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Information unsymmtry is a big obstacle in environment management. In this paper, an incentive mechanism for implementation of effluent charge under unsymmetrical information was designed. This mechanism will provide incentives for true information and lower down the transaction cost in environment management.
A review of experimental papers on the problem of incentive motivation reveals little or no support for the hypothesis that conditioned food signals facilitate autochthonous instrumental responses (i.e., responses motivated by the same drive and rewarded by the same unconditioned stimulus). The existing data are explained most parsimoniously by assuming that reward, or its conditioned signal, inhibits the central drive process, and, that the termination of either primary (food US) or secondary (food CS) reward causes the rebound of drive which energizes instrumental behavior. This post-consummatory arousal of drive retains some specificity related to the reward and is assumed to represent a mechanism of the phenomena usually referred to as incentive motivation.
Fee for activity based payment systems create a matrix of conflicting incentives. Hospitals, desiring to maximize revenues and minimize expenses, seek high patient volume with minimal direct variable expenses. The mix of patients, sought bias towards those whose disease related group (DRG), provide the largest contribution to hospitals fixed costs, are frequently characterized by the DRG with high reimbursements, coupled with both low length of stay and low utilization of expensive resources. Physicians, on the other hand, find hospital environments to be extraordinary practice sites. In the hospital, they can generate practice revenue without paying overhead for hospital resources. The incentives to rapidly discharge patients and reduce utilization of resources which are charged to the hospital's expense line are obscure. Hospital treatment of CHF frequently characterizes this conflict; hospitals are seeking rapid through put of CHF patients who neither require expensive hospital based resources nor demonstrate excessive length of stay. Physicians are not encumbered with immediate concerns about costs during the hospitalization, nor the length of hospitalization. The absence of absolute medical consensus on appropriateness of diagnostic and treatment strategies in this population has allowed significant variation on practice patterns to evolve, and consequently, variation on the contribution to hospital fiscal viability made by each physician. (c)1999 by CHF, Inc.
A micro study of inter-regional migration by women in Nicaragua is presented. The authors "explore three sets of migratory incentives: (1) labor market factors such as usually are emphasized; (2) 'demographic marriage market' considerations (i.e., the probability of having a male companion)...; and (3) 'economic marriage market' considerations (i.e., the expected earnings from a companion given regional labor market conditions and assortative mating)....[They] use estimates of expected outcomes in origin, destination and third regions--conditional upon the woman's characteristics and upon regional differences in labor and marriage markets--to explore the consistency of actual migratory flows with these three sets of migratory incentives." Data are from a sample of approximately 4,000 women aged 15-45 who were interviewed in 1977-1978.
It is imperative that the health care system provide mechanisms to improve cancer control. The most effective way of limiting cancer morbidity and mortality is by prevention (modification of behaviors that increase cancer risk), and by early diagnosis in the asymptomatic stage of the disease, which allows for curative therapies. This article has enumerated barriers that make preventive and early diagnostic maneuvers more difficult for both patients and physicians. Some of the barriers are common to both patients and physicians, such as discontinuity of care. The barriers were discussed from both perspectives. Suggestions were made for modification of these barriers, so that incentives might make provision of the preventive and early diagnosis more likely. The incentives are attainable; however, to make improvements on a large scale will require the efforts of the public, physicians, and the health care system. It will effect physicians from the beginning of their medical education and through their entire practice. A large amount of effort directed at a focused population by a small team of health care workers can make a large difference in preventive care. This was shown effectively by a general practitioner in England who undertook a 15-month "campaign" on a "deprived" community, and raised the level of preventive care to that of an "endowed" community. This type of effort by an individual is desirable, but much smaller individual efforts directed over an entire population can have a much greater ultimate effect. That is why the efforts must be directed toward the primary care physician. These physicians care for the majority of the population, so if each primary care doctor increased current efforts of prevention by just three patients per day, then over the entire population inestimable improvements on preventive care would result. There is some evidence that improvements in preventive care are occurring. As further research is directed at how best to provide preventive services in the physician's office, our skills and effectiveness will improve. Each physician should accept as his or her responsibility the ongoing preventive needs of the population he or she serves. The prevention and early diagnosis of cancer can be coordinated in the office with episodic care to minimize costs. The necessary knowledge and technology are available, application is the key. By applying these in a cost-effective way, we can hopefully attain control of cancer in the next decade.
Results of a survey of six Midwestern states demonstrated that although some state Medicaid agencies have had work incentive policies for ICF/MR residents for some time, others continue to utilize policies that are a disincentive to work. Policy changes toward employment incentives in state Medicaid agencies should improve work opportunities for workers with mental retardation at little expense to the government.
Objections to commerce in organs has not stopped the spread of such practice around the world. In most countries the gap between supply and demand for organs continues to increase. Kidneys from living donors are considered a valuable addition to the donor pool, and in a more acquisitive world, donor incentives are becoming thinkable, even acceptable. Current incentives for cadaver and living organ donation are reviewed from ethical and legal perspectives. A new principle of reimbursement for the living donor's risk and pain is defined and presented for debate.
In 5 experiments the role of incentive learning in instrumental performance following a shift in primary motivation was examined. In Experiments 1 and 2 rats trained to perform an instrumental action reinforced by either pellets or maltodextrin when in a low-deprivation state were shifted to a high-deprivation state and tested in extinction. This shift in deprivation increased performance only if the animals had been exposed to the reinforcer in the high-deprivation state prior to instrumental training. Experiments 3, 4, and 5 examined the reverse shift training in a high-deprivation state and testing in a low-deprivation state, and found, similarly, that performance was only sensitive to this shift if animals were previously exposed to the reinforcer while in the low-deprivation state. These experiments support the conclusion that instrumental performance following revaluation of the reinforcer depends on a process of incentive learning.
On January 4, 2002, President Bush signed into law the Best Pharmaceuticals for Children Act, which is the government's most comprehensive legislation regarding pediatric research to date. The Act offers pharmaceutical companies a six-month exclusivity term in return for their agreement to conduct pediatric tests on drugs. It also provides public funding and organizes private funding to help conduct pediatric research on those drugs that pharmaceutical companies opt not to test in children. This Note reviews the history of pediatric research and traces the development of the Best Pharmaceuticals for Children Act's unique incentive and public funding structure. The Note contends that, while the Act is comprehensive and promotes important pediatric studies, its incentive structure forces consumers and taxpayers to bear the costs of testing pharmaceuticals in children instead of the manufacturers who research, develop, and market those drugs. Congress should consider mandating pediatric studies in any future enactment of the legislation.
Worksite smoking cessation intervention programs have become increasingly popular, although program evaluations are often unavailable. In 1984, the Texas Operations of Dow Chemical USA offered a Smoking Cessation Incentive Program (SCIP) to its employees. SCIP was a highly publicized, upbeat program that had the active support of management and union. Altogether, 7,516 employees (95.4% of all employees) were surveyed about their smoking habits; 28.3% identified themselves as smokers. A total of 1,113 employees voluntarily enrolled in SCIP from March 1, 1984, through March 1, 1985. Smoking cessation methods included a buddy program, nicotine-containing chewing gum, American Lung Association self-help material and group clinics, and incentive prizes. SCIP registrants, compared to employees identified as smokers in a pre-program survey who did not participate in SCIP, were significantly (P less than .01) more often females, whites, administrators, professionals, heavier smokers, and smokers who had tried to quit at least two times prior to SCIP. There were 326 (29.3%) SCIP participants who quit smoking for at least one month during SCIP. A total of 265 (23.8%) succeeded at quitting for at least six months and remained ex-smokers at the end of the program. Logistic regression analysis showed administrators had significantly higher six-month or more rates of quitting than did professionals, craftsmen, operators or clerical workers.(ABSTRACT TRUNCATED AT 250 WORDS)
A food service establishment incentive program was developed by the Allentown Bureau of Health to provide the city's food service industry with a financial incentive to help promote community health. This program refunds food service establishments part of their annual operational fees for the designation of nonsmoking patron dining areas, the certification of personnel in CPR and antichoking techniques, and the employment of a certified food service manager.
This study was designed to discover perceived incentives for employment in terms of similarities in how employed and nonemployed nurses ranked employment inducements, and if the two groups could be differentiated on the basis of their rankings. March and Simon's (1958) theory was the basis for identifying inducements/incentives. A 47-item instrument was distributed randomly to a 5% sample of registered nurses (RNs) from a midwestern state. Similarities in incentives existed in the factor structure for both the employed and nonemployed. The factor structure for the part-employed approximated both groups depending on items considered. Little variance was accounted for by the instrument, indicating other variables need to be identified. Data indicate that the area of professionalism would be valuable in developing more items related to inducements/incentives.
Schizophrenic patients have been observed to have a significantly diminished P300 component of the event-related potential (ERP). We investigated whether this result would be obtained with high-incentive stimuli. We presented 14 unmedicated patients and 14 controls with two easily identified visual stimuli under three conditions: (i) a nonincentive condition, (ii) under the condition of $1 payment for each correct identification, and (iii) under the condition of $1 payment for each correct identification within a criterion time. The patients responded accurately but showed a significantly reduced P300 in the incentive conditions. We interpret our results as neurophysiological evidence for possible limbic system dysfunction in schizophrenia.
This article is the second in a series of articles that use data from the New Beneficiary Followup survey to analyze the work efforts of the Social Security Administration's Disability Insurance beneficiaries. Survival analysis techniques are used to determine the effect of vocational rehabilitation efforts and work incentive program provisions on actual work outcomes. The findings indicate that the demographic variables of age, gender, race, education, and marital status affect the tendency to return to work in the expected way. The results suggest a possible disincentive effect may be built into certain work incentive provisions of the program. The encouraging news is that the vocational rehabilitation efforts seem to have a positive effect on the tendency to return to work. Physical therapy, vocational training, general education, and job placement efforts all seem to increase the tendency to go back to work.
Required request laws that mandate hospital personnel to request organ donations have not substantially increased the supply of organs for transplantation. Frustration caused by the continuing shortage of organs has led several experts to promote controversial options for expanding the pool of available organs, including the offer of financial incentives. Pilot programs to test the use of incentives are warranted, but such experiments must be approached cautiously, given the moral qualms they might raise and the availability of other options. One promising strategy is to install standardized hospital procedures to ensure that all potential donors are identified, that every family is approached about the possibility of donation, and that the request is properly structured. The second strategy is to refocus public education to encourage family discussion about organ donation so that the families of those individuals who are disposed to donate will be more likely to grant consent when asked.
The effects of incentive spirometry on pulmonary functions were studied in 46 normal adults of advanced age ('N' group) and 42 patients with chronic pulmonary emphysema ('E' group). Subjects of the both groups carried out deep breathing exercises by using incentive spirometry, 'Souffle', for five minutes, five times daily for four weeks. Pulmonary functions and arterial blood gases were measured at the start of exercise program, and at two and four weeks after the start. Both groups showed significant increases in VC, FEV1.0, peak expiratory flow, the flow at 75 percent VC (V75), maximal voluntary ventilation and PaO2, and a significant decrease in A-aDO2 at both two and four weeks after the start. In addition, V25 increased significantly in 'E' group. It is concluded that 'Souffle' is one of the useful preoperative respiratory managements for elderly patients and those with chronic pulmonary emphysema.
The dramatic rise in cesarean-section (C-section) rates, and their high costs and wide variation, has raised interest in understanding the factors affecting decisions to use this procedure. The economic incentives of physicians, hospitals, payers, and mothers are examined. In the economic framework, physicians must balance their short-term interests against their reputation, which is derived from efficiently providing what mothers want. Providers who encounter higher opportunity costs while attending to mothers in prolonged labor can reduce these costs by operating or by restructuring their practices. The mainly indirect evidence on financial incentives indicates that insured mothers have low marginal financial costs when they undergo C-section. Mothers with private, fee-for-service insurance have higher C-section rates than mothers who are covered by staff-model HMOs, who are uninsured, or who are publicly insured. In conclusion, research and payment reforms to reduce distortions to good practice are proposed.
Universities and dental schools are increasingly emphasizing the importance of transferring technology based upon faculty research into marketable products. One area of current interest to dentistry involves the utilization of recombinant DNA and protein purification technologies to produce therapeutics based upon the biologic activity of the proteins. This work builds upon the discovery and characterization of several families of protein capable of inducing potent biological responses both in vitro and in vivo. It is motivated by the need to provide patients with additional alternatives for the prevention, diagnosis, arrest or repair of a number of oral conditions or their sequela such as periodontitis, caries, and neoplasia. This article addresses some incentives and disincentives extant within academic institutions encountered during the development of a therapeutic agent for the regeneration of the periodontium. Incentives include professional rewards associated with the development of new therapeutics and disincentives include conflicts between traditional measures of academic achievement and the nature of the work associated with the development of such products. Some ideas for the resolution of disincentives are presented.