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PubMed2003

Financial considerations in living organ donation.

The shortage of cadaveric organs and increased success of living donor transplantation support the use of living organ donors. Clinical social workers have the opportunity to explore a variety of donor-specific issues when performing psychosocial evaluations of living donors, including motivation, psychological stability, and personal and family consequences of donation, as well as the direct and indirect financial consequences faced by living donors. Although most donor-related medical costs are covered, other associated expenses are not reimbursable and may put donors at risk for financial hardship. Out-of-pocket expenses also serve as a disincentive to donate for some volunteers. During the evaluation process, healthcare professionals should openly discuss how surgery, recovery, and any potential complications might impact prospective donors' financial situation. Donors can then decide whether they are able to realistically handle the costs of donation. We present the financial dilemmas experienced by many living donors and highlight efforts that have been made to deal with them.

Absenteeism↗
PubMed2002

Participation in labor-intensive public works program (LIPWP): effect on staple crop production in southeastern Botswana.

A labor-intensive public works program (LIPWP) aims to improve the income of rural households. One of the common criticisms of the LIPWP is that it is a disincentive for staple crop production. This study, conducted between February and May 2000, examined the association between participation in an LIPWP and staple crop production in southeastern Botswana. Participant households were those with at least one member on a semipermanent LIPWP. A control group was drawn from households that were eligible to participate in the LIPWP. All participants in the LIPWP were included, while nonparticipant households were randomly selected. A structured questionnaire was administered to 160 control and 153 participant households. The odds of having no staple crop in the control group were 1.8 times (95% CI, 0.98 to 3.54) higher than that of the LIPWP participants (p = .087), while the odds of having no staple crop in a household with a head between 45 and 64 years of age were 2.5 times (95% CI, 1.06 to 5.96) higher than that of a household with a head less than 45 years old (p < .037). Having more than 10 livestock equivalent units reduced the risk of having no harvest by 40% (95% CI, 0.29 to 1.12). The view that participation in the LIPWP results in reduced staple crop production does not seem to be supported by our data.

Adult↗
PubMedDate not supplied

Experiments in transforming the global workplace: incentives for and impediments to improving workplace conditions in China.

This article highlights current economic conditions in China and analyzes existing obstacles to improving workplace conditions and labor practices. There are significant disincentives to strengthening workplace protections, and downward pressures are currently worsening conditions in a number of economic sectors. However, there are also potential strategies for motivating multinational corporations (MNCs) and Chinese government agencies to improve workplace conditions and to implement international and national laws and corporate codes of conduct. Four key principles are discussed that hold promise for creating incentives and sustainable mechanisms to improve factory conditions: transparency, verification, and accountability for MNCs and Chinese government agencies, and greatly strengthening worker participation.

China↗
PubMed2006

Scratch lottery tickets are a poor incentive to respond to mailed questionnaires.

BACKGROUND: It has been demonstrated that the enclosure of money with a mailed questionnaire increases the response rate significantly. We evaluated scratch lottery tickets as an alternative to cash. METHODS: 1500 randomly selected Norwegians between the ages of 40 and 65 years were sent a short questionnaire. 250 received one lottery scratch ticket worth 20 Norwegian kroner (approximately 3 USD) together with the questionnaire, 250 received two scratch tickets, and 250 were promised two scratch tickets if they replied within one week. A fourth group of 250 persons received a 50 kroner banknote with the questionnaire. The remaining 500 letters served as controls. RESULTS: The overall response rate after 6 weeks was 77%. Logistic regression analysis showed that only the 50 kroner group had a response rate that was statistically significantly higher than the controls (p < 0.0001). It was also significantly higher than that in any of the other incentive groups (p < 0.0001, p < 0.004 and p < 0.0001 respectively). Female sex (p < 0.001) and age (p < 0.002) increased the response rate significantly. CONCLUSION: It is possible that the recipients scratched their cards before completing the questionnaire, and that it was a disincentive for the majority that they did not win anything. Lottery scratch tickets are no substitute for cash as an incentive to respond to a questionnaire.

Adult↗
PubMed2003

Economic incentive in community nursing: attraction, rejection or indifference?

BACKGROUND: It is hard to imagine any period in time when economic issues were more visible in health sector decision-making. The search for measures that maximize available resources has never been greater than within the present decade. A staff payroll represents 60%-70% of budgeted health service funds. The cost-effective use of human resources is thus an objective of paramount importance.Using incentives and disincentives to direct individuals' energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas. CONCLUSION: Understanding the value system of community nurses and how they respond to economic incentives/disincentives facilitates the development of reward systems more likely to be relevant and strategic. If nurse rewards are to become more effective organizational tools, the data suggest that future initiatives should:bullet; Improve nurses' salary/income relativities (e.g. comparable pay/rates);bullet; Provide just compensation for job-related expenses (e.g. petrol, clothing);bullet; Introduce promotional opportunities within the clinical area, rewarding skill and competence development;bullet; Make available a range of financed rewards.- Direct (e.g. subsidized education, additional leave, insurance benefits);- Indirect (e.g. better working conditions, access to professional support network, greater participation in decision-making bodies).

Journal Article↗
PubMed2005

Illegal births and legal abortions--the case of China.

BACKGROUND: China has a national policy regulating the number of children that a woman is allowed to have. The central concept at the individual level application is "illegal pregnancy". The purpose of this article is to describe and problematicize the concept of illegal pregnancy and its use in practice. METHODS: Original texts and previous published and unpublished reports and statistics were used. RESULTS: By 1979 the Chinese population policy was clearly a policy of controlling population growth. For a pregnancy to be legal, it has to be defined as such according to the family-level eligibility rules, and in some places it has to be within the local quota. Enforcement of the policy has been pursued via the State Family Planning (FP) Commission and the Communist Party (CP), both of which have a functioning vertical structure down to the lowest administrative units. There are various incentives and disincentives for families to follow the policy. An extensive system has been created to keep the contraceptive use and pregnancy status of all married women at reproductive age under constant surveillance. In the early 1990s FP and CP officials were made personally responsible for meeting population targets. Since 1979, abortion has been available on request, and the ratio of legal abortions to birth increased in the 1980s and declined in the 1990s. Similar to what happens in other Asian countries with low fertility rates and higher esteem for boys, both national- and local-level data show that an unnaturally greater number of boys than girls are registered as having been born. CONCLUSION: Defining a pregnancy as "illegal" and carrying out the surveillance of individual women are phenomena unique in China, but this does not apply to other features of the policy. The moral judgment concerning the policy depends on the basic question of whether reproduction should be considered as an individual or social decision.

Journal Article↗
PubMed2006

Significance of the oceanic CO2 sink for national carbon accounts.

BACKGROUND: Under the United Nations convention on the law of the sea (1982), each participating country maintains exclusive economic and environmental rights within the oceanic region extending 200 nm from its coastline, known as the Exclusive Economic Zone (EEZ). Although the ocean within each EEZ has a vast capacity to absorb anthropogenic CO2 and therefore potentially be used as a carbon sink, it is not mentioned within the Kyoto Protocol most likely due to inadequate quantitative estimates. Here, I use two methods to estimate the anthropogenic CO2 storage and uptake for a typically large EEZ (Australia). RESULTS: Depending on whether the Antarctic territory is included I find that during the 1990s between 30-40% of Australia's fossil-fuel CO2 emissions were absorbed by its own EEZ. CONCLUSION: This example highlights the potential significance of the EEZ carbon sink for national carbon accounts. However, this 'natural anthropogenic CO2 sink' could be used as a disincentive for certain nations to reduce their anthropogenic CO2 emissions, which would ultimately dampen global efforts to reduce atmospheric CO2 concentrations. Since the oceanic anthropogenic CO2 sink has limited ability to be controlled by human activities, current and future international climate change policies should have an explicit 'EEZ' clause excluding its use within national carbon accounts.

Journal Article↗
PubMed2006

Profiles in patient safety: Antibiotic timing in pneumonia and pay-for-performance.

The delivery of antibiotics within four hours of hospital arrival for patients who are admitted with pneumonia, as mandated by the Joint Commission for the Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services, has gained considerable attention recently because of the plan to implement pay-for-performance for adherence to this standard. Although early antibiotic administration has been associated with improved survival for patients with pneumonia in two large retrospective studies, the effect on actual patient care and outcomes for patients with pneumonia and other emergency department patients of providing financial incentives and disincentives to hospitals for performance on this measure currently is unknown. This article provides an in-depth case-based description of the evidence behind antibiotic timing in pneumonia, discusses potential program effects, and analyzes how the practical implementation of pay-for-performance for pneumonia conforms to American Medical Association guidelines on pay-for-performance.

Aged, 80 and over↗
PubMed1988

Neurology, age, hospital costs, and DRGs.

The DRG payment scheme is causing hospitals to examine the financial consequences of treating various patient populations. The purpose of this study was to examine resource utilization for hospitalized neurology patients treated during a 2-year period at an academic medical center. All patients (N = 1,993) were stratified by payor (Medicare, Medicaid, Blue Cross, and other) and age (0-35 years, 35-65 years, and 65 years and above). Mean hospital cost per patient (exclusive of MD fees) for each payor generally rose with age. Patients 35 years of age and over consumed a disproportionately larger share of resources than younger patients. DRG payment under an all payor system would have produced a substantial deficit for this group of patients. The mean hospital length of stay, number of diagnoses per patient, and mortality, as well as percent of admission through the emergency department generally rose with age. This study demonstrated that neurology patients 35 years of age and older generated higher resource utilization than their younger counterparts and were underpaid by the current DRG reimbursement. In this study, DRG payment appeared to provide significant financial disincentives to treat older neurology patients. If our findings are widespread, the quality of neurologic care and the elderly's access to it could become limited in the future.

Aged↗
PubMed2002

Prevalence, expenditures, utilization, and payment for persons with MS in insured populations.

OBJECTIVE: To determine the prevalence, expenditures, and utilization of enrollees with MS relative to all enrollees in privately insured, Medicare, and Medicaid populations. METHODS: The authors used insurer administrative billing data to identify persons with MS, their insured medical expenditures and utilization, and benchmark general insured population expenditures and utilization. Three samples of insurer billing data were analyzed: nationally representative samples for the privately insured (1994 through 1995) and Medicare (1996 though 1997) populations, and Medicaid data for disabled (1991 through 1996) populations from six states. RESULTS: Using 2 years of diagnoses on claims, the prevalence of MS in the privately insured population was 24 per 10,000, 36 per 10,000 in the Medicare population, and 71 per 10,000 in the Medicaid disabled population. Annual insured expenditures were $7,677 per privately insured enrollee with MS vs $2,394 for all privately insured enrollees, $13,048 per Medicare beneficiary with MS compared with $6,006 for all Medicare beneficiaries, and $7,352 per Medicaid disabled recipient with MS vs $4,088 per disabled recipient without MS. Home health expenditures were very high for Medicare beneficiaries with MS and nursing facility expenditures were very high for Medicaid disabled recipients with MS. A small proportion of enrollees with MS accounted for most expenditures. CONCLUSIONS: Insured enrollees with MS are two to three times more expensive than average insured enrollees. If the premiums that employers or governments pay health insurers and the capitation amounts that insurers pay health care providers do not account for these higher costs, a disincentive is created for the enrollment and care of persons with MS.

Adolescent↗
PubMed1994

Nursing studies laid end to end form a circle.

As early as 1915, leaders in the nursing profession were concerned with the "image problem of nurses," which they saw as needing improvement. Since then, countless studies, reports, and commissions have attempted to explain and solve perceived shortages of registered nurses, which have occurred regularly after brief periods of quiescence or oversupply. Usually, their recommendations have hinged on nurses changing their image. In fact, few of these studies have dealt with the real issues of nursing work, which are a narrow pay range, little extra pay for working on undesirable shifts, disincentives for full-time work, pay unrelated to education, and education unconnected to job level. The multiple studies and commissions do nothing more than recycle data and in the process obscure fundamental problems. Educational funding has been no more successful. Their ineffectiveness suggests the need for less "image enhancement" and more support from physicians and employers to bring about systemic reform. This includes licensing nurses according to their education, assigning them according to their competencies and education, and paying accordingly. These measures, and only these, will eventually curtail the cycles of nursing "shortages."

Education, Nursing↗
PubMed1982

Employer-based health insurance.

Employer-based health insurance (insurance that is purchased by employers for their employees and financed through employer or joint employer-employee contributions) is currently subsidized in part by the federal government through tax exclusions for employer contributions to employee health insurance plans. This subsidization costs the federal government close to 10 billion dollars a year in lost revenues. Many proposed national health insurance plans assign a key role to employer-based health insurance as a vehicle for financing health care. Federal subsidization of employer-based health insurance and plans that assign employers a key role in the administration of a national health insurance plan both assume that private industry acts to realize federal health policy goals-- particularly cost containment--in administering health insurance plans. Little is known, however, about how employers go about selecting the plans they offer their employees or about the incentives and disincentives regarding cost of care than are created by employer-based health insurance. Existing evidence suggests that rather than helping to contain health care costs, employer-based health insurance may be partly responsible for their present escalation. In addition, employer-based health insurance may not be the most equitable way to implement a national health insurance plan.

Blue Cross Blue Shield Insurance Plans↗
PubMed2001

Assessing the value of hospital-in-the-home: lessons from Australia.

OBJECTIVES: To identify factors that influence the cost-effectiveness of hospital-in-the-home (HITH) and to discuss the impact of funding arrangements in creating incentives or disincentives for the establishment of HITH services. METHODS: A review of HITH services in Australia was undertaken. Based on the review, factors affecting the relative costs of HITH and conventional care were identified, in particular, the effect of funding and organisational arrangements on the incentives for managers and providers to choose between HITH and conventional care. RESULTS: The review of HITH services identified a wide range of models of HITH in Australia. Factors identified as important to the success of HITH included demographic and location issues, referral mechanisms, the choice of staffing and the management of the programme. However, it was clear that the structure of the programme often related to funding arrangements. Issues such as 'incentive funding', establishment costs and opportunity for cost-shifting were identified as being relevant to incentives for the efficient provision of HITH. CONCLUSIONS: Evaluations are essential to inform decisions about whether HITH is likely to be a viable and cost-effective alternative to inpatient care. However, the relative costs of HITH and conventional care will depend on local factors. From the point of view of the decision-maker, these will be affected by funding and organisational arrangements. Funders must be aware that complex financial incentives may mask the true costs of HITH services relative to hospital services. They need to ensure that the incentives created by funding arrangements are transparent.

Australia↗
PubMed2000

A pilot study of an educational service for rural mental health practitioners in South Australia using telemedicine.

Studies have found that rural patients want to be treated in their local hospitals. However, there have been difficulties with recruiting and retaining professionals in rural areas of Australia. Isolation, lack of professional development programmes, lack of academic programmes, lack of peer consultation and the need to travel long distances are some of the reasons identified in the National Rural Health strategy. A pilot service of educational programmes delivered by telemedicine was initiated and then evaluated. Forty-six community mental health workers from nine rural areas and 20 general practitioners from five rural areas participated. High satisfaction with the use of telemedicine was recorded by both groups. Telemedicine reduced the disincentives to rural practice, and also improved the professionals' competence and confidence in managing patients with psychiatric illness.

Education, Distance↗
PubMed2004

Overweight and obesity: helping clients to take action.

This article presents the results of a qualitative research project to explore factors that encourage or discourage overweight people from low income groups to access weight loss services. Semi-structured interviews were conducted with 16 people attending a commercial slimming organization in South Yorkshire. The study revealed weight loss decisions to be complex and fragile. The experiences reported mirror the 'stages of change' model described by Prochaska and DiClemente (1992). Triggers to action occurred cumulatively and decisions were reached gradually. The triggers included embarrassment and humiliation, health, fear, critical events and image. Disincentives to action were denial, previous bad experiences, previous failure and money. Decisions were linked to low self-esteem and confidence, making people vulnerable at the point they take action. The implications of this for nursing practice and services in primary care are considered.

Adult↗
PubMed1990

Barriers to vaccinating preschool children.

Immunization represents one of the most effective tools in preventive medicine. But despite what should be a universal practice, preschool children, particularly in the inner cities, are not being adequately vaccinated. The responsibility for low immunization levels does not rest solely with the parents. Major obstacles within the health care system provide disincentives to immunization. Local resource problems such as inadequate clinic staff, hours, and locations make immunizations difficult to obtain. When comprehensive care is not easily accessible (e.g., requiring appointments weeks or months in advance), policies which require immunization to take place only within such a setting are further barriers. Many opportunities for vaccination are lost when children interact with the health care system but do not receive all the immunizations they need. Policies must be changed to facilitate immunization and to take advantage of all health care visits to provide vaccines.

Chicago↗
PubMedDate not supplied

Factors affecting U.S. manufacturers' decisions to produce vaccines.

Recent supply interruptions of childhood vaccines have had negative impacts on U.S. public health policies and vaccine delivery. To understand how manufacturers perceive production incentives and disincentives, the Centers for Disease Control and Prevention (CDC) met with the four pharmaceutical firms that sold vaccines through CDC-negotiated contracts during 2002 and 2003. These meetings shed light on the regulatory burden, high costs of the delay between initial investment and sales, and higher costs of new technologies versus older vaccines. All four manufacturers are investing more in research and development because new technologies have advanced their ability to create vaccines not thought possible before.

Centers for Disease Control and Prevention, U.S.↗
PubMed2003

DRG, costs and reimbursement following Roux-en-Y gastric bypass: an economic appraisal.

BACKGROUND: There is disagreement regarding hospital and physician reimbursement fees when DRG codes are used. We have found that physicians and hospitals are rewarded differently depending on the type of insurance coverage - per diem HMO (Health Maintenance Organization) vs public. METHODS: 133 patients were retrospectively analyzed in a single institution. There were 59 privately-insured and 74 publicly-insured patients. Using DRG 288, hospital and surgeon reimbursement rates, complications, length of stay, blood loss and basic demographics were evaluated on all patients. Reimbursement rates were then compared to inpatient hospital costs per case for both open and laparoscopic Roux-en-Y gastric bypass (RYGBP). Statistical analysis used Student's t-test and standard deviation. RESULTS: The 2 groups were similar in terms of age, sex and BMI. There was a large difference in physician reimbursement when comparing public to private insurance (931 US dollars +/-73 vs 2356 US dollars +/-822, P<0.001). Likewise, there was a large difference in hospital reimbursement (public 11773 US dollars +/- 4462 vs private 4435 US dollars +/- 3106, P<0.001). The estimated costs for open gastric bypass was 3179 US dollars vs 4180 US dollars for the laparoscopic bypass. The HMO per diem rate was 1000 US dollars per day. CONCLUSION: There is a relative disincentive for surgeons to treat publicly-insured patients, while there is an incentive for hospitals to treat those patients. The converse is true for the privately-insured patients. This dichotomy will impede the development of new centers and place greater burden on bariatric surgeons to reduce cost by performing the open RYGBP.

Adult↗