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PubMed1986

Incentives and disincentives for schizophrenia research careers.

A meeting was convened to discuss schizophrenia research career incentives and disincentives. A diverse group of scientists from different fields and in different career stages discussed the causes of and potential solutions to schizophrenia research manpower problems. The scientific and clinical, individual and institutional factors involved were identified and numerous disincentives to careers in schizophrenia research were noted. A number of possible incentives were also suggested and debated. There was general agreement on the following issues: attracting and maintaining a larger group of young investigators is crucial; multidisciplinary studies combining clinical and basic science approaches should be strongly encouraged; and mechanisms for increasing funding and stimulating interest in schizophrenia research careers should be studied by the National Institute of Mental Health. Specific recommendations are now being assessed to determine how best to respond to the schizophrenia research manpower needs that were identified at the meeting.

Congresses as Topic↗
PubMed1997

Workplace injuries and the role of insurance: claims costs, outcomes, and incentives.

Workplace disability and workers' compensation systems were designed in the first 3 decades of the twentieth century with 3 major objectives. The first objective was to reduce the inequities and uncertainties in compensating disabled and injured workers inherent in the previously existing tort based system. The second was to create appropriate employer incentives for safety by internalizing the costs of accidents to the firm. The third, and perhaps little appreciated at the time for its impact on the provision of care and the healing process of injured workers, was to introduce a no fault, prefunded insurance mechanism to guarantee certain benefits to workers injured on the job. Throughout its history, there have been periodic attempts to reform the workers' compensation system. During the past 15 years there has been a growing body of theoretic and empiric social science research that suggests that many of the attempted reforms have not necessarily worked as planned. Indeed, it has become clear that the workers' compensation system, through its varying financial incentives on the system participants, and the differing levels of information that are available, may itself play an important and perhaps not benign role in the outcomes and costs for treating injured workers. The existing research is summarized and some new evidence on the workers' compensation insurance effect is provided.

Accidents, Occupational↗
PubMed1997

Incentive effects of workers' compensation.

Economic theory and evidence indicate that workers, employers, and healthcare personnel respond to the incentives built into state workers' compensation systems. Although empirical studies cannot provide precise estimates of the quantitative effects resulting from specific policy changes, research is useful in evaluating the qualitative effects of alternative policies. Studies show that workers' compensation claims are higher the more generous the level of benefits, the shorter the waiting period, and the more readily available is information on benefits to workers. States that decrease real benefit levels and lengthen the period required before workers are compensated for lost earnings can constrain future growth in workers' compensation costs, while continuing to provide partial compensation for workers with the most serious injuries. The most difficult problem facing policymakers is to design and implement reforms that take into account what are often the incompatible incentives of workers, employers, and medical care providers.

Eligibility Determination↗
PubMed2000

Incentive spirometry does not enhance recovery after thoracic surgery.

OBJECTIVE: To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections. DESIGN: Randomized controlled trial. SETTING: University hospital, intensive care unit, and surgical department. PATIENTS: Sixty-seven patients (age, 59 +/- 13 yrs; forced expiratory volume in 1 sec, 93% +/- 22% predicted) undergoing elective thoracic surgery for lung (n = 40) or esophagus (n = 27) resection. INTERVENTIONS: Physiotherapy (breathing exercises, huffing, and coughing) (PT) plus incentive spirometry (IS) was compared with PT alone. MEASUREMENTS AND MAIN RESULTS: Lung function, body temperature, chest radiograph, white blood cell count, and number of hospital and intensive care unit days were all measured. Pulmonary function was significantly reduced after surgery (55% of the initial value) and improved significantly in the postoperative period in both groups. However, no differences were observed in the recovery of pulmonary function between the groups. The overall score of the chest radiograph, based on the presence of atelectasis, was similar in both treatment groups. Eight patients (12%) (three patients with lobectomy and five with esophagus resection) developed a pulmonary complication (abnormal chest radiograph, elevated body temperature and white blood cell count), four in each treatment group. Adding IS to regular PT did not reduce hospital or intensive care unit stay. CONCLUSIONS: Pulmonary complications after lung and esophagus surgery were relatively low. The addition of IS to PT did not further reduce pulmonary complications or hospital stay. Although we cannot rule out beneficial effects in a subgroup of high-risk patients, routine use of IS after thoracic surgery seems to be ineffective.

Analysis of Variance↗
PubMed1975

The long-term care marketplace: an analysis of deficiencies and potential reform by means of incentive reimbursement.

This study analyzes the institutional, economic, and regulatory deficiencies of the long-term care sector of the health industry and develops an incentive reimbursement model as a means for correcting or ameliorating some of the stated deficiencies. The reimbursement model presents a schema which attempts to match patients to facilities, needs to services, and services to cost. A capital expansion coupon program is proposed, both as a suitable vehicle for channeling incentive rewards accruing to nonprofit institutions, and as a mechanism for subsidizing the approved expansion and/or renovation plans of "efficient" providers of care.

Community Participation↗
PubMed1978

Financial incentives to perform medical procedures and laboratory tests: illustrative models of office practice.

Financial return is one of several factors that may affect a physician's decision to order services for a patient. The extent of financial incentives to perform in-office medical procedures and laboratory tests is illustrated by four hypothetical models of general internal medicine office practice. The model practices consist of fixed ratios of history and physical examinations to return visits, with numbers and types of medical procedures and laboratory tests increasing stepwise through the four models. The procedures and tests included are an electrocardiogram, urinalysis, complete blood count, sigmoidoscopy, tuberculin skin test, two-view chest x-ray, cardiovascular treadmill stress test, and an automated 12-channel blood chemistry test. Charges and office expenses are estimated at 1977 Northern California levels. Net incomes derived for the four models are as follows: $31,000, $55,000; $60,000; and $90,000. The demonstrated financial incentives, which apply not only to internal medicine, but to all fields of medical care, are in conflict with policies that would emphasize personal rather than technical services. National health insurance proposals should include a continuing review of medical services valuation.

California↗
PubMed1996

Effects of an incentive and education program on return rates for PPD test reading in patients with HIV infection.

To determine the impact of a food voucher incentive and patient education program on compliance with tuberculin skin test (PPD, purified protein derivative) performance in HIV-infected adults, we analyzed return rates for PPD reading for patients at our urban HIV clinic. The groups studied included patients who received no intervention (controls), patients offered a food voucher incentive, and patients offered a food voucher and patient education intervention. Return rates for PPD reading were 96 (35%) of 272 for the control group, 111 (48%, p = 0.004) of 229 for the food voucher group, and 96 (61%, p < 0.0001) of 158 for the food voucher and patient education group. By univariate analysis, black patients (p = 0.01), males (p = 0.01), older patients (p = 0.04), city residents (p = 0.001), and injection drug users were more likely to return for PPD reading. By logistic regression, food voucher, food voucher plus education, city residence, and male sex were significantly associated with return for PPD reading. Two simple, inexpensive interventions were found to increase compliance with tuberculin skin test performance in HIV-infected adults. Additional interventions are required to achieve better rates of return for PPD reading.

Adult↗
PubMed2007

Barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia.

OBJECTIVE: To examine the barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia. METHODS: In-depth, semi-structured interviews were conducted between February and September 2003 with 20 Aboriginal people who were HIV-positive; almost half the total number of Aboriginal people known to be living with HIV in Western Australia at that time. RESULTS: Despite having access to treatments in both urban and rural areas, only 11 of the 20 participants were on antiretroviral treatment at the time of interview. Four of the women had been prescribed treatment during pregnancy only. The main barriers to treatment uptake were fear of disclosure and discrimination, heavy alcohol consumption and poverty. The incentives were pregnancy and access to services whose approach can be described as broad-based and holistic, i.e. supporting people in the context of their everyday lives by providing psychosocial and welfare support as well as healthcare. CONCLUSION: For many Aboriginal people, maintaining social relationships, everyday routines and the respect of friends, families and community is a greater priority than individual health per se. Treatment regimens must be tailored to fit the logistical, social and cultural context of everyday life, and be delivered within the context of broad-based health services, in order to be feasible and sustainable.

Adult↗
PubMed2006

Partners in lowering cholesterol: comparison of a multidisciplinary educational program, monetary incentives, or usual care in the treatment of dyslipidemia identified among employees.

OBJECTIVE: We sought to assess whether either a low-cost educational intervention or small monetary incentive is more effective than usual care in lowering low-density lipoprotein (LDL) cholesterol among employees. METHODS: Employees with an LDL-C >130 mg/dL were eligible. After receiving on-line educational materials, subjects were assigned to three groups: group 1 received dollar 100 if they reduced their LDL-C by 15% within 6 months, group 2 participated in a multi-disciplinary educational program, and group 3 received no further intervention. RESULTS: In total, 171 employees participated. Baseline mean LDL-C was 156 mg/dL. Approximately 6 months after randomization, mean LDL-C was reduced 17.9 mg/dL (11.3%) in group 1, 17.9 mg/dL (11.5%) in group 2, and 5.5 mg/dL (3.5%) in group 3. Reductions in groups 1 and 2 were statistically superior to group 3 (P = 0.02). CONCLUSIONS: Both an employer directed low-cost educational program and small monetary incentives similarly lowered LDL-C compared with usual care.

Cholesterol, LDL↗
PubMed2003

Selection incentives in a performance-based contracting system.

OBJECTIVE: To investigate whether a performance-based contracting (PBC) system provides incentives for nonprofit providers of substance abuse treatment to select less severe clients into treatment. DATA SOURCES: The Maine Addiction Treatment System (MATS) standardized admission and discharge data provided by the Maine Office of Substance Abuse (OSA) for fiscal years 1991-1995, provides demographic, substance abuse, and social functional information on clients of programs receiving public funding. STUDY DESIGN: We focused on OSA clients (i.e., those patients whose treatment cost was covered by the funding from OSA) and Medicaid clients in outpatient programs. Clients were identified as being "most severe" or not. We compared the likelihood for OSA clients to be "most severe" before PBC and after PBC using Medicaid clients as the control. Multivariate regression analysis was employed to predict the marginal effect of PBC on the probability of OSA clients being most severe after controlling for other factors. PRINCIPAL FINDINGS: The percentage of OSA outpatient clients classified as most severe users dropped by 7 percent (p < = 0.001) after the innovation of performance-based contracting compared to the increase of 2 percent for Medicaid clients. The regression results also showed that PBC had a significantly negative marginal effect on the probability of OSA clients being most severe. CONCLUSIONS: Performance-based contracting gave providers of substance abuse treatment financial incentives to treat less severe OSA clients in order to improve their performance outcomes. Fewer OSA clients with the greatest severity were treated in outpatient programs with the implementation of PBC. These results suggest that regulators, or payers, should evaluate programs comprehensively taking this type of selection behavior into consideration.

Adult↗
PubMed2006

Subjective responses to initial experience with cocaine: an exploration of the incentive-sensitization theory of drug abuse.

AIMS: This study investigated the relationship between positive and negative subjective responses at the time of initial cocaine use with adult cocaine dependence and life-time use rates. Psychostimulant pre-exposure, regular smoking or stimulant treatment before initiation were examined to explore the incentive sensitization theory of addiction. PARTICIPANTS: A total of 202 adult participants who had tried cocaine on at least one occasion were studied prospectively from childhood into adulthood. The cocaine-initiated group included 89 who met Diagnostic and Statistical Manual version IV (DSM-IV) criteria for attention deficit hyperactive disorder (ADHD) and 113 age-matched controls. DESIGN: Five childhood and three adulthood interviews provided data on ages of initiation into cocaine and life-time use of cocaine from ages 16-40 years. Correlations of each subjective response and analyses of variance (ANOVAs) of cocaine 'liking' and 'wanting' with DSM-III-R cocaine dependence and life-time use provided support for the validity of the measures. ANOVA provided evidence of the effect of psychostimulant pre-exposure on 'liking' and 'wanting'. Logistic regression modeled the prediction of dependence and life-time use with the independent variables of 'liking' and 'wanting', psychostimulant pre-exposure and participant characteristics. RESULTS: When cocaine was first tried, 'liking' and 'wanting' were significant predictors of cocaine dependence and life-time use. Mean 'liking' or 'wanting' responses did not differ by participant characteristics. Those who were pre-exposed by regular smoking or stimulant treatment had higher 'liking' and 'wanting' scores; but participants who were pre-exposed by both stimulant treatment and regular smoking reported the lowest liking and the highest wanting responses, consistent with the incentive sensitization theory. Logistic regression showed that the 'liking' and 'wanting' responses increased significantly the odds of DSM-III-R cocaine dependence and life-time use. CONCLUSION: In this sample, subjective 'liking' and 'wanting' measured risk for cocaine abuse.

Adult↗
PubMed2007

Effects of varying the monetary value of voucher-based incentives on abstinence achieved during and following treatment among cocaine-dependent outpatients.

AIMS: This study examined whether increasing the amount of abstinence achieved during outpatient treatment for cocaine dependence is an effective method for increasing longer-term cocaine abstinence. DESIGN: A two-condition, parallel groups, randomized controlled trial was conducted. SETTING: The trial was conducted in a university-based research clinic. PARTICIPANTS: A total of 100 cocaine-dependent outpatients participated in the trial. INTERVENTION: Participants were assigned randomly to receive treatment based on the community reinforcement approach (CRA) plus voucher-based incentives set at a relatively high monetary value (maximal value = $1995/12 weeks) or CRA with vouchers set at a relatively low monetary value (maximal value = $499/12 weeks). Vouchers were earned contingent on cocaine-negative urinalysis results during the initial 12 weeks of the 24-week outpatient treatment. MEASUREMENTS: Outcomes were evaluated using urine-toxicology testing, questionnaires and other self-report instruments. FINDINGS: Increasing voucher value increased the duration of continuous cocaine abstinence achieved during the 24-week treatment period. Point-prevalence cocaine abstinence assessed every 3 months throughout an 18-month follow-up period was greater in the high- than low-value voucher conditions. The duration of abstinence achieved during treatment predicted abstinence during follow-up, although that relationship weakened over time. CONCLUSIONS: Increasing the value of abstinence-contingent incentives during the initial weeks of treatment appears to represent an effective method for increasing during-treatment and longer-term cocaine abstinence, but the positive association of during-treatment abstinence with longer-term outcome dissipates with time.

Adult↗
PubMed1988

An evaluation of the incentive spirometer to improve lung function after cholecystectomy.

Forty patients who underwent elective cholecystectomy were allocated randomly to one of two groups. Patients in one group used an incentive spirometer as part of their postoperative chest physiotherapy; those in the other received routine postoperative physiotherapy as dictated by their needs. Each group contained equal numbers of smokers and nonsmokers, and the data from each group were analysed separately. The use of the incentive spirometer did not confer any benefits as judged by clinical evidence of pulmonary complications, pulmonary function tests or length of hospital stay.

Adult↗
PubMed2006

Swedish Registered Nurses' incentives to use nursing diagnoses in clinical practice.

AIMS AND OBJECTIVES: The purpose of this study was to describe Registered Nurses' incentives to use nursing diagnoses in clinical practice. BACKGROUND: The use of nursing diagnoses is scarce in Swedish patient records. However, there are hospital wards were all nurses formulate and use nursing diagnoses in their daily work. This leads to the question of what motivates these nurses who do use nursing diagnoses in clinical practice. DESIGN: A qualitative descriptive design. METHODS: A purposeful sampling of 12 Registered Nurses was used. Qualitative interviews to collect data and a content analysis were performed. RESULTS: Five categories were identified: identification of the patient as an individual and as a whole, a working tool for facilitating nursing care, increasing awareness within nursing, support from the management and influence on the professional role. The principle findings of this study were: (i) that the Registered Nurses perceived that nursing diagnoses clarified the patient's individual needs and thereby enabled them to decide on more specific nursing interventions, (ii) that nursing diagnoses were found to facilitate communication between colleagues concerning patient care and thus promoted continuity of care and saved time and (iii) that nursing diagnoses were perceived to increase the Registered Nurses' reflective thinking leading to a continuous development of professional knowledge. CONCLUSIONS: The present findings suggest that the incentives to use nursing diagnoses originate from effects generated from performing a deeper analysis of the patient's nursing needs. Further research is needed to test and validate the usability and consequences of using nursing diagnoses in clinical practice. Motivating factors found in this study may be valuable to Registered Nurses for the use and development of nursing diagnoses in clinical care. Moreover, these factors may be of relevance in other countries that are in a similar situation as Sweden concerning application of nursing diagnoses.

Attitude of Health Personnel↗
PubMed2002

Increases in vaccination coverage for children in child care, 1997 to 2000: an evaluation of the impact of government incentives and initiatives.

OBJECTIVE: To compare vaccination coverage of children in child care before (1997) and after (2000) implementation of government immunisation strategies including parent/providers incentives and surveillance of vaccination uptake. METHODS: Cross-sectional parent surveys of vaccination coverage for children (<3 years old regularly attending child care) in 47 child care centres and 19 councils operating family day care in metropolitan Melboume. RESULTS: Data were collected for 1,578 (72%) children in 1997 and 1,793 (72%) in 2000. In 2000, 93% were completely immunised, a 9% (95% CI 6%-11%, p<0.001) increase from 1997. Less than 1% of children were unimmunised (0.8% in 1997, 0.5% in 2000). For those >2 years, 94% were completely immunised before their second birthday in 2000 compared with 80% in 1997. Immunisation levels were 10% (95% Cl 6-12) higher in 2000 than in 1997 for those receiving child care benefits compared with a 7% (95% Cl 3-10) increase for families not receiving benefits. In 1997, 8 (17%) child care centres and 4 (21%) councils reported > or = 90% children completely immunised increasing to 33 (70%) and 16 (84%) in 2000 respectively. Fewer families reported delaying immunisations because of minor illness in 2000 (27%) compared to 1997 (44%, p<.001). Updating immunisation data by child care coordinators increased from 51% in 1997 to 98% in 2000. CONCLUSION: A substantial increase in immunisation uptake has been achieved for this population of young children attending child care. This study provides evidence that the increase in vaccination rates is attributable to some extent to increased surveillance of immunisation rates and both parent and provider incentives to immunise.

Australia↗
PubMed1993

Blood pressure responses and incentive appraisals as a function of perceived ability and objective task demand.

This experiment examined the role perceptions of ability may play in determining the impact of task demand on cardiovascular responses indicative of active coping. Subjects first performed a scanning task and received feedback indicating that they had either low or high scanning ability. They then were presented with the opportunity to earn one of two incentives by attaining either an objectively low or objectively high standard of performance on a second scanning task. Immediately prior to and during the 1-min performance period, systolic and diastolic blood pressure responses were greater in the difficult standard condition than in the easy standard condition for those who received high-ability feedback but were somewhat diminished in the difficult standard condition as compared with the easy standard condition for those who received low-ability feedback. Whereas high-ability subjects tended to have less pronounced pressor responses than did low-ability subjects when the second task was objectively easy, they had more pronounced pressor responses than low-ability subjects when the second task was objectively difficult. Analysis of goal attractiveness ratings obtained just prior to task performance showed a general correspondence between subjects' anticipatory blood pressure responses and their appraisals of the incentives. Implications for several lines of investigation are discussed.

Adaptation, Psychological↗
PubMed1997

Social determinants of cardiovascular reactivity: effects of incentive to exert influence and evaluative threat.

The effects on cardiovascular reactivity of incentive to influence the judgements of the experimenter and the threat of social evaluation were examined in a sample of 60 male and 60 female undergraduates. Participants either were guaranteed $5.00 to prepare and deliver a brief speech or were told that the money was contingent on an evaluation by the experimenter. Participants believed that their speech would be rated for either simple clarity or verbal intelligence. The contingent incentive increased systolic blood pressure reactivity by 6.5 mmHg (32%). Evaluative threat increased systolic reactivity by 7.1 mmHg (36%). These interpersonal processes could increase the risk of cardiovascular disease and are likely to affect the degree of cardiovascular reactivity in laboratory studies.

Adult↗
PubMed2005

Incentive models to increase living kidney donation: encouraging without coercing.

Kidney transplantation is a superior treatment strategy than chronic dialysis for end-stage renal disease patients. However, there is a severe shortage of cadaveric kidneys that are available for transplantation. Therefore many patients are turning to living donors. We describe four models of incentives to improve rates of living kidney donation: the market compensation model, the fixed compensation model, no-compensation model and the expense reimbursement model. We discuss the advantages and disadvantages of each of these models. Any incentive to improve rates of living kidney donation must be accompanied by safeguards. These safeguards will prevent living donors from being viewed primarily as a resource for transplants. These safeguards will also prevent vulnerable individuals from being coerced into donation and will monitor long-term outcomes of donors using a donor registry. We recommend the use of the expense reimbursement model along with these safeguards, in order to increase rates of living kidney donation.

Humans↗