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PubMed1996

[Cardiovascular effects of active coping behavior in mental and social stress situations during various incentive conditions].

The main purpose of this study was to examine the cardiovascular effects of active coping behavior during mental and social challenge. Furthermore, the additional effects of monetary incentives were explored. A total of 80 normotensive male students of the ages 19 to 30 years served as subjects. Statistical analyses revealed strong task-specific effects on systolic (SBP) and diastolic blood pressure (DBP) as well as heart rate (HR). Compared to Mental Arithmetic and Preparing a Discussion Task, social challenges during Discussion lead to exaggerated increases in SBP (37.6 mmHg) and HR (26.1 bpm) coupled with intermediate elevations in DBP (18.0 mmHg). Monetary incentives were associated with enhanced HR reactivity. The intra-task correlation pattern showed a remarkable across-task stability of correlations between SBP and HR reactivity scores, with an apparent lack of significant correlations between SBP and DBP reactivity scores. Results of inter-task correlations supported the hypothesis of specific cardiovascular response patterns that might be indicative of different aspects of active coping with mental and social stress.

Adaptation, Psychological↗
PubMed1997

Family physician perception of economic incentives for the provision of office procedures.

BACKGROUND AND OBJECTIVES: The influence of capitation versus fee-for-service reimbursement for services provided by primary care physicians is an important topic as capitation becomes increasingly prevalent. This study ascertained whether family physicians perceive an economic incentive to perform flexible sigmoidoscopy, colposcopy, and vasectomy under capitated versus fee-for-service payment structures. METHODS: In May 1995, questionnaires were mailed to 592 randomly selected physician "diplomates" of the American Board of Family Practice in California, Florida, Texas, Virginia, and Minnesota. Nonrespondents received an additional mailing in July 1995. RESULTS: The return rate was 62%. Of 336 responses: 1) 177 (52%) provide flexible sigmoidoscopy; 68 (20%) think capitation and 173 (51%) think fee for service provide sufficient reimbursement to make this procedure profitable. 2) 69 (20%) provide colposcopy; 50 (16%) think capitation and 99 (30%) think fee for service provide sufficient reimbursement to make this procedure profitable. 3) 91 (27%) provide flexible sigmoidoscopy; 36 (11%) think capitation and 84 (25%) think fee for service provide sufficient reimbursement to make this procedure profitable. CONCLUSIONS: A significant number of family physicians provide these three procedures in their offices. Most physicians view fee-for-service payment as providing an economic incentive to provide these procedures. Capitation was less frequently perceived as providing sufficient reimbursement to make the provision of these procedures profitable.

Capitation Fee↗
PubMed1998

A clinical trial of a financial incentive to go to the tuberculosis clinic for isoniazid after release from jail.

SETTING: Screening for active tuberculosis (TB) and providing isoniazid (INH) preventive therapy in jails are important control measures. In San Francisco, however, historical data showed that 62% of inmates were released before completing preventive therapy, and of those only 3% attended the TB Clinic for follow-up. OBJECTIVE AND DESIGN: A randomized clinical trial to compare a $5 cash incentive plus standardized TB education with standardized TB education alone in encouraging released inmates to make a first visit to the clinic. RESULTS: Of 79 persons enrolled in the trial, 77.2% were released before INH completion. Rates of first visit were not significantly different for those receiving +5 plus standardized education (25.8%) versus standardized education alone (23.3%), but were higher than rates seen in historical data for inmates not receiving standardized education. Age was an important predictor of completion of a first visit (odds ratio 1.09, 95% confidence interval 1.02-1.16, P = 0.017). Other variables predicting adherence included intent to adhere, more previous time in jail, stable housing, and being partnered versus alone, although these were not statistically significant. CONCLUSION: Standardized education may be important in improving follow-up after release. Further work on the role of a financial incentive in this population is needed.

Adult↗
PubMed1993

General practitioners and the new contract: promoting better health through financial incentives.

In this paper the changes in payment of general practitioners in the UK, introduced in the 1990 contract, are described in detail. The effects of the changes on the structure of general practitioners' incomes is discussed. More emphasis on capitation payments may increase preventive activity in general practice, but, depending on the level at which the capitation fee is set, could lead to shifting of patients to other sectors in the health care economy. Target payments appear to have been successful in increasing the numbers of smears taken. It is clear that doctors respond to financial incentives, but what is not clear is whether their responses will always be in the way intended or lead to more efficient practice.

Capitation Fee↗
PubMed2001

Workforce productivity and incentive structures in the UK National Health Service.

The UK National Health Service (NHS) is a labour-intensive service, yet the productivity of one of the largest labour forces in the world has been relatively ignored over the last 50 years. The data available to measure productivity over time are limited and focus on inputs and activity, not outcome. However, what data there are indicate that, despite major increases in NHS funding and staffing, changes in technology and continuous reorganisation of structures, productivity tends to show little or no change over successive decades. The challenges to policy-makers are how to improve the measurement of productivity and how to alter the behaviour of hospital clinicians and general practitioners by reform of incentive structures in the UK NHS.

Efficiency, Organizational↗
PubMed1997

Going global puts everyone on same incentive page.

Payment schemes vary widely among hospitals and physicians, and one of the key goals of a PHO is to make payments equitable. One method of doing this is bundling services under a global pricing structure, which helps align incentives for both sets of providers. The result often is greater medical and financial efficiencies.

Cost Control↗
PubMed2002

Rewarding for quality: new incentives emerge to improve healthcare and promote best practices.

When the Institute of Medicine's Committee on Quality of Health Care in America released its second report, Crossing the Quality Chasm, last year, criticism was leveled at the "toxic reimbursement system" that failed to reward efforts to achieve quality care. However, times are changing, and this issue of The Quality Letter looks at new ways incentive programs are being implemented and fine-tuned at the hospital, health plan, and medical practice level to promote the delivery of quality healthcare.

Benchmarking↗
PubMed1995

Improving physicians' preventive health care behavior through peer review and financial incentives.

We assessed improvement of preventive health care behaviors by physicians in an independent practice association-health maintenance organization. A before-after, 3-year study of a defined cohort measured changes through chart audit, accompanied by peer review, feedback, and financial incentives. Outcome measures consisted of rates of mump-measles-rubella (MMR) immunization, screening for cholesterol levels, and charting adequacy. Offices meeting MMR vaccination standards over 3 years increased from 78% to 96% (P < .05); those meeting standards for screening for cholesterol levels, from 92% to 95%. The average scores for charting adequacy rose from 87% to 92% (P < .05). The percentage of practices not in compliance with a standard of 90% decreased as follows: for MMR vaccination, from 57% to 12%; for screening for cholesterol levels, from 21% to 11%; and for charting adequacy, from 53% to 29% (P < .05).

Cholesterol↗
PubMedDate not supplied

Financial incentives and productive efficiency in Finnish health centres.

This paper examines the productive efficiency of Finnish health centres by applying data envelopment analysis (DEA) and econometric methods. The Tobit model was used in an attempt to find out how various economic, structural and demographic factors affect efficiency. The dependent variable of the model, the coefficient of inefficiency, was obtained by deducting the DEA efficiency score from one. According to the results, a high percentage of funding coming from central government matching grants and high taxable income per inhabitant are significant predictors of inefficiency. The results suggest that more generous resources tend to increase inefficiency since they may lessen incentives for tight cost and performance control. A high share of doctors and a low share of administrative, maintenance and support personnel promote efficiency. A low population share of the elderly and a long distance to the nearest hospital are positively associated with inefficiency.

Community Health Centers↗
PubMedDate not supplied

An incentive approach to physician implementation of medical practice guidelines.

We propose a probabilistically based incentive payment system for guideline implementation that provides rewards for physicians who follow practice guidelines and additional remuneration for physician leaders who engage in information sharing. All payments are based on observed outcomes of patient treatment. A fixed base payment forms the core of the system with probabilistic offsets calculated from the chance that a 'good' outcome occurs without optimal treatment or information. The system pays different physician types for different task sets.

Cost Control↗
PubMed2006

Revisiting physicians' financial incentives in Quebec: a panel system approach.

Do Primary Care Physicians (PCPs) react strategically to financial incentives and if so how? To address this question, we follow a quasi-natural experiment in Quebec, using a panel system technique. In so doing, we both correct for underestimation biases in earlier time series findings and generate new results on the issue of complementarity/substitution between consultations with varying levels of technicality. Under both techniques, we show that PCPs are sensitive to the enforcement and subsequent temporary removals of expenditure caps and more generally, to changes in consultations' relative prices over time. These results support the existence of a discretionary power over the choice of consultation, PCPs increasing strategically the number of the more technical (and therefore more lucrative) consultations when pressed to defend their income. This finding for primary care parallels the now well-established DRG creep in hospitals. The panel system approach offers a better account of the complexity surrounding PCPs' decision-making process. In particular, it successfully addresses issues of physician heterogeneity, jointness between consultations and temporal breaks and generates robust estimates of PCPs volume and quality reactions to regulatory changes.

Budgets↗
PubMedDate not supplied

The uptake of childhood immunization and financial incentives to general practitioners.

Among the target-linked services introduced by the 1990 general practitioners' contract, childhood immunization in Scotland is the best suited for GPs to achieve the high target, given a centralized call and recall system and public confidence in the service. Yet over 25% of the practices in the area of the Greater Glasgow Health Board did not qualify for the high target payments in the last quarter of the 1991/92 financial year. Examining indicators of the socioeconomic characteristics of the patient population, practice profiles and the effect of financial incentives, we discuss the reasons for cross-practice variation in the uptake of this service and estimate the probability of practices which missed the high target achieving it in the future.

Appointments and Schedules↗
PubMed2004

Should physicians' dual practice be limited? An incentive approach.

We develop a principal-agent model to analyze how the behavior of a physician in the public sector is affected by his activities in the private sector. We show that the physician will have incentives to over-provide medical services when he uses his public activity as a way of increasing his prestige as a private doctor. The health authority only benefits from the physician's dual practice when it is interested in ensuring a very accurate treatment for the patient. Our analysis provides a theoretical framework in which some actual policies implemented to regulate physicians' dual practice can be addressed. In particular, we focus on the possibility that the health authority offers exclusive contracts to physicians and on the implications of limiting physicians' private earnings.

Contracts↗
PubMedDate not supplied

The impact of financial constraints and incentives on professional autonomy.

General practice has been the subject of extensive reforms over the 1990s in Australia as elsewhere. Reforms have attempted to improve quality and contain the overall cost of health care, and have often been seen as reducing the autonomy of medical professionals. This paper examines the impact of financial constraints and incentives introduced during the 1990s on Australian GPs' perceptions of autonomy. An existing seven component definition of autonomy and six themes that emerged from reviewing publications were used to construct focus group questions. A total of 25 GPs participated in four focus groups. Those who participated believe that their financial autonomy has been diminished by policy changes and consumer expectations. They also perceive that their ability to control clinical decisions, which they regard as the most important aspect of professional autonomy, has been reduced along with financial autonomy. Organized medicine in Australia sees financial accountability and clinical decision making as polar opposites, and has continued to argue that fee-for-service payment is the only appropriate method of remuneration, despite increasing evidence that this does not guarantee clinical autonomy. Major changes to the financing of general practice in Australia are required to address the concerns of GPs, governments and patients.

Attitude of Health Personnel↗
PubMed1990

Employee and organizational factors associated with participation in an incentive-based worksite smoking cessation program.

This study investigated employee and worksite characteristics prospectively predictive of participation among 474 smokers in nine different worksites taking part in a year-long incentive-based smoking cessation program. Several different ways of defining participation (e.g., joining versus level of attendance, first 6 months versus entire program) were studied. A consistent pattern of results was observed across two of the participation indices, joining the program and participating in one or more monthly follow-up meetings. Both worksite (number of employees, previous health promotion history, degree of support from management) and employee (gender, motivation, previous quit attempts) variables were predictive of participation. Logistic regression analyses revealed that each set of variables, worksite and employee characteristics, was significantly related to participation after controlling for the effects of the other set. We were less able to predict level of attendance among participants who joined the program. Implications of these findings for future studies of participation in health promotion programs are discussed.

Employee Incentive Plans↗
PubMed1987

Utilizing a microcomputer-based physician incentive compensation program to increase inpatient hospital utilization and improve cost management.

This paper will address the complex issues of effective cost management and declining inpatient volume. Utilizing a microcomputer-based physician incentive compensation program, it will show how a hospital developed a plan to increase inpatient hospital utilization and improve cost management. It will discuss the Internal Revenue, HCFA, and legal implications of the plan.

Chicago↗
PubMed1993

Doctors and resource management: incentives and goodwill.

The increasing pressure on resources available for health care in many countries has led to a re-examination of the way in which resources are allocated and committed. One important and innovative option is for managers and doctors to collaborate formally in decision-making. This paper draws on experience of this approach in the UK National Health Service, in the Resource Management Initiative and suggests that its success or failure depends on the nature and strength of the incentives to the two sides to collaborate.

Decision Making, Organizational↗