on health risks or nutritional assessment studies of genetically modified products

    OpenAIRE

    Diels, Johan; Cunha, Mario; Manaia, Célia; Sabugosa-Madeira, Bernardo; Silva, Margarida

    2011-01-01

    Since the first commercial cultivation of genetically modified crops in 1994, the rapidly expanding market of genetically modified seeds has given rise to a multibillion dollar industry. This fast growth, fueled by high expectations towards this new commercial technology and shareholder trust in the involved industry, has provided strong incentives for further research and development of new genetically modified plant varieties. Considering, however, the high financial stakes invo...

  6. Teacher Incentive Pay Programs in the United States: Union Influence and District Characteristics

    Directory of Open Access Journals (Sweden)

    Guodong Liang

    2015-06-01

    Full Text Available This study examined the characteristics of teacher incentive pay programs in the United States. Using the 2007–08 SASS data set, it found an inverse relationship between union influence and districts’ incentive pay offerings. Large and ethnically diverse districts in urban areas that did not meet the requirements for Adequate Yearly Progress as defined under the No Child Left Behind Act are more likely to offer a larger number of economic incentives. Although rural districts are likely to reward teachers in hard-to-staff schools, they are not more likely to reward teachers who are certified by the National Board or who teach in the subject areas of shortage, nor are they more likely to offer multiple financial incentives.

  7. Financial benchmarking

    OpenAIRE

    Palanevich, Yana

    2014-01-01

    This bachelor thesis is focused on financial benchmarking of KBJ VELKOOBCHODY s.r.o. The aim of this study is to evaluate the financial situation of the company and to compare the results within the same field and with the best companies in this branch as well as direct competitors. The purpose is to gain an overview of the financial health of the company and also the relevation of strengths and weaknesses through Benchmarking diagnostic system of financial indicators INFA. The theoretical pa...

  8. Financial mathematics

    CERN Document Server

    Jothi, A Lenin

    2009-01-01

    Financial services, particularly banking and insurance services is the prominent sector for the development of a nation. After the liberalisation of financial sector in India, the scope of getting career opportunities has been widened. It is heartening to note that various universities in India have introduced professional courses on banking and insurance. A new field of applied mathematics has come into prominence under the name of Financial Mathematics. Financial mathematics has attained much importance in the recent years because of the role played by mathematical concepts in decision - m

  9. Are policy incentives for solar power effective? Evidence from residential installations in the Northeast

    Energy Technology Data Exchange (ETDEWEB)

    Crago, Christine Lasco; Chernyakhovskiy, Ilya

    2017-01-01

    State incentives for solar power have grown significantly in the past several years. This paper examines the effectiveness of policy incentives to increase residential solar photovoltaic (PV) capacity. We use county-level panel data and control for demographic characteristics, solar resources, and pro-environmental preferences. Results show that among financial incentives, rebates have the most impact with an additional $1 per watt rebate increasing annual PV capacity additions by close to 50%. Factors that affect financial returns to solar PV such as electricity price and solar insolation are also found to be significant. Results also point to a significant positive relationship between hybrid vehicle sales and residential PV capacity growth, indicating the importance of pro-environmental preferences as a predictor of solar PV demand. Back of the envelope calculations suggest that the cost of carbon mitigation through rebates is around $184 per ton of CO2.

  10. Variation in Incentive Effects across Neighbourhoods

    Directory of Open Access Journals (Sweden)

    Mark J Hanly

    2014-03-01

    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.

  11. Incentive Contracts and Cost Growth

    Science.gov (United States)

    1983-10-31

    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

  12. Incentive Ratios of Fisher Markets

    DEFF Research Database (Denmark)

    Chen, Ning; Deng, Xuaitue; Zhang, Hongyang

    2012-01-01

    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....

  13. Incentives in Supply Function Equilibrium

    DEFF Research Database (Denmark)

    Vetter, Henrik

    2014-01-01

    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...

  14. Incentives in Supply Function Equilibrium

    DEFF Research Database (Denmark)

    Vetter, Henrik

    2015-01-01

    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...

  15. On supplementing "Foot in the door" incentives for eHealth program engagement.

    Science.gov (United States)

    Mitchell, Marc Steven; Faulkner, Guy E

    2014-07-25

    Financial health incentives, such as paying people to lose weight, are being widely implemented by Western nations and large corporations. A growing number of studies have tested the impact of incentives on health behaviors, though few have evaluated the approach on a population-scale. In this issue of the Journal of Medical Internet Research, Liu et al add to the evidence-base by examining whether a single incentive can motivate enrollment and engagement in a preventive eHealth program in a sample of 142,726 Canadian adults. While the incentives increased enrollment significantly (by a factor of about 28), a very high level of program attrition was noted (90%). The "foot in the door" incentive technique employed was insufficient; enrollees received incentives for signing-up for, but not for engaging with, the eHealth program. To supplement this technique and drive sustained behavior change, several theoretically- and empirically-based strategies are proposed. Specifically, incentives indexed to behavioral achievements over time are highlighted as one approach to boost engagement in this population in the future.

  16. Understanding the Complexities of Subnational Incentives in Supporting a National Market for Distributed Photovoltaics

    Energy Technology Data Exchange (ETDEWEB)

    Bush, B.; Doris, E.; Getman, D.

    2014-09-01

    Subnational policies pertaining to photovoltaic (PV) systems have increased in volume in recent years and federal incentives are set to be phased out over the next few. Understanding how subnational policies function within and across jurisdictions, thereby impacting PV market development, informs policy decision making. This report was developed for subnational policy-makers and researchers in order to aid the analysis on the function of PV system incentives within the emerging PV deployment market. The analysis presented is based on a 'logic engine,' a database tool using existing state, utility, and local incentives allowing users to see the interrelationships between PV system incentives and parameters, such as geographic location, technology specifications, and financial factors. Depending on how it is queried, the database can yield insights into which combinations of incentives are available and most advantageous to the PV system owner or developer under particular circumstances. This is useful both for individual system developers to identify the most advantageous incentive packages that they qualify for as well as for researchers and policymakers to better understand the patch work of incentives nationwide as well as how they drive the market.

  17. An incentive-based architecture for social recommendations

    KAUST Repository

    Bhattacharjee, Rajat

    2009-01-01

    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.

  18. Engendering Organizational Commitment through “Non­‐financial” Rewards and Incentives

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Sluhan, Anne

    In this paper, we present findings from the analysis of a qualitative case study exploring how a novel approach to a reward and incentive scheme was used engender organizational commitment in employees in a Danish Professional Service Firm (PSF) in the financial service sector. The firm’s efforts...

  19. Engendering organizational commitment through “non­‐financial” rewards and incentives

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Sluhan, Anne

    In this paper, we present findings from the analysis of a qualitative case study exploring how a novel approach to a reward and incentive scheme was used engender organizational commitment in employees in a Danish Professional Service Firm (PSF) in the financial service sector. The firm’s efforts...

  20. The financial impact of orthopaedic fellowship training.

    Science.gov (United States)

    Gaskill, Trevor; Cook, Chad; Nunley, James; Mather, R Chad

    2009-07-01

    Previous reports have compared the expected financial return of a medical education with those expected in other professions. However, we know of no published report estimating the financial return of orthopaedic training. The purpose of this study was to estimate the financial incentives that may influence the decision to invest an additional year of training in each of the major orthopaedic fellowships. With survey data from the American Academy of Orthopaedic Surgeons and using standard financial techniques, we calculated the estimated return on investment of an additional year of orthopaedic training over a working lifetime. The net present value, internal rate of return, and the break-even point were estimated. Eight fellowships were examined and compared with general orthopaedic practice. Investment in an orthopaedic fellowship yields variable returns. Adult spine, shoulder and elbow, sports medicine, hand, and adult arthroplasty may yield positive returns. Trauma yields a neutral return, while pediatrics and foot and ankle have negative net present values. On the basis of mean reported incomes, the break-even point was two years for spine, seven years for hand, eight years for shoulder and elbow, twelve years for adult arthroplasty, thirteen years for sports medicine, and twenty-seven years for trauma. Fellowship-trained pediatric and foot and ankle surgeons did not break even following the initial investment. When working hours were controlled for, the returns for adult arthroplasty and trauma became negative. The financial return of an orthopaedic fellowship varies on the basis of the specialty chosen. While reasons to pursue fellowship training vary widely, and many are not financial, there are positive and negative financial incentives. Therefore, the decision to pursue fellowship training is best if it is not made on the basis of financial incentives. This information may assist policy makers in analyzing medical education economics to ensure the

  1. FINANCIAL PERFORMANCES MEASUREMENT TOOLS

    National Research Council Canada - National Science Library

    BÎRCĂ ALIONA

    2016-01-01

    ... of objectives in line with the strategic policies of the entity. Measuring the financial performance without considering the strategic, tactical and operational objectives does not provide a real situation...

  2. Using Publicly Available Data to Characterize Consumers Use of Email to Communicate with Healthcare Providers.

    Science.gov (United States)

    Sandefer, Ryan H; Khairat, Saif S; Pieczkiewicz, David S; Speedie, Stuart M

    2015-01-01

    The use of patient focused technology has been proclaimed as a means to improve patient satisfaction and improve care outcomes. The Center for Medicaid/Medicare Services, through its EHR Incentive Program, has required eligible hospitals and professionals to send and receive secure messages from patients in order to receive financial incentives and avoid reimbursement penalties. Secure messaging between providers and patients has the potential to improve communication and care outcomes. The purpose of this study was to use National Health Interview Series (NHIS) data to identify the patient characteristics associated with communicating with healthcare providers via email. Individual patient characteristics were analyzed to determine the likelihood of emailing healthcare providers. The use of email for this purpose is associated with educational attainment, having a usual place of receiving healthcare, income, and geography. Publicly available data such as the NHIS may be used to better understand trends in adoption and use of consumer health information technologies.

  3. 20 CFR 638.519 - Incentives system.

    Science.gov (United States)

    2010-04-01

    ... 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...

  4. Incentive Systems for Education Personnel. Final Report.

    Science.gov (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,…

  5. Merger incentives and the failing firm defense

    NARCIS (Netherlands)

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

    2014-01-01

    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

  6. 28 CFR 544.43 - Incentives.

    Science.gov (United States)

    2010-07-01

    ... 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. ...

  7. 12 CFR 708a.12 - Voting incentives.

    Science.gov (United States)

    2010-01-01

    ... 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...

  8. 7 CFR 3560.656 - Incentives offers.

    Science.gov (United States)

    2010-01-01

    ... 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...

  9. 28 CFR 544.72 - Incentives.

    Science.gov (United States)

    2010-07-01

    ... 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...

  10. Start-up incentives the Netherlands

    NARCIS (Netherlands)

    Bekker, S.; van den Eijnden, J.

    2014-01-01

    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

  11. 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...

  12. Market liquidity and financial stability.

    OpenAIRE

    Crockett, A.

    2008-01-01

    Stability in financial institutions and in financial markets are closely intertwined. Banks and other financial institutions need liquid markets through which to conduct risk management. And markets need the back-up liquidity lines provided by financial institutions. Market liquidity depends not only on objective, exogenous factors, but also on endogenous market dynamics. Central banks responsible for systemic stability need to consider how far their traditional responsibility for the health ...

  13. Financial Engineering: an Islamic Perspective

    OpenAIRE

    Suwailem, Sami Al

    2007-01-01

    Islamic financial industry is growing rapidly. Markets are increasingly appreciat-ing Islamic instruments, and more institutions are willing to provide Islamic services to their clients. However, development of Islamic financial products through appropriate processes of financial engineering has remained an important area of researches. Two issues are always faced by any Islamic financial products in one go, competitiveness and shariah compliance. Not only Islamically acceptable, but any Isla...

  14. Medicaid program; cost limit for providers operated by units of government and provisions to ensure the integrity of federal-state financial partnership. Final rule with comment period.

    Science.gov (United States)

    2007-05-29

    This regulation clarifies that entities involved in the financing of the non-Federal share of Medicaid payments must be a unit of government; clarifies the documentation required to support a Medicaid certified public expenditure; limits Medicaid reimbursement for health care providers that are operated by units of government to an amount that does not exceed the health care provider's cost of providing services to Medicaid individuals; requires all health care providers to receive and retain the full amount of total computable payments for services furnished under the approved Medicaid State plan; and makes conforming changes to provisions governing the State Child Health Insurance Program (SCHIP) to make the same requirements applicable, with the exception of the cost limit on reimbursement. The Medicaid cost limit provision of this regulation does not apply to: Stand-alone SCHIP program payments made to governmentally-operated health care providers; Indian Health Service (IHS) facilities and tribal 638 facilities that are paid at the all-inclusive IHS rate; Medicaid Managed Care Organizations (MCOs), Prepaid Inpatient Health Plans (PIHPs), and Prepaid Ambulatory Health Plans (PAHPs); Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Moreover, disproportionate share hospital (DSH) payments and payments authorized under Section 701(d) and Section 705 of the Benefits Improvement Protection Act of 2000 are not subject to the newly established Medicaid cost limit for governmentally-operated health care providers. Except as noted above, all Medicaid payments and SCHIP payments made under the authority of the State plan and under waiver and demonstration authorities, as well as associated State Medicaid and SCHIP financing arrangements, are subject to all provisions of this regulation. Finally, this regulation solicits comments from the public on issues related to the definition of the Unit of Government.

  15. Using a Mnemonic to Develop Effective Incentive Systems

    Science.gov (United States)

    Forbringer, Linda L.

    2007-01-01

    Special educators frequently provide consultation for parents and general education teachers who are struggling to manage student behavior. One intervention often discussed is the use of rewards to increase student motivation. While research has shown that well-designed incentive systems can provide an effective intervention, poorly designed…

  16. "Creating hope" and other incentives for drug development for children.

    Science.gov (United States)

    Connor, Edward; Cure, Pablo

    2011-01-19

    Enhancing drug development for pediatric disease is a priority and a public responsibility. The Creating Hope Act of 2010 is important new proposed legislation that adds drugs and biologics for treating rare diseases in children to those for neglected tropical diseases as eligible for a priority review voucher from the U.S. Food and Drug Administration. The Act enhances existing incentive programs through specific financial benefits to companies who seek a pediatric indication for a new drug to treat an orphan disease that occurs specifically in children.

  17. The response of maize production in Kenya to economic incentives

    Directory of Open Access Journals (Sweden)

    Onono, P.A.,

    2013-06-01

    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.

  18. 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.

    1981-08-01

    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)

  19. What incentives influence employers to engage in workplace health interventions?

    Directory of Open Access Journals (Sweden)

    Camilla Martinsson

    2016-08-01

    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.

  20. Implementation of Client Incentives within a Recovery Navigation Program.

    Science.gov (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

    2017-01-01

    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.