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PubMed2005

Monetary incentives enhance processing in brain regions mediating top-down control of attention.

To evaluate the effect of an abstract motivational incentive on top-down mechanisms of visual spatial attention, 10 subjects engaged in a target detection task and responded to targets preceded by spatially valid (predictive), invalid (misleading) or neutral central cues under three different incentive conditions: win money (WIN), lose money (LOSE), and neutral (neither gain nor lose). Activation in the posterior cingulate cortex was correlated with visual spatial expectancy, defined as the degree to which the valid cue benefited performance as evidenced by faster reaction times compared to non-directional cues. Winning and losing money enhanced this relationship via overlapping but independent limbic mechanisms. In addition, activity in the inferior parietal lobule was correlated with disengagement (the degree to which invalid cues diminished performance). This relationship was also enhanced by monetary incentives. Finally, incentive enhanced the relationship of activation in the visual cortex to visual spatial expectancy and disengagement for both types of incentive (WIN and LOSE). These results show that abstract incentives enhance neural processing within the attention network in a process- and valence-selective manner. They also show that different cognitive and motivational mechanisms may produce a common effect upon unimodal cortices in order to enhance processing to serve the current behavioral goal.

Adult↗

PubMed1985

Age differences in cerebral blood flow during rest and during mental activation measurements with and without monetary incentive.

This experiment compared the diffuse and regional cerebral blood flow (CBF) during rest and during cognitive activation with and without incentive-induced arousal in young, middle-aged, and older adults. Two normal rest CBF measurements were followed by two mental mathematics activation CBF measurements. For the first activation measurement, half the participants in each age group were offered monetary incentive for correct performance and half the participants received no monetary incentive. All participants were offered monetary incentive on the final activation measurement. Older participants had lower resting blood flow at all detectors, but age-related reductions in blood flow were statistically significant only in anterior and inferior rolandic regions. The effect of monetary incentive was to increase blood flow at the inferior rolandic detector in both hemispheres. The CBF response to cognitive activation and monetary incentive did not differ in the three age groups.

Adult↗

PubMed2004

The case and opportunity for public-supported financial incentives to implement integrated pest management.

Food, water, and worker protection regulations have driven availability, and loss, of pesticides for use in pest management programs. In response, public-supported research and extension projects have targeted investigation and demonstration of reduced-risk integrated pest management (IPM) techniques. But these new techniques often result in higher financial burden to the grower, which is counter to the IPM principle that economic competitiveness is critical to have IPM adopted. As authorized by the 2002 Farm Bill and administered by the U.S. Department of Agriculture (USDA) Natural Resources Conservation Service (NRCS), conservation programs exist for delivering public-supported financial incentives to growers to increase environmental stewardship on lands in production. NRCS conservation programs are described, and the case for providing financial incentives to growers for implementing IPM is presented. We also explored the opportunity and challenge to use one key program, the Environmental Quality Incentives Program (EQIP), to aid grower adoption of IPM. The EQIP fund distribution to growers from 1997 to 2002 during the last Farm Bill cycle totaled approximately 1.05 billion dollars with a portion of funds supporting an NRCS-designed pest management practice. The average percentage of allocation of EQIP funds to this pest management practice among states was 0.77 +/- 0.009% (mean +/- SD). Using Michigan as an example, vegetable and fruit grower recognition of the program's use to implement IPM was modest (25% of growers surveyed), and their recognition of its use in aiding implementation of IPM was improved after educational efforts (74%). Proposals designed to enhance program usefulness in implementing IPM were delivered through the NRCS advisory process in Michigan. Modifications for using the NRCS pest management practice to address resource concerns were adopted, incentive rates for pest management were adjusted, and an expanded incentive structure for IPM technique adoption was tabled for future consideration. The case is strong for using public-supported financial incentives offered by the EQIP to aid grower adoption of IPM as a means to address resource concerns, but current use of the EQIP for this purpose is modest to meager. With appropriate program adjustments and increased grower awareness, USDA NRCS conservation programs, and the EQIP in particular, may provide an important opportunity for growers to increase their use of IPM as a resource conservation and farm management tool.

Agriculture↗

PubMed1987

Incentives and obligations under prospective payment.

In this paper I analyze the alleged conflict between economic incentives to efficiently utilize health care resources and the obligation to provide patients with the best possible medical care. My analysis is developed in four stages. First, I discuss briefly the nature of prospective payment systems and economic incentives as well as the issue of professional autonomy. Second, I disscuss the notion of an incentive for action both as an economic incentive and as a concept of moral psychology. Third, I analyze several definitions of the physician's professional obligation and discuss four conditions that morally qualify the obligation. And fourth, I explore why the views of economists and physicians differ so strikingly on the question of economic incentives. In the process of this analysis, I argue that criticisms of prospective payment systems which are premised primarily on the conflict between economic incentives to contain cost and the professional obligation of beneficence are probably as much a matter of rhetoric as serious argumentation.

Beneficence↗

PubMed1997

P300 from men with a family history of alcoholism under different incentive conditions.

OBJECTIVE: Males with a family history of alcoholism (Family History Positive [FHP]) have frequently been reported to show an attenuated amplitude of the P300 component of the EEG event-related potential (ERP). The purpose of the present study was to explore the influence of incentives on the amplitude of the P300 to Target stimuli in FHP and FHN (Family History Negative) men. METHOD: The ERPs of 20 FHP and 20 FHN men were recorded in a visual discrimination task under two conditions: a no incentive (Neutral) and a reward/loss of reward (Incentive) conditions. ERPs following Target, Non-Target and Novel stimuli were examined. RESULTS: The FHP subjects displayed the expected attenuation of P300 amplitude, regardless of the stimulus type (Target, Non-Target or Novel), compared to the FHN subjects. The FHN subjects showed the predicted effect of a significantly increased P300 amplitude following Target stimuli in the Incentive condition whereas the FHP subjects did not display significantly greater P300 amplitudes in response to the incentive. CONCLUSIONS: These results may reflect a deficit in the motivational-cognitive system of FHP subjects. Analyses suggest that changes in P300 amplitude in response to the incentive can be predicted by subjects' scores on self-report measures of sensation seeking and behavioral undercontrol. However, such measures could not explain subjects' absolute P300 amplitude to Target stimuli.

Adult↗

PubMed1979

Responsiveness of pre- and non-delinquents to incentive aspects of a reinforcing event.

A learning task, a six-position modification of a Fellows (1967) sequence, was used to examine the differences in responsiveness to symbolic and tangible incentives with 24 pre-delinquent and 25 non-delinquent 15-yr.-old boys. Under the low-incentive condition, only the symbolic incentive was available while under the high-incentive condition a symbolic and material reinforcer was employed. The high-incentive condition had no significant effect on the non-delinquents but did significantly affect the delinquents. Also, the high-incentive delinquent group performed similarly to both non-delinquent groups. Recommendations for research are given.

Adolescent↗

PubMed1988

Learning and memory test performance in alcoholics as a function of monetary incentive.

The performance deficits of alcoholics on tests of learning and memory are typically attributed to cognitive impairment. This study tests an alternative hypothesis that the deficits are due to motivational impairment. A face-name learning and memory test was administered to 30 sober male nonalcoholic and 40 alcoholic subjects in a 2 x 2 [Group (alcoholic, nonalcoholic) x Monetary incentive (incentive, no incentive)] between-subjects design. The monetary incentive was made contingent upon performance. Alcoholics required significantly more trials to learn face-name pairs, and they recalled fewer face-name pairs at the delayed recall. Incentive subjects manifested a trend toward impairment on the trials-to-learn measure. However, there were no significant Group x Incentive interactions in learning or memory, or on a self-report questionnaire of subjective states (e.g., effort expended) experienced during the test. Thus, no evidence was found to support the impaired motivation hypothesis; the cognitive hypothesis remains as the most credible hypothesis to account for the performance deficits of alcoholics.

Adult↗

PubMedDate not supplied

The impact of including incentives and competition in a workplace smoking cessation program on quit rates.

PURPOSE: To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition. DESIGN: A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs, each assigned to separate worksite. SETTING: The study was conducted from 1990 to 1991 at three aerospace industry worksites in California. SUBJECTS: All employees who were current, regular tobacco users were eligible to participate in the program offered at their site. INTERVENTION: The multicomponent program included a self-help package, telephone counseling, and other elements. The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program. The traditional program offered a standard smoking cessation program. MEASURES: Self-reported questionnaires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period. RESULTS: The incentive-competition program had an abstinence rate of 41% at 6 months (n = 68), which was significantly better than the multicomponent program (23%, n = 81) or the traditional program (8%, n = 36). At 12 months, the quit rates for the incentive and multicomponent-programs were statistically indistinguishable (37% vs. 30%), but remained higher than the traditional program (11%). Chi-square tests, t-tests, and logistic regression were used to compare smoking abstinence across the three programs. CONCLUSIONS: Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition, and more effective than a traditional program.

Adult↗

PubMed1999

Use of incentives to increase compliance for TB screening in a population of intravenous drug users. Vancouver Injection Drug Use Study Group.

SETTING: Intravenous drug users (IDUs) represent a high risk group for dual human immunodeficiency virus (HIV) and tuberculosis (TB) infection. Screening with TB skin testing has therefore been suggested in this group. Subjects' compliance for returning to have TB skin test results read is a major problem. In the setting of a needle exchange program we evaluated the role of financial incentives to increase compliance. METHODS: We evaluated the role of giving a small financial incentive of Can $5 to subjects if they returned to have their purified protein derivative (PPD) skin test read. IDUs who had previously been skin-tested were compared with IDUs drawn from a similar population who, prospectively, were offered a financial incentive. RESULTS: During the initial period 558 subjects were evaluated and no incentive was offered. During the second phase of the study 549 IDUs were assessed but were also offered Can $5 if they returned to have their skin test read. Use of incentives increased compliance from 43% to 78% (P = 0.001). During the same period three active cases of TB were also diagnosed. CONCLUSIONS: We suggest that use of financial incentives can increase the return of IDUs to have their skin tests read. Further studies are required to assess the efficacy of follow-up interventions, especially the use of isoniazid chemoprophylaxis.

Adult↗

PubMed1999

Effect of incentives on the use of indicated services in managed care.

In managed care, financial incentives and utilization review create conflicts of interest for physicians. We sought to determine whether these incentives would lead physicians to deny indicated services. We surveyed internists practicing in areas with at least 30% penetration of managed care. Our questionnaire included four scenarios in which a test or referral is indicated according to clearly established practice guidelines. We randomly assigned physicians to receive one of five versions of the questionnaire, which differed only in the type of reimbursement incentive and utilization review that applied to the scenarios. We received responses from 710 (70%) of 1,009 internists. Although physicians underutilized services regardless of incentives in all scenarios, physicians whose questionnaires depicted full capitation said that they would order fewer services than physicians whose questionnaires depicted fee-for-service. In the scenario in which an x-ray of the lumbosacral spine is indicated for a patient with low back pain, 86% of physicians randomized to the full capitation version said that they would order the test compared to 94% in the fee-for-service version. Similarly, physicians randomized to scenarios requiring utilization review said that they would order fewer services than those randomized to scenarios requiring completion of an insurance form. Scenarios depicting managed care incentives caused consistent, modest underutilization compared to fee-for-service scenarioes, although physicians underutilized services under all financial incentives and utilization review. In response, physicians must develop better methods for detecting underutilization and devise programs to increase the provision of indicated services.

Adult↗

PubMed2004

Aligning financial incentives with "Get With The Guidelines" to improve cardiovascular care.

OBJECTIVE: To describe the impact of a commercial insurer's financial incentives to hospitals in conjunction with collaboration with the American Heart Association (AHA) to accelerate implementation of Get With The Guidelines-Coronary Artery Disease (GWTG-CAD), a quality improvement program to rapidly improve cardiovascular secondary prevention in hospitalized patients. STUDY DESIGN: Observational assessment of quality improvement program participation and implementation in response to financial incentives. METHODS: The study population included all hospitals that participated with the Hawaii Medical Service Association (HMSA, Blue Cross Blue Shield of Hawaii) Hospital Quality and Service Recognition Program and had more than 30 annual admissions for acute coronary artery disease. These 13 hospitals were given encouragement and financial incentives to implement GWTG-CAD. Financial incentives were determined by a prorated amount of the total HMSA hospital reimbursement for all acute services, as part of a more comprehensive hospital "pay for performance" program. RESULTS: Incentives to 10 of 13 eligible hospitals included reimbursement for half the annual cost of the AHA Patient Management Tool. In addition, HMSA's pay for performance program--the Hospital Quality and Service Recognition Program--distributed monetary awards totaling 354,883 dollars, based on points awarded for GWTG-CAD workshop attendance documentation (10 hospitals), recognition by the AHA as a GWTG-CAD hospital, and attainment of 85% adherence to the GWTG-CAD performance measures (4 hospitals). CONCLUSIONS: Community-based promotion of GWTG-CAD and financial incentives provided by a commercial insurer resulted in the rapid implementation of a secondary prevention program for coronary artery disease in most hospitals in the State of Hawaii within a single year.

Cardiovascular Diseases↗

PubMed2004

Aligning incentives in supply chains.

Most companies don't worry about the behavior of their supply chain partners. Instead, they expect the supply chain to work efficiently without interference, as if guided by Adam Smith's famed invisible hand. In their study of more than 50 supply networks, V.G. Narayanan and Ananth Raman found that companies often looked out for their own interests and ignored those of their network partners. Consequently, supply chains performed poorly. Those results aren't shocking when you consider that supply chains extend across several functions and many companies, each with its own priorities and goals. Yet all those functions and firms must pull in the same direction for a chain to deliver goods and services to consumers quickly and cost-effectively. According to the authors, a supply chain works well only if the risks, costs, and rewards of doing business are distributed fairly across the network. In fact, misaligned incentives are often the cause of excess inventory, stock-outs, incorrect forecasts, inadequate sales efforts, and even poor customer service. The fates of all supply chain partners are interlinked: If the firms work together to serve consumers, they will all win. However, they can do that only if incentives are aligned. Companies must acknowledge that the problem of incentive misalignment exists and then determine its root cause and align or redesign incentives. They can improve alignment by, for instance, adopting revenue-sharing contracts, using technology to track previously hidden information, or working with intermediaries to build trust among network partners. It's also important to periodically reassess incentives, because even top-performing networks find that changes in technology or business conditions alter the alignment of incentives.

Commerce↗

PubMed2006

Choosing incentives to stimulate tuberculosis treatment compliance in a poor county in Rio de Janeiro state, Brazil.

BACKGROUND: Tuberculosis (TB) treatment default is a major constraint of TB control, resulting in continued disease transmission and possibly the emergence of multidrug resistance. Marginalized populations may abandon treatment before being cured. The objective of this study was to evaluate the socioeconomic status (SES) of TB patients and identify potential incentives for improving treatment compliance by SES. MATERIAL AND METHODS: A cross-sectional survey was conducted in a public health unit in Duque de Caxias, a county with one of the lowest per capita incomes in Rio de Janeiro state. From November 2003 to March 2004, 305 TB patients answered an anonymous questionnaire on socio-demographic aspects, household items and family income, history of previous treatment default, and on incentives for improving treatment adherence. Incentives were classified as economic, administrative, health service support, and habits, and scored as fundamental (3), important (2), desirable (1), or irrelevant (0). RESULTS: Health service support incentives had the highest scores overall. The aggregate economic incentive score correlated with SES (r = -0.191, p = 0.001). Among the 20% poorest patients, 16.7% had a previous history of default vs. 1.6% among the wealthiest (p = 0.004). Patients with a history of treatment default were significantly more likely to choose health service support incentives than other patients (r = -0.263, p = 0.039). CONCLUSIONS: Professional commitment will be needed to effect the necessary changes in health service support. Financial support for food and transportation subsidies may be required to improve treatment compliance among the poorest TB patients, i.e. those most likely to have previously defaulted from treatment.

Adolescent↗

PubMed1980

Irrelevant-incentive learning with flavors in rats.

In four experiments, rats were trained to associate one cue with one incentive and another cue with a different incentive. Experiment 1 used food and water as the incentives, and Experiments 2-4 used arbitrarily flavored sugar solutions as the incentives; Experiments 1-3 used flavor cues, and Experiment 4 used exteroceptive cues. Preference between the cues was tested under deprivation conditions different from training. With flavor cues, the rats preferred the cue for the incentive with which they were not satiated in the test (Experiments 1 and 2), but they showed no tendency to prefer the cue for the incentive with which they had not been satiated during training (Experiments 2 and 3). With exteroceptive cues, on the other hand, preference in the test depended upon satiation during training but not upon satiation in the test (Experiment 4). These results indicate latent learning but no learning of a habit with flavor cues, and learning of a habit but no latent learning with exteroceptive cues.

Animals↗

PubMed1997

The effect of monetary incentives and peer support groups on repeat adolescent pregnancies. A randomized trial of the Dollar-a-Day Program.

OBJECTIVES: To test the hypotheses that (1) a monetary incentive promotes peer-support group participation; and (2) peer-support group participation decreases repeat adolescent pregnancies. DESIGN: Two-year, prospective, randomized controlled trial. SETTING: Denver, Colo. PARTICIPANTS: A total of 286 primiparous girls younger than 18 years, whose infants were younger than 5 months. INTERVENTION: Participants were randomized to 4 interventions: monetary incentive and peer-support group, peer-support group only, monetary incentive only, or no intervention. MAIN OUTCOME MEASURES: Consistency of participation in planned intervention and repeat pregnancy. RESULTS: Participation in interventions was generally low. Hypothesis 1 was supported: 58% of those offered a monetary incentive participated in the peer-support groups, compared with 9% of those who were not offered the incentive. Hypothesis 2 was rejected: the peer-support group experience failed to prevent repeat pregnancies. The incidence of second pregnancies at 6 months (9%, 22/248), at 12 months (20%, 49/248), at 18 months (29%, 72/248), and at 24 months (39%, 97/248) following delivery did not vary significantly in relation to intervention strategy. Background sociodemographic characteristics significantly affected the timing of subsequent conceptions but not intervention participation. CONCLUSION: A monetary incentive draws adolescent mothers to sites where they can discuss the costs and benefits of contraception and conception with knowledgeable adults and supportive peers. These discussions do not prevent repeat pregnancies. Further studies are needed to determine if an intervention that produces substantive changes in the daily living environment will eliminate the sexual practices that are responsible for the high rate of repeat pregnancy in this population.

Adolescent↗

PubMed1997

[The evaluation of an incentive system for the primary care professionals of Mallorca].

OBJECTIVE: 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. DESIGN: A descriptive, crossover study. SETTING: Primary care in Mallorca (INSALUD of the Balearics). PARTICIPANTS: All the health professionals and ancillary workers (554) of Mallorca's 24 Health Centres. MEASUREMENTS AND MAIN RESULTS: 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%). CONCLUSIONS: 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.

Attitude of Health Personnel↗

PubMed2006

Incentive implementation in physician practices: A qualitative study of practice executive perspectives on pay for performance.

Pay-for-performance (P4P) programs offer health care providers financial incentives to achieve predefined quality targets. Practice executives sit at a key nexus point for determining how P4P programs are implemented in physician practices. Using a qualitative interview design, this article examines the role practice executives play in the implementation of P4P programs and how their perspectives and decisions can influence the success of these programs. The authors identified five key findings related to practice executives' views on P4P: quality incentives are better than utilization incentives, quality incentives are bonus rewards, quality incentives are agents for change, providers do not feel they have control over attaining quality targets, and the ways in which quality is measured are problematic. The authors discuss five different ways in which practice executives distribute rewards to physicians. These findings may help payers more effectively design and implement financial rewards for quality.

Attitude of Health Personnel↗

PubMedDate not supplied

How disclosing HMO physician incentives affects trust.

Opinions are deeply divided over whether rewarding physicians for lowering costs decreases trust in physicians or insurers. To explore the effects of disclosing physician payment methods in HMOs, members of two similar HMO plans were randomized to intervention and control groups, and the experimental arm was told how the HMO paid their primary care physician. Separate disclosures were developed for each plan, one describing primarily capitation payment, and the other (mixed-incentive plan) describing fee-for-service payment with a bonus that rewards cost savings, satisfaction, and preventive services. The disclosures pointed out more of the positive than the negative features of these incentives. We found that the disclosures doubled the number of subjects with substantial knowledge of the physician incentives and halved the number with no knowledge. Nevertheless, the disclosures had no negative effects on trust of either physicians or insurers. The capitated plan disclosure had a small positive effect on trust of physicians. Disclosing the positive and negative features of incentives and increasing knowledge of these incentives does not, in the short term, reduce trust in physicians or insurers and may have a mild positive impact on physician trust, perhaps as a consequence of displaying candor and increasing understanding of positive features.

Adult↗