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PubMed1997

An informational versus monetary incentive in increasing physicians' response rates.

This study examined return rates for a cancer prevention survey by pediatricians in relation to an informational booklet versus a monetary incentive in the first of a three-wave mailing. Of the 300 surveys sent which included an informational booklet incentive, 189 (64%) were returned. Of the 300 surveys sent which included a $1.00 incentive 227 (79%) were returned, indicating the $1.00 incentive was more effective than the informational incentive in increasing return rates in this sample of physicians.

Attitude of Health Personnel↗

PubMed2004

Influence of paper color and a monetary incentive on response rate.

This study examined whether survey response rate differed based on the color of the paper the survey was printed on (blue vs green) and presence of a monetary incentive. A 4-page survey on eating disorders was mailed to Division 1A and 1AA college head athletic trainers (N=223) with half of the surveys on blue paper and half on green paper. Half of the athletic trainers (n = 111) received a $1.00 monetary incentive, and half (n = 112) received no monetary incentive. A total of 166 (71%) athletic trainers returned completed surveys. Response rates did not differ based on survey color but did differ based on presence of a monetary incentive. Athletic trainers who received a monetary incentive were significantly more likely than those who did not to return completed surveys (86% vs 63%, respectively).

Adult↗

PubMed1983

Social and economic incentives for family caregivers.

The recent emphasis on developing programs and policies to support families who care for aged relatives makes it important to understand the families' receptivity to the specific social and economic incentives under consideration. The research reported in this paper draws on the experiences of 203 individuals identified as the primary caregiver to an aged frail relative currently receiving home care or day care services in New York City. As part of a larger study of caregiving behavior, respondents were asked to rank their preferences for various service and economic support programs. Findings indicate that family caregivers perceive service and social supports, specifically medical care and homemaker service, as more crucial than both direct and indirect financial incentives. Furthermore, the issue of economic incentives elicited an extremely negative reaction from a significant minority who refused to consider such support in their personal family situations. The analysis indicated that the caregiver's background characteristics were not critical in differentiating caregivers who select either a service or an economic incentive. Among the set of variables defining the current caregiving situation, only sex of the aged relative and utilization of home care services were significantly related to choice of program. Respondents caring for females and high service utilizers were more likely to prefer service supports. Relevance of findings to current policy initiatives regarding financial incentives to families are presented.

Aged↗

PubMedDate not supplied

Using administrative data to reward agency performance: the case of the federal adoption incentive program.

This article explores the history of the federal Adoption Incentive Program, the first federal child welfare outcome-based incentive program to rely solely on administrative data, and discusses it within the context of other prior and ongoing federal child welfare incentive programs. Various data-related issues are also examined, including the use of data to project program utilization and costs, set baselines for the number of adoptions, and award funds. Challenges in the legislatively required use of AFCARS data for determining the amount of incentive funds awarded and the impact of the program on AFCARS reporting are also discussed. The article concludes with a look at the impact of the Adoption Incentive Program on adoption and predictions for the future.

Adoption↗

PubMed1989

Effect of incentive spirometry on diaphragmatic function after surgery.

Many of the alterations in lung function that occur after upper abdominal surgery are attributable to reduced diaphragmatic activity. This study was undertaken to determine whether incentive spirometry produces a voluntary activation of diaphragmatic movement in patients with postoperative diaphragmatic dysfunction. Inductance plethysmography was used to measure the tidal volumes of the abdomen and chest in eight women before cholecystectomy and on the first and third postoperative days. In resting patients the relative contribution of the abdominal compartment decreased from 0.520 +/- 0.100 preoperatively to 0.274 +/- 0.265 on postoperative day 1 (p less than 0.01), reflecting the effect of surgery on diaphragmatic function. Inspiratory flow (an index of inspiratory drive) was unaltered by surgery during both resting and incentive spirometry breaths, despite changes in tidal volume. Preoperatively, incentive spirometry increased the tidal volume of the abdominal compartment from 141 +/- 26 ml to 285 +/- 188 ml (p less than 0.005) as a result of increased diaphragmatic movement. This effect was not seen postoperatively; instead, postoperative patients responded to incentive spirometry by increasing the tidal excursion of the chest compartment (158 +/- 37 to 630 +/- 253, p less than 0.005), without any increase in abdominal tidal volume. Thus, incentive spirometry failed to increase diaphragmatic movement in postoperative patients.

Abdomen↗

PubMed1977

Governmental population incentives: ethical issues at stake.

Governmental incentives to influence population-related decisions are examined in terms of the ethical issues at stake. A typology of incentive schemes is presented, and ethical implications of various incentives are discussed. It is argued that, in a just scheme, a progressive, negative incentive or fee, calculated as a surtax on a modified income tax or an equivalent standard, would distribute burdens equally. A set of guidelines for ethical evaluation of incentive schemes is proposed.

Contraception Behavior↗

PubMed2001

Financial incentives in health care. The impact of performance-based reimbursement.

The key question addressed in this study is whether performance-based reimbursement (PBR) is a useful way to create the right incentive for efficiency improvements in health care. In this 4-year prospective cohort study, physicians in one council with PBR and in ten councils without such a system were studied. The results of this study indicate that PBR, compared to an annual budget system, creates a different incentive, an 'inner incentive' which may be stronger than the external incentive of financial pressures. PBR may result in a greater cost awareness and shorter average length of stay, but it may also lead to negative effects on the quality of care. A strong cost awareness was found to be a negative predictor of quality of care indicating that it is a difficult balancing act to maintain cost considerations at a 'good' level in order to retain the benefits of cost awareness without adversely impacting quality of care. There is a need for further studies of the impact of PBR on financial performance and quality of care issues.

Adult↗

PubMed1996

A prescribing incentive scheme for non-fundholding general practices: an observational study.

OBJECTIVE: To examine the effects of a financial incentive scheme on prescribing in non-fundholding general practices. DESIGN: Observational study. SETTING: Non-fundholding general practices in former Northern region in 1993-4. INTERVENTION: Target savings were set for each group of practices; those that achieved them were paid a portion of the savings. MAIN OUTCOME MEASURES: Financial performance; prescribing patterns in major therapeutic groups and some specific therapeutic areas; rates of generic prescribing; and performance against a measure of prescribing quality. SUBJECTS: 459 non-fundholding general practices, grouped into three bands according to the ratio of their indicative prescribing amount to the local average (band A > or = 10% above average, B between average and 10% above, C below average). RESULTS: 102 (23%) of 442 practices achieved their target savings (18%, 19%, and 27% of bands A, B, and C respectively). Band C practices that achieved their target had a lower per capita prescribing frequency for gastrointestinal drugs, inhaled steroids, antidepressants, and hormone replacement therapy. There were no other significant differences in prescribing frequency, and no reduction in the quality of prescribing in achieving practices. Total savings of pounds 1.54 m on indicative prescribing amounts were achieved. Payments from the incentive scheme and discretionary quality awards resulted in pounds 463,000 being returned to practices for investment in primary care. CONCLUSIONS: The prescribing behaviour of non-fundholding general practitioners responded to financial incentives in a similar way to that of fundholding practitioners. The incentive scheme did not seem to reduce the quality of prescribing.

Budgets↗

PubMed2004

Penetrating the "black box": financial incentives for enhancing the quality of physician services.

This article addresses the impact of financial incentives on physician behavior, focusing on quality of care. Changing market conditions, evolving social forces, and continuing organizational evolution in health services have raised societal awareness and expectations concerning quality. This article proceeds in four parts. First, the authors place financial incentives in the context of broader forces shaping the quality of physician services. Second, the article reviews the literature on financial incentive effects on physician behavior. Third, a simple net income maximization model of physician choices is presented, from which are derived formal hypotheses regarding the effect of financial incentives on physician choices of quality per unit of physician service and the quantity of services per patient. The model is extended qualitatively to offer further hypotheses and research directions. Finally, gaps and limitations of the model and of the extant empirical research are articulated, and additional researchable questions are posed.

Attitude of Health Personnel↗

PubMedDate not supplied

Impact of financial incentives on documented immunization rates in the inner city: results of a randomized controlled trial.

OBJECTIVE: This study determined the effect of 2 financial incentives---bonus and enhanced fee-for-service---on documented immunization rates during a second period of observation. METHODS: Incentives were given to 57 randomly selected inner-city physicians 4 times at 4-month intervals based on the performance of 50 randomly selected children. Coverage from linked records from all sources was determined for a subsample of children within physician offices. RESULTS: Up-to-date coverage rates documented in the charts increased significantly for children in the bonus group (49.7% to 55.6%; P <.05) and the enhanced fee-for-service group (50.8% to 58.2%; P <.01) compared with the control group. The number of immunizations given by these physicians did not change significantly, although the number of immunizations given by others and documented by physicians in the bonus group did increase (P <.05). Up-to-date coverage for all groups increased from 20 to 40 percentage points when immunizations from physician charts were combined with other sources. CONCLUSIONS: Both financial incentives produced a significant increase in coverage levels. Increases were primarily due to better documentation not to better immunizing practices. The financial incentives appeared to provide motivation to physicians but were not sufficient to overcome entrenched behavior patterns. However, true immunization coverage was substantially higher than that documented in the charts.

Child, Preschool↗

PubMed1989

Cost-containment incentives in HMOs. What's known, what's not known.

HMOs use various incentives to control utilization of health care resources, and physicians who are thinking of joining these organizations should understand how these factors will influence their practice. Financial incentives include withheld funds, penalties against those at risk, and bonuses for physicians with good practice habits. Nonfinancial incentives include education concerning efficient use of health care resources, feedback mechanisms, participation in planning cost-containment programs, and administrative constraints. There are also less obvious, nonfinancial incentives; one involves inclusion of ancillary office personnel in bonus distribution, and these individuals may thus influence a physician's prescribing habits.

Cost Control↗

PubMed1991

Incentive-based management for nonprofit organizations.

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

Employee Incentive Plans↗

PubMed2005

Financial incentives, cross-purposes, and moral motivation in health care provision.

Financial incentives and disincentives are fundamental to a category of proposals, usually characterised as forms of managed care, whereby the pecuniary interests of health care providers are directly affected by their clinical decision-making. Presently, Australian health care administrators and private insurers are adopting financial incentives as a means of ensuring provider compliance with 'health outcome' and cost-constraint objectives. To the extent that this has occurred, health-care relationships are transformed to emulate, more closely, a commercial transaction. This paper questions the ideological assumptions which inform the use of financial incentives in the health care domain and raises concerns with regard to the potential for financial incentives to undermine the moral integrity of clinical decision-making. It also challenges the legitimacy of rationing health care resources through the use of this measure, particularly when adopted by private insurers of health care.

Australia↗

PubMed2005

Performance incentives in the Massachusetts behavioral health program.

Since 1996, the Massachusetts Behavioral Health Partnership (the Partnership/MBHP) has been the behavioral health carve-out vendor for the Commonwealth of Massachusetts Primary Care Clinician (PCC) Plan. Its use of performance standards and incentives has become one of the central organizing activities for both the Commonwealth and the vendor, and one of the program's hallmarks. Each year, the Commonwealth uses a participative process for generating suggestions for performance incentives, which are then negotiated with the Partnership. Success or failure of projects is judged in accordance with objective measures developed for each incentive project. From 1996 to 2004, 123 performance projects have been completed. Some projects have become contract requirements, and others have developed into programs or services. The performance incentive process blends features of more traditional performance standards with performance-based contracting approaches. This process gives both the Commonwealth and the Partnership the flexibility to reflect changing state policies and to develop a contract that meets the most current needs of members.

Massachusetts↗

PubMed2006

Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care.

BACKGROUND: A new economic incentive scheme based on (i) quality of care objectives for physicians, and (ii) professional development for both physicians and nurses, was introduced in primary care teams. OBJECTIVE: To assess weather the implementation of these economic incentive schemes has had an impact on the quality of professional life (QPL) of both physicians and nurses and on end-user satisfaction. METHODS: Before-after study. Participants are 257 primary care teams in Catalonia, Spain, in the period 2002-2003. QPL and end-user satisfaction were used as outcome measures. RESULTS: QPL was improved in terms of the dimension "perception of support from the management structure" among physicians (4.897 versus 5.220; p<0.001) as well as nurses (5.272 versus 5.638; p<0.001). Further, physicians perceived an increase in the dimension "demands made upon them" (6.124 versus 6.364; p<0.001), differently from the nurses group (5.8191 versus 5.929; p=0.063). Overall, user satisfaction did not vary significantly, although a positive relationship was found between "perception of support from the management structure" and user satisfaction among nurses (beta=0.078, p=0.007), and a negative relationship between "demands made upon them" and user satisfaction in the case of physicians (beta=-0.057, p=0.011). CONCLUSIONS: Incentives related to quality of care annual targets may increase physicians' perception of burden and it may have a negative impact on consumer satisfaction. Incentives on long-term professional development seem to be related to an increase in professionals' perception of support from the management structure. Among nurses, this increase is related to an improvement of user satisfaction.

Female↗

PubMed2006

A behavioral model of clinician responses to incentives to improve quality.

The use of pay for performance (P4P) and public reporting of performance (PR) in health care is increasing rapidly worldwide. The rationale for P4P and PR comes from experience in other industries and from theories about incentive use from psychology, economics, and organizational behavior. This paper reviews the major themes from this prior research and considers how they might be applied to health care. The resulting conceptual model addresses the dual nature (combining direct financial and reputational incentives) of the initiatives many policymakers are pursuing. It also includes explicit recognition of the key contextual factors (at the levels of the markets and the provider organization) and provider and patient characteristics that can enhance or mitigate response to incentives. Evaluation of the existing literature (through June 2005) about incentive use in health care in light of the conceptual model highlights important weaknesses in the way that trials have been reported to date and suggests future research topics.

Behavior↗

PubMed1999

Financial incentives for ambulatory care performance improvement.

BACKGROUND: Measuring and improving the quality of care while curtailing costs are essential objectives in capitated care. As patient care moves from the hospital to outpatient settings, quality management resources must be shifted to ambulatory care process improvement. The Quality Improvement and Efficiency Financial Incentives Program at Stanford University Medical Center was adopted to increase quality improvement efforts and contain costs. THE INCENTIVE PROGRAM: Each department's budget for care of capitated patients was reduced by 5% from the previous year. Return of a reserve fund (10% of payments for specialty care) required completion of substantive quality improvement projects and containing costs. Successful departments were also eligible for bonus funds. Implementation strategies included endorsement by clinical leaders, physician education, use of administrative data to identify project topics and support measurement of quality and cost variables, project templates and time lines, and the availability of clinical quality managers with special expertise in clinical process improvement. RESULTS: Eight of 13 clinical departments developed and implemented 19 ambulatory quality improvement projects to varying degrees. Success in the program was roughly correlated with the potential impact of the incentive on revenues and the status of the lead person selected by the department to spearhead their efforts. Only 5 departments achieved their cost containment goals. DISCUSSION: Financial incentives are one method of encouraging physicians to use clinical process improvement methods. Endorsement by clinical leaders and selection of realistic beginning projects enhance chances for success. The capitated population has attributes that make it an attractive focus for initial quality improvement efforts.

California↗

PubMed2002

The impact of financial incentives on physician productivity in medical groups.

OBJECTIVE: To estimate the effect of financial incentives in medical groups--both at the level of individual physician and collectively--on individual physician productivity. DATA SOURCES/STUDY SETTING: Secondary data from 1997 on individual physician and group characteristics from two surveys: Medical Group Management Association (MGMA) Physician Compensation and Production Survey and the Cost Survey Area Resource File data on market characteristics, and various sources of state regulatory data. STUDY DESIGN: Cross-sectional estimation of individual physician production function models, using ordinary least squares and two-stage least squares regression. DATA COLLECTION: Data from respondents completing all items required for the two stages of production function estimation on both MGMA surveys (with RBRVS units as production measure: 102 groups, 2,237 physicians; and with charges as the production measure: 383 groups, 6,129 physicians). The 102 groups with complete data represent 1.8 percent of the 5,725 MGMA member groups. PRINCIPAL FINDINGS: Individual production-based physician compensation leads to increased productivity, as expected (elasticity = .07, p < .05). The productivity effects of compensation methods based on equal shares of group net income and incentive bonuses are significantly positive (p < .05) and smaller in magnitude. The group-level financial incentive does not appear to be significantly related to physician productivity. CONCLUSIONS: Individual physician incentives based on own production do increase physician productivity.

Cross-Sectional Studies↗