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PubMed2006

Effects of small monetary incentives on return rates of a health survey to adults in rural areas.

This study assessed differences in response rates to a mailed health survey by adults in two neighboring rural midwestern counties with differential incentives, of dollar 2.00 and dollar 5.00. Potential respondents in each county were randomly selected from a commercial database of residents' addresses. County "F" respondents (n = 541) which were 57% female and 95% Euro-American having a mean age of 47.3 yr. (SD= 16.9), received the dollar 5 incentive. County "H" respondents (n= 514) were 63% female, 95% Euro-American, had a mean age of 49.0 yr. (SD= 14.7), and received a S2 incentive. The response rates were 71% using the dollar 2 incentive and 73% using the dollar 5 incentive. These were not significantly different by chi-square test. The more cost-effective incentive for increasing the response rate of adults in this rural midwestern sample was to code the envelopes and use a dollar 2.00 rather than dollar 5.00 incentive, a cost per returned survey of dollar 5.24 versus dollar 9.13, respectively. The findings support Dillman's principle of diminishing returns as the size of the incentive goes up.

Adult↗

PubMedDate not supplied

The use and impact of incentives in population-based smoking cessation programs: a review.

PURPOSE: This review discusses current published literature on population-based smoking cessation interventions that involve incentives and examines whether such interventions are effective in reducing the prevalence of smoking. SEARCH METHOD: Studies published between 1975 and Spring 1997 were identified through a computerized search of four electronic databases (MEDLINE, HEALTH, CINAHL, and PSYCINFO) and reference lists of key articles using the following key words: (smoking cessation OR quit smoking) AND (contest OR competition OR incentive OR lottery OR quit and win). This search yielded 79 articles. To be included, studies had to be published in English and had to have presented either quit rates or participation rates for an incentive-based program that used population-based recruitment. Of the 79 articles, 17 met these criteria. FINDINGS: Population-based interventions generally attract 1 to 2% of the target population, but these participation rates can potentially be increased through the use of innovative recruitment techniques. No specific type of recruitment strategy was shown to be consistently more effective than others. There is no evidence that particular types of incentives are able to influence participation or quit rates, but the size of an incentive does appear to be important, with larger incentives viewed as more effectively motivating smokers to quit and stay smoke free than smaller ones. Estimates of the cost per quitter have ranged from less than $20 to over $400. There are some indications that the costs of such programs compare favorably with smoking cessation classes or clinic-based approaches. CONCLUSION: Incentive-based smoking cessation programs that target an entire community have the advantage of reaching a large and diverse group of smokers. They may, however, attract only smokers who are already motivated to quit. Realistically, incentive-based programs aimed at the general population can expect 1% of all their smokers to quit smoking. Quit rates among participants may initially be high (i.e., mean quit rate of 34% at 1-month follow-up) but decrease over time (i.e., mean rate of 23% at 1 year). The results of this review suggest a continued need to establish standard and valid criteria for the evaluation of smoking cessation interventions. Methodological differences among existing studies make them difficult to compare and interpret.

Canada↗

PubMed1997

The effects of incentive on antisaccades: is a dopaminergic mechanism involved?

The effect of incentive was investigated upon performance in the antisaccade (AS), memory saccade (MS) and reflexive saccade (RS) task, alone and following performance in tasks of a psychometric battery. Accuracy performance (correct saccades) in the AS and MS task is dependent on two prefrontal functions, the preservation of transient information across short time intervals and the inhibition of prepotent but inappropriate responses, and is impaired in patient populations with known prefrontal dysfunction. It was predicted that, in normal humans, incentive will improve accuracy performance in the AS and MS task, leaving performance in the RS task unaffected (study 1). Saccades were recorded in 24 healthy young male volunteers. Measurements of saccades were performed (in the presence and absence of monetary incentive) alone or following performance on a psychometric test battery that included tasks of working memory, vigilance, attention and psychomotor activity. Incentive increased the number of correct saccades in the AS task and the performance index in the working memory task. No other direct changes were seen in the presence of incentive. The role of dopamine in performance in the AS compared to the RS task was investigated subsequently in study 2. Twenty healthy young male volunteers received levodopa and benserazide (100 and 25 mg, respectively) orally, and 1 and 5 h later measurements of AS and RS were performed. Levodopa significantly decreased the number of correct saccades in the AS task. No other effects were seen. These data, taken together, suggest, first, that the accuracy performance in the AS task is more sensitive than in the MS or RS task, to positive incentive due to monetary reward; and second, that the dopaminergic system may mediate such an effect, because levodopa, a dopaminergic drug, influenced the same performance measurement. The relationship, however, between these two manipulations (incentive and administration of dopaminergic drugs) is not clear, because incentive improved and levodopa impaired performance.

Adult↗

PubMed2006

Counselor incentives to improve client retention in an outpatient substance abuse aftercare program.

Pay for performance, the provision of financial incentives for favorable performance, is increasingly under study as an evidence-based practice. This study estimated the improvement in client retention from offering incentives to 11 substance abuse counselors providing outpatient aftercare treatment. During the incentive period, a counselor could earn a bonus of $100, in addition to his regular compensation, for each client who completed at least five aftercare sessions (the "milestone" which we considered the minimum adequate dose of the aftercare curriculum). We evaluated this and a similar, 12-session incentive using a logistic regression in which the retention "milestone" was the dependent variable and the proportion of time in the incentive condition was the independent variable. Among the 123 clients offered this aftercare program, their probability of completing at least 5 sessions was 59% with the incentive compared to 33% beforehand (odds ratio 4.1, P<.01). These findings suggest that counselor incentives are an effective strategy to improve client retention in substance abuse treatment.

Aftercare↗

PubMed2000

Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues.

OBJECTIVE: To identify all financial incentives that had been proposed, described, or used regardless of their initial objective and, when possible, to assess the results of these incentives on costs, process or outcomes of care. MATERIAL AND METHODS: Systematic review of the literature. Databases searched were: Medline, Embase, Health Planning and Administration, Pascal, International Pharmaceutical Abstracts and the Cochrane Library. Search terms were: health professionals and tape of practice, type of incentive, methodology, languages English or French, January 1993 to May 1999. RESULTS: Financial incentives concerned the modalities of physician payment and financing of the health care system. Confounding factors included: age of the doctor, training, speciality, place and type of medical practice, previous sanctions for over-prescribing, type and severity of disease, type of insurance. Risks of financial incentives were: limited access to certain types of care, lack of continuity of care, conflict of interests between the physician and the patient. Any form of fund-holding or capitation decreased the total volume of prescriptions by 0-24%, and hospital days by up to 80% compared with fee-for-service. Annual cap on doctors' incomes resulted in referrals to colleagues when target income is reached. DISCUSSION: Financial incentives can be used to reduce the use of health care resources, improve compliance with practice guidelines or achieve a general health target. It may be effective to use incentives in combination depending on the target set for a given health care programme.

Capitation Fee↗

PubMed2001

An incentive plan for professional fee collections at an indigent-care teaching hospital.

The authors describe the implementation and development of an incentive plan to improve professional fee collections at an indigent-care teaching hospital. They theorized that an incentive plan based on relative value unit (RVU) productivity would increase billings and collections of professional fees. Unique RVU targets were set for individual services based on the number of faculty full-time equivalents and average reported productivity for academic physicians by specialty. The incentive plan was based on the level of expected faculty billings, measured in RVUs, for each department. A "base + incentive" model was used, with the base budget being distributed monthly throughout the year, and the incentive held as a "withhold" to be paid at the year's end only if the billing target in RVUs was met. Additionally, a task force worked with physician billing office and the hospital to improve collections. In the first year after implementation of the system was in place, important increases were noted in total RVU productivity (30.5% over the previous year) and in collections (49.5% over the previous year). Sixteen of 23 departments exceeded their incentive targets, and it was possible to make distributions of professional fees to those departments, to be used within the hospital system to enhance clinical services. Moreover, the plan created an overall positive attitude toward billings and documentation of faculty activities. The authors believe that this kind of incentive plan will be increasingly important for academic faculty working in public hospital systems.

Efficiency↗

PubMed2004

Assessing the influence of incentives on physicians and medical groups.

This article describes issues that should be considered in the development of a theory or theories about incentives from which testable hypotheses could be derived. Economic, psychological, and organizational theories are described, and issues that should be considered in hypothesis generation are presented. Psychological factors influencing incentives include decision framing, regret, heuristics, and reinforcements. Organizational factors influencing incentives include bundling of services or people, matching of incentive structure with work organization, and the incompletely contained hierarchical nesting of incentives. Finally, the dynamics of incentive change are considered, with a focus on describing the conditions under which physicians and physician organizations respond to incentive changes.

Attitude of Health Personnel↗

PubMed2000

Measuring the effects of managed care on physicians' perceptions of their personal financial incentives.

Using data from the 1997 Resurvey of Young Physicians (N = 1,549), this study examines whether several measures of physicians' contractual arrangements with health plans are associated with their perceptions of overall financial incentives to either decrease or increase the volume of services to patients. Results indicate the following factors were significantly associated with an increased likelihood of reporting an incentive to decrease services: a gatekeeper arrangement with a compensation incentive; the perception of a high risk of plan deselection for physicians with high costs; the perception that referrals received depended on the costs of care provided; communication prohibiting or discouraging the disclosure to patients of the physician's financial relationship with the health plan; receiving capitation payments from at least one plan; and employment in a health maintenance organization. Being compensated on a fee-for-service basis or receiving a salary with incentive or bonus provisions (compared to straight salary) were associated with an increased likelihood of reporting an incentive to increase services to patients. Physicians' overall methods of compensation had a relatively small impact on their perceived financial incentives compared to other statistically significant factors. Our findings suggest that physicians' self-reported, overall personal financial incentives within their practices are a valid summary measure of the heterogeneous mix of specific financial arrangements faced by most physicians.

Adult↗

PubMed2001

The effect of explicit financial incentives on physician behavior.

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.

Attitude of Health Personnel↗

PubMed2001

Influence of financial productivity incentives on the use of preventive care.

PURPOSE: We examined whether physician factors, particularly financial productivity incentives, affect the provision of preventive care. SUBJECTS AND METHODS: We surveyed and reviewed the charts of 4,473 patients who saw 1 of 169 internists from 11 academically affiliated primary care practices in Boston. We abstracted cancer risk factors, comorbid conditions, and the dates of the last Papanicolaou (Pap) smear, mammogram, cholesterol screening, and influenza vaccination. We obtained physician information including the method of financial compensation through a mailed physician survey. We used multivariable logistic regression to examine the association between physician factors and four outcomes based on Health Plan Employer Data and Information Set (HEDIS) measures: (1) Pap smear within the prior 3 years among women 20 to 75 years old; (2) mammogram in the prior 2 years among women 52 to 69 years old; (3) cholesterol screening within the prior 5 years among patients 40 to 64 years old; and (4) influenza vaccination among patients 65 years old and older. All analyses accounted for clus-tering by provider and site and were converted into adjusted rates. RESULTS: After adjustment for practice site, clinical, and physician factors, patients cared for by physicians with financial productivity incentives were significantly less likely than those cared for by physicians without this incentive to receive Pap smears (rate difference, 12%; 95% confidence interval [CI]: 5% to 18%) and cholesterol screening (rate difference, 4%; 95% CI: 0% to 8%). Financial incentives were not significantly associated with rates of mammography (rate difference, -3%; 95% CI: -15% to 10%) or influenza vaccination (rate difference, -13%; 95% CI: -28% to 2%). CONCLUSIONS: Our findings suggest that some financial productivity incentives may discourage the performance of certain forms of preventive care, specifically Pap smears and cholesterol screening. More studies are needed to examine the effects of financial incentives on the quality of care, and to examine whether quality improvement interventions or incentives based on quality improve the performance of preventive care.

Adult↗

PubMed1994

Fertility incentives and participation in localities with limited means: a dynamic model of per capita resources.

Several countries have attempted to change human fertility through economic incentives. This paper presents simple mathematical models of the participation of couples in a locally funded program of economic incentives. The models take as a springboard China's one-child program. Localities with low per capita incentives attract few couples to the program, while localities with high incentives attract many couples at first, but the value of the benefits is then watered down. The models show that participation in the program may persistently oscillate or may decay to a stationary level. Which behavior occurs is determined by whether there are decreasing, constant, or increasing returns in the rates of participation in response to successive equal increments in the incentive offered, and by the extent to which prospective parents learn from experience with past oscillations in the incentives. The models raise many empirical questions about the dynamics of incentive programs.

Asia↗

PubMed2000

The orthopaedic surgeon and industry. Ethics and industry incentives.

Physicians may receive various gifts and incentives from companies that make pharmaceuticals and medical devices. Although such incentives may benefit patients and physicians, they often pose serious conflicts of interest that violate a physician's professional responsibility. The physician-patient relationship is predicated on the physician acting in the best interest of the patient. The application of medical knowledge to complex clinical circumstances is difficult, even without biased sources of information and internal conflicts attributable to financial incentives. Yet, industry resources often are dedicated to the dissemination of information and incentives aimed to influence decisions not necessarily aimed at the goals of the patient. Physicians often are unaware of the nature of the incentives and commonly deny their demonstrated impact. Any incentive that is designed to impede, rather than enhance, the clinician's ability to make optimal patient care decisions is unethical for a physician to accept. These incentives should play no role in the practice of orthopaedic surgery.

Ethics, Medical↗

PubMed1998

Getting the incentives right for children.

OBJECTIVE: One way to improve the functioning of the American child healthcare system is through the design of incentives. Objective: to examine what we know and need to know about designing incentives to encourage the production of high-quality care both for healthy children and for children with serious illnesses. SUMMARY AND CONCLUSIONS: For healthy children, incentives should encourage the provision of preventive services, including services that encourage healthy behavior. For children with serious illnesses, incentives should reduce risk selection, promote collaborative systems of care, and ensure access to appropriate specialty services. Research findings needed for incentive design includes information on the actual working of existing incentive mechanisms as well as information about risk adjustment, mixed payment system, carve-outs, and other mechanisms to reduce risk selection; options for defining service scope that encourage collaboration; and information about the ways in which quality measurement interacts with payment incentives.

Capitation Fee↗

PubMed1998

[Motivation and incentives: different perceptions of administrators and professionals. Evaluation Team of the Materno-Infantile Health Program].

OBJECTIVE: To find the views of Primary Care District managers and Health Centre (HC) professionals in Andalusia on systems of motivation and incentive in use in this autonomous community. DESIGN: A descriptive study which uses qualitative and quantitative methodology. SETTING: Primary Care districts and Health Centres in Andalusia. PARTICIPANTS: Primary Care district managers (51) and HC professionals (91). MATERIAL AND METHODS: Information-gathering: self-administered questionnaire (managers) and focus groups (professionals). ANALYTICAL TECHNIQUES: Non-parametric tests to compare means and analysis of contents of discourse. Field-work. July 1994 and February 1995. RESULTS: 55% of the district managers thought that the incentive systems in use were inadequate and insufficient. Enabling professionals to be trained is the main motivating and incentive mechanism in place. Variable productivity was the next most common mechanism. However, variable productivity, in the view of the professionals, was the main demotivating factor of recent years. Professionals thought that the economic rewards of the incentives system were slight, the target variables were unsuitable, there were no objective evaluation mechanisms and the economic differences between the incentives earned by managers and professionals were too great. CONCLUSIONS: The District managers indicated that improvements in the incentives systems used are needed. The HC professionals affirmed that the Andalusian incentives system has demotivated Primary Care teams and has had little effect on orienting professional practice.

Administrative Personnel↗

PubMed2005

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

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

Adult↗

PubMed2005

Competitions and incentives for smoking cessation.

BACKGROUND: Material or financial incentives may be used in an attempt to reinforce behaviour change, including smoking cessation. They have been widely used in workplace smoking cessation programmes, and to a lesser extent within community programmes. Quit and Win contests are the subject of a companion review. OBJECTIVES: To determine whether competitions and incentives lead to higher long-term quit rates. We also set out to examine the relationship between incentives and participation rates. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE (January 1966 to September 2004), EMBASE (1980 to 2004/8), CINAHL (1982 to 2004/8) and PsycINFO (1872 to 2004/6). Search terms included incentive*, competition*, contest*, reward*, prize*, contingent payment*, deposit contract*. SELECTION CRITERIA: We considered randomized 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. DATA COLLECTION AND ANALYSIS: Data were extracted by one author and checked by the second. We contacted study authors for additional data where necessary. The main outcome measure was abstinence from smoking for at least six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Where possible we performed meta-analysis using a generic inverse variance model, grouped by timed endpoints, but not pooled across the subgroups. MAIN RESULTS: Fifteen studies met our inclusion criteria. None of the studies demonstrated significantly higher quit rates for the incentives group than for the control group beyond the six-month assessment. There was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that different types of incentives were more or less effective. There is some evidence that although cessation rates have not been shown to differ significantly, recruitment rates can be improved by rewarding participation, which may be expected to deliver higher absolute numbers of successful quitters. Cost effectiveness analysis is not appropriate to this review, since the efficacy of the intervention has not been demonstrated. AUTHORS' CONCLUSIONS: Incentives and competitions do not appear to enhance long-term cessation rates, with early success tending to dissipate when the rewards are no longer offered. Rewarding participation and compliance in contests and cessation programmes may have more potential to deliver higher absolute numbers of quitters.

Health Promotion↗

PubMed1978

Role of incentives in the training of the frontal EMG relaxation response.

Male college students were assigned to a feedback condition in which an auditory signal was correlated with forehead electromyographic (EMG) responses or to a control condition in which a constant low tone was provided. Within each condition, half of the subjects were provided with an incentive for successful reductions of EMG levels from session to session. In the control condition incentives were actually given on the basis of performance of yoked feedback partners. The remaining subjects in each condition (no incentive) were instructed that the incentive was available for reliable participation in the experiment. Feedback subjects acquired lower EMG levels than control subjects, and the yoked-incentive subjects acquired lower levels than no-incentive subjects in the control condition. There were no major differences in EMG levels attributable to locus of control orientation. The results are discussed mainly in terms of implications of incentive variables for reinforcement analyses of biofeedback effects and the validity of the locus of control construct in this application.

Adolescent↗

PubMed1984

Focal changes in cerebral blood flow produced by monetary incentive during a mental mathematics task in normal and depressed subjects.

The purpose of this experiment was to determine the effect of incentive-induced arousal on the diffuse and regional cerebral blood flow (rCBF) response during cognitive activation for normal and depressed groups. Two normal rest CBF measurements were followed by two mental mathematics activation CBF measurements. For the first activation measurement, half the subjects in each group were offered monetary incentive for correct performance and half the subjects received no monetary incentive. All subjects were offered monetary incentive on the final activation run. The effect of monetary incentive on the first activation run was to increase CBF activation at four detectors in the left hemisphere. Incentive did not affect the CBF activation response when introduced following practice on the activation task (on the final run). Depressed groups had lower resting blood flow than normals, but the distribution of flow and the CBF response to incentive were almost identical in the two groups.

Adult↗