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PubMed1994

Personal incentives for exercise and body esteem: a canonical correlation analysis.

Two hundred twelve women and 93 men enrolled in physical education courses were administered the Personal Incentives for Exercise Questionnaire and the Body Esteem Scale. Canonical correlation was conducted. For women, it was determined that personal incentives for exercise have modest predictive power for the weight concern and physical conditioning dimensions of body esteem and very little predictive power for the sexual attractiveness dimension; the body esteem variates have slight predictive power for the competition and weight management dimensions of investment in exercise. For men, it was determined that personal incentives for exercise have modest predictive power for the physical conditioning dimension of body esteem, slight predictive power for physical attractiveness, and none for upper body strength; the body esteem variate has modest predictive power for the weight management dimension of incentives for exercise and slight predictive power for appearance and affiliation.

Adult↗

PubMedDate not supplied

The impact of providing incentives for attendance at AIDS prevention sessions.

The research literature on AIDS prevention efforts contains many reports on the impact of intervention sessions. Little information is available, however, on the success of various strategies to recruit clients to attend these sessions. An assessment of the comparative impact of money and other types of incentives on group attendance in two AIDS risk reduction projects, in the Harlem area of New York City and in Cleveland, OH, was undertaken. In both projects, injecting drug users and the sex partners of injecting drug users were recruited to participate in group sessions that focused on the reduction of AIDS risk behaviors. Data on group attendance were analyzed for 838 people in the New York project and 1,168 in the Ohio project. After the projects were underway, attendance incentives at both were changed from money to food coupons or gift certificates. Results indicated that a nonmonetary incentive was associated with a significant decline in group attendance. Concerns regarding paying monetary incentives to injecting drug users are discussed.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

A performance-based incentive program for influenza immunization in the elderly.

Our objective was to implement and evaluate performance-based reimbursement for influenza immunization of the elderly in physician offices. We performed a community-based quasi-experiment with historic and concurrent comparisons, using primary care physician offices in Monroe County, New York. Participants in the intervention group included 53 primary care physicians admitting to one hospital, and the comparison group included 82 primary care physicians admitting to other hospitals. All physicians participated in a Medicare-sponsored demonstration to increase influenza immunization rates, and, during the 1990-1991 immunization season, used a target-based poster to track immunization rates. Physicians in the intervention group were enrolled in a performance-based financial incentive program that rewarded immunization rates above 70%. A survey concerning influenza immunization practices and opinions was sent to all physicians. The average physician-specific immunization rate in the incentive group was 73.1% versus 55.7% in the comparison practices (P < .001). Eligibility for incentives, practice size, sex of physician, medical specialty, reminder postcards, and practice populations including medically indigent patients were associated with immunization level. Controlling for the above variables, we completed a regression analysis showing that eligibility for the incentive was still significant (P = .003). The survey responses were not predictive of performance or significantly different between the two groups, except for the negative influence of sending postcards. This study in a community setting suggests that linking reimbursement to performance may be a successful strategy to increase influenza immunization levels for the elderly.

Aged↗

PubMed1997

Incentives and barriers to exercise in women with a history of breast cancer.

PURPOSE/OBJECTIVES: To develop and test an instrument to identity the most important incentives and barriers to exercise in women with breast cancer. DESIGN: Descriptive, quantitative, retrospective. SETTING: Ambulatory, national. SAMPLE: Phase I-11 Caucasian women, with a mean age of 43 years, who were treated for breast cancer within the past five years; Phase II-64 primarily Caucasian women, with a mean age of 47 years, who were treated for breast cancer within the past 10 years. METHODS: Content analysis of structured interviews, questionnaire. FINDINGS: The mean score on the decisional balance index (DBI), an overall exercise weight, was a low +19. The range of scores was from a low -26 to a moderate +57 on a scale from -72 to +72. The DBI accurately predicted 88% of the distribution of women who exercised regularly and those who did not. The most important incentives for exercise in a sample of women with a history of breast cancer were expectation of benefit and sense of responsibility. The most important barriers were lack of time and inertia. CONCLUSIONS: Replication is needed with larger, more diverse samples, but the Incentive and Barriers to Exercise Scale (IBES) potentially can screen women with breast cancer with the greatest need for exercise interventions. An individualized plan to promote incentives and reduce barriers should be incorporated into interventions. IMPLICATIONS FOR NURSING PRACTICE: Nurses' proactive support for and education about exercise is needed.

Adult↗

PubMed1997

An incentive in tuberculosis preventive therapy for an inner city population.

SETTING: Measures known to improve adherence such as short course chemoprophylaxis and directly observed therapy can be enhanced to a significant extent/by the use of incentives. Adherence to tuberculosis therapy is influenced by several factors, including the health care system, complexity of therapeutic regimens and patient's characteristics. Individual factors that negatively influence patient's adherence are the most difficult to counter. Preventive tuberculosis therapy is doubly challenging because the benefit of treatment is not felt, while toxicity from the medication, when it occurs, is experienced immediately. Ingenious incentives therefore have to make it worth the patient's while. During a study on preventive regimens, a request for an incentive, Sustacal, was observed to help completion of preventive regimens. Components of individual TB programs may help in patient adherence; it is important for health care staff to identify these aspects and, if they are successful, utilize these as an incentive to complete treatment.

AIDS-Related Opportunistic Infections↗

PubMed1998

Designing an incentive based health promotion program.

1. A health incentive program can be an effective intervention for reducing employee population risk and altering health care utilization patterns. 2. An incentive based health promotion program rewards employees for performing a selected set of behaviors. 3. Collecting supporting data (benchmarking, needs assessment, organization data, published data) provides the foundation for the health incentive program design. 4. Choose an incentive appropriate to the employee population and worksite culture.

Benchmarking↗

PubMed2001

Reimbursement policies, incentives and disincentives to perform laparoscopic surgery in Israel.

The introduction of laparoscopic surgery was believed to bestow great advantages to patients and health services. Health services and societal costs may also be affected by changes in length of hospital stay, operating room costs and return to normal activity. The aim of this paper is to examine the influence of two different reimbursement methods (per diem and DRG) on the incentives and disincentives given to different role players in the Israeli health-care system regarding two common surgical procedures: appendectomy and inguinal hernia repair. Three different perspectives are discussed: society, the hospitals and the sick funds. From the hospital's perspective, laparoscopic surgery is usually more expensive compared to open procedures, mainly due to higher operating room costs. We suggest that as far as current reimbursement methods are preserved, hospitals have no economic incentive to adopt the laparoscopic technology as benefits occur only to society. In general, sick funds would encourage hospitals to perform laparoscopic appendectomy, where the payment is per diem and would be economically indifferent regarding laparoscopic inguinal hernia repair, where hospitals are compensated on a DRG basis. It has been suggested that economic advantages to society may arise from a faster return to work after laparoscopic appendectomy and laparoscopic inguinal hernia repair. In this case, new payment arrangements should be set to give proper incentives for the adoption of laparoscopic procedures.

Appendectomy↗

PubMed2003

Financial incentives, competition and a two tier service: lessons from the UK National Health Service internal market.

The experience of General medical practitioner (GP) fundholding is analysed for evidence of the response by family doctors to financial incentives. An analysis of consultant outreach, the local provision of out-patient services, in Scotland finds little evidence of a response, based on comparing the experience of fundholders with non-fundholders. At least in the case of hospital based services, financial incentives seem to be of secondary importance. Financial incentives for such services depend on consultant compliance which, arguably, was missing when it came to creating a two-tier service which deliberately favoured patients from fundholding practices.

Budgets↗

PubMed1999

The utility of decision support, clinical guidelines, and financial incentives as tools to achieve improved clinical performance.

BACKGROUND: Whether one seeks to reduce inappropriate utilization of resources, improve diagnostic accuracy, increase utilization of effective therapies, or reduce the incidence of complications, the key to change is physician involvement in change. Unfortunately, a simple approach to the problem of inducing change in physician behavior is not available. COMPREHENSIVE CLINICAL GUIDELINES: There is a generally accepted view that expert, best-practice guidelines will improve clinical performance. However, there may be a bias to report positive results and a lack of careful analysis of guideline usage in routine practice in a "postmarketing" study akin to that seen in the pharmaceutical industry. FINANCIAL INCENTIVES: Systems that allow the reliable assessment of quality of outcomes, efficiency of resource utilization, and accurate assessment of the risks associated with the care of given patient populations must be widely available before deciding whether an incentive-based system for providing the full range of medical care is feasible. DECISION SUPPORT: Decision support focuses on providing information, ideally at the "point of service" and in the context of a particular clinical situation. Rules are self-imposed by physicians and are therefore much more likely to be adopted. CONCLUSION: As health care becomes corporatized, with increasing numbers of physicians employed by large organizations with the capacity to provide detailed information on the nature and quality of clinical care, it is possible that properly constructed guidelines, appropriate financial incentives, and robust forms of decision support will lead to a physician-led, process improvement approach to more rational and affordable health care.

Benchmarking↗

PubMed2006

Cost-effectiveness of hospital pay-for-performance incentives.

One increasingly popular mechanism for stimulating quality improvements is pay-for-performance, or incentive, programs. This article examines the cost-effectiveness of a hospital incentive system for heart-related care, using a principal-agent model, where the insurer is the principal and hospitals are the agents. Four-year incentive system costsfor the payer were dollar 22,059,383, composed primarily of payments to the participating hospitals, with approximately 5 percent in administrative costs. Effectiveness is measured in stages, beginning with improvements in the processes of heart care. Care process improvements are converted into quality-adjusted life years (QALYs) gained, with reference to literatures on clinical effectiveness and survival. An estimated 24,418 patients received improved care, resulting in a range of QALYs from 733 to 1,701, depending on assumptions about clinical effectiveness. Cost per QALY was found to be between dollar 12,967 and dollar 30,081, a level well under consensus measures of the value of a QALY.

Blue Cross Blue Shield Insurance Plans↗

PubMedDate not supplied

Incentives and provider payment methods.

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

Argentina↗

PubMed1989

A worksite smoking cessation intervention involving the media and incentives.

This study evaluated an attempt at 38 workplaces to help employees stop or reduce their levels of smoking. In past research, worksite support groups, in combination with a media smoking cessation program and self-help manuals, were found to be effective in helping employees quit smoking. Unfortunately, recidivism was found at the follow-up evaluations. The present study replicated the results of the previous worksite smoking cessation program with support groups, a television intervention, and self-help manuals. At this postpoint, 42% of employees provided groups plus incentives were abstinent compared to only 15% who were only provided self-help materials. An important difference in this study was that there were also monthly follow-up support groups and incentives. Work settings can be a source of stress and conflict, which can precipitate relapse. At a 12-month follow-up, 26% of those participants who were provided support and incentives were abstinent compared to 16% who were only provided the self-help materials.

Adult↗

PubMed1986

An incentive management plan for hospital-based physicians.

Arthur D. Little, Inc., has developed an incentive management program for salaried, hospital-based physicians. The program is based on the tracking of physician productivity through the assignment of work units for both routine inpatient care and all medically performed tests and outpatient procedures. A monetary pool based on increases in the hospital's profitability over a base year is divided among physicians on the basis of their relative productivity throughout the year. Administratively assigned work units can be used to give physicians credit for activities which benefit the institution but which are not revenue producing. The system puts incentives in place for physicians to increase revenues while holding down costs. The main feature of the incentive system is a bonus pool, the size of which is based on hospital net income. A reporting application was developed that downloads data from the hospital's service bureau data-processing vendor, preprocesses the data through a C program, and produces reports through an extremely user-friendly, menu-driven, spreadsheet-based program.

Efficiency↗

PubMed1990

An analysis of financial incentives in the performance contract of Montana.

In an effort to contain costs and provide appropriate services, a growing number of states are experimenting with the terms of their fiscal transfers to localities. This paper contains an analysis of the economic incentives present in one such effort, the performance contract of the state of Montana. This contract contains incentives which do not fully support the attainment of a number of possible social goals, but these incentives could be strengthened by some simple amendments to the existing structure.

Community Mental Health Centers↗

PubMed1992

Incentive regulation of nursing homes.

A social experiment was conducted in San Diego to test the effectiveness of monetary incentives in improving the health of nursing home residents and lowering Medicaid expenditures. Use of a Markov model to represent the resulting health changes of nursing home residents shows that the monetary incentives had beneficial effects on both the quality and the cost of nursing home care. Moreover, the nursing homes admitted more people with severe disabilities, and the average length of their stays was shortened. If implemented, this kind of incentive program would save Medicaid substantial amounts of money, but not through lowering nursing home payments. Instead, the more efficient use of nursing homes would transfer more people out of hospitals and thereby save unnecessary hospital reimbursement.

Aged↗

PubMed1987

Incentives for cost-effective physician behavior.

The objective of the National Health Service is to maximise improvements in the health status of patients regardless of their willingness and ability to pay. To achieve this objective it is necessary to identify those procedures which maximise improvements in health or quality adjusted life years (QALYs) and direct scarce resources to those therapies with the best cost-QALY characteristics. Unfortunately in the NHS and elsewhere cost-QALY characteristics are largely unknown and the structure of the health service and its provider remuneration systems are such that objectives are vague, behavior perverse due to the haphazard construction of incentive systems, and health status outcomes often unknown due to the failure to evaluate input-outcome relationships. To reform the NHS, in particular ensure more efficient practice by physicians, existing perverse incentives will have to be replaced by the use of buyer (NHS) power and by budgeting mechanisms which induce economizing behavior. It is not clear which type of incentive mechanism will produce outcomes consistent with NHS goals. To remedy this ignorance experimentation with careful evaluation would seem appropriate.

Cost-Benefit Analysis↗

PubMed2006

Do religious nonprofit and for-profit organizations respond differently to financial incentives? The hospice industry.

We study how for-profit and religious nonprofit hospices respond to an exogenous Medicare reimbursement incentive that encourages maximization of patient length of stay. Hospices have the incentive to selectively admit patients with longer expected lengths of stay, and admit patients sooner after a hospital discharge. We find that for-profit hospices are significantly less likely to admit patients with shorter, less profitable, expected lengths of stay. We do not find any difference in the timing of admission by ownership. Incentives for efficiency could be strengthened by a Medicare pricing system that replaced the current flat per diem payment with one that reflected the high costs at the beginning and end of hospice stay and the lower costs in between.

Aged↗

PubMed2026

Financial incentives and social messaging for repeat SARS-CoV-2 antibody testing among the underserved: A randomized trial.

Financial incentives may influence health behavior beyond their expected monetary value, and their effectiveness may depend on how the behavior is framed. Behavioral theories of decision making suggest that individuals may value protection against small-stakes losses more than expected utility predicts, while theories of family-centered health behavior suggest that messages emphasizing benefits to family members may strengthen participation in preventive health activities. We tested these ideas in a 2×2 factorial randomized trial involving 625 households recruited from a Federally Qualified Health Center serving low-income Latino/Hispanic communities. Participants completed repeat SARS-CoV-2 antibody testing. The trial crossed two messaging strategies (Family vs. Personal) with two incentive structures (Loss Protection vs. Lottery) that offered equivalent expected monetary value. Family Messaging emphasized protecting one's family from COVID-19, whereas Personal Messaging emphasized protecting oneself. Loss Protection allowed participants to secure an at-risk reward through repeat testing, whereas the Lottery condition offered a chance of a large reward. Repeat testing was approximately 8 percentage points higher under Family Messaging and 7 percentage points higher under Loss Protection. Baseline trust in medical providers, financial barriers to vaccination, and risk aversion were associated with initial testing, whereas household characteristics were not associated with repeat testing. Incentive design may matter beyond expected monetary value and that framing health behaviors in terms of family welfare may increase participation in repeated healthy activities. Broadly, the results support behavioral theories emphasizing loss aversion, anticipated regret, and family-centered motivations, and suggest practical approaches for improving engagement in repeat health behaviors. CLINICALTRIALS.GOV REGISTRATION NUMBER:: NCT01901624.

Adult↗