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PubMed2003

Practice and incentive motivation in recognition of inverted faces.

In each of three experiments, participants received successive daily practice sessions on the task of recognizing inverted faces. In all practice sessions, an initial study series of 25 inverted faces was followed immediately by a test series of 17 pairs of inverted faces. Each test pair comprised a face from the study series and a new face. Completely new sets of faces were used in each session. Recognition of inverted faces did not improve across sessions in Exp. 1 but did improve in Exps. 2 and 3. Unlike Exp. 1, Exps. 2 and 3 employed an explicit incentive for improved performance. These results show that sufficiently motivated participants can become quite proficient at recognizing inverted faces. Implications of the results for the role of expertise at recognition in producing the inversion effect are discussed.

Adult↗

PubMed2005

Goal orientation, goal difficulty, and incentive values of academic goals.

We examined relationships among goal attributes (difficulty and affective value) and goal types (mastery, performance, intrinsic, and extrinsic). Goal attributes of positive affect value and relative salience of positive value were higher for intrinsic goals, mastery goals, and more difficult goals, qualified by an interaction between difficulty and type of goal. Intrinsic goals were more affectively positive than extrinsic goals and mastery goals were more positive than performance goals, but these differences vanished if goals were also perceived as difficult. Results were consistent with goal-orientation theories and suggest the usefulness of integrating incentive-attribute concepts with goal-orientation theories.

Achievement↗

PubMed2006

Sex differences in correlations between personal incentives and self-motivation, and occurrence of perceived positive changes in feeling states after exercise.

Personal incentives for exercising of weight management and appearance improvement were significantly correlated with percentage of positive exercise-induced feeling changes in women (n=23) and men (n=20) initiating 12-wk. exercise programs. No significant differences were found by sex. Self-motivation was also significantly related to occurrence of positive feeling changes for men.

Adult↗

PubMedDate not supplied

Incentives and barriers to physical activity for working women.

A questionnaire was completed by 393 working women to examine incentives and barriers to physical activity based on the stages of change from the transtheoretical model. Using Chi Square tests, differences were found across the five stages suggesting that work site programs be designed and tailored for women at different stages of readiness.

Adult↗

PubMedDate not supplied

Implementing a year-long, worksite-based incentive program for smoking cessation.

BACKGROUND: There have been few reports of the process of implementing ongoing worksite health promotion programs. This article describes the implementation of a year-long smoking cessation program in nine worksites employing a total of approximately 700 smokers. METHODS: Issues discussed include: forming a partnership with organizations, design of the multicomponent incentive intervention, program promotion, maintaining participation, and the need to modify program components over time. RESULTS: The program produced high participation rates (29% of smokers joined the program) and moderate cessation rates among participants (during the last half of the program, monthly cessation rates averaged 20%). There was marked variability across worksites on both participation and cessation, and qualitative features of organizations associated with outcome are discussed. DISCUSSION: The importance of working with employee steering committees to tailor health promotion programs to fit the organization is discussed. The article concludes with recommendations for implementation of similar programs.

Follow-Up Studies↗

PubMed1992

Are financial incentives for wellness fair?

Employers have shown considerable enthusiasm for programs that use financial incentives to stimulate health-related changes in employee behavior and lifestyle. This article raises fairness issues in relation to these programs.

Cost-Benefit Analysis↗

PubMed1993

Network unites payers, physicians, hospitals. System participants work together to improve access to care and to design cost-saving incentives.

Through Sacred Heart Health System (SHHS), Eugene, OR, physicians, payers, and hospitals are designing a network that will integrate care and improve access by reducing healthcare costs. Together, system members design cost-saving incentives and the products the system offers the community. They promote managed care as the most efficient means to coordinate care and reduce costs. All participants share in the risks of a capitated payment system. Since the system pulled together the payers, physician groups, and hospitals, many of these entities' management functions were consolidated at the system level to avoid duplication and reduce administrative costs. Bringing in physicians was the most difficult yet important aspect of forming a successful network. Working with two physician groups in the community, the system's sponsor-the Sisters of St. Joseph of Peace, Health and Hospital Services-developed the Physician Practice Board. The board, representing 300 physicians, meets weekly and makes recommendations on issues that affect physicians. SHHS also added innovative new functions such as an integrated medical cost management and continuous quality improvement program. Another key to success is a clinically oriented information system, which will allow the system to track patients once they leave the hospital. It also will provide a better understanding of what things have an impact on outcomes and will reduce paperwork. A portion of the system's revenue is designated for initiatives to improve access. And the system recently appointed a tack force on access to explore what they can do in cooperation with others in the community.

Capitation Fee↗

PubMed1988

Product line management: financial incentives mean healthier patients.

For the past few years, The Washington Hospital Center has had a prepaid obstetric clinic program for uninsured patients. Although the program was satisfactory, some deficiencies had developed. For example, research had shown a high correlation between a mother's lack of prenatal care and high healthcare expenditures. By implementing a new program that included financial incentives for various prenatal care programs, the hospital was able to financially break even with the old program, have a more predictable financial performance evaluation, and have healthier mothers and babies.

District of Columbia↗

PubMed1984

Incentives in case-mix measures for long-term care.

Several States now use patient-based payments for skilled nursing facilities and intermediate care facilities; others are in the process of developing case-mix systems. The Health Care Financing Administration is working under congressional mandate to develop a prospective case-mix system for Medicare payments to skilled nursing facilities. If new payment methods follow the existing pattern, they will be based not on the patient's clinical characteristics but rather on a mixture of clinical characteristics and services delivered. As a result, innate incentives are contained in data collection systems which are cost-increasing at best and dangerous at worst. A preferable approach would be to develop payment schemes based on the patient's degree of dependence.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1985

Health spending trends in the 1980's: adjusting to financial incentives.

Health expenditure growth is projected to moderate considerably during 1983-90, reaching $660 billion in 1990 and consuming over 11 percent of the gross national product. During 1973-83, spending for health care more than tripled, increasing from $103 billion to $355 billion and moving from 7.8 percent to 10.8 percent of the gross national product. Government spending for health care is projected to reach $284 billion by 1990, with the Federal Government paying 73 percent. The Medicare Prospective Payment System, private sector initiatives, and State and local government actions are providing incentives to substantially increase competition and cost effectiveness in health care provision.

Data Collection↗

PubMed1989

Can payment incentives improve quality and efficiency of care?

Faced with increasing health care costs, America's major corporations are beginning to explore a variety of mechanisms to assure that health care providers are delivering high quality care. The General Motors Corporation (GM), with approximately two million employees, retirees and family members, and annual health care expenditures of approximately $3 billion, has developed a quality review system and a hospital payment mechanism that includes incentives to enhance the quality of care provided to GM beneficiaries. The following article describes this project.

Cost Control↗

PubMed2000

Lessons from the London Initiative Zone Educational Incentives funding: associations between practice characteristics, funding, and courses undertaken.

BACKGROUND: Following the Tomlinson report of 1992, London Initiative Zone Educational Incentives (LIZEI) funding was introduced for a three-year period to improve recruitment, retention, and educational opportunities for general practitioners working within inner London. AIM: To test the hypothesis that general practices that show evidence of good organisation achieved better access to LIZEI funding than less organised practices. METHOD: Observational practice-based study involving all 164 general practices in EAst London and the City Health Authority during the first two years of the scheme, April 1995 to March 1997. RESULTS: Univariate analysis showed that higher levels of LIZEI funding were associated with practices where there was evidence of good organisation, including higher targets for cervical cytology screening and immunisation rates for under two-year-olds, better asthma prescribing, and training status. Using ten practice and population explanatory variables, multiple regression models were developed for fundholding and non-fundholding practices. Among non-fundholding practices, the asthma prescribing ratio was the variable with the greatest predictive value, explaining 14.7% of the variation in LIZEI funding between practices. Strong positive associations existed between taking further degrees and diplomas, practice size, training, and non-fundholding status. CONCLUSION: Larger practices, training practices, and those that demonstrated aspects of good practice organisation gained more LIZEI funding: an example of the 'inverse funding law'. Practices within a multifund, based in the Newham locality, gained LIZEI funding regardless of practice organisation. Networks of practices, and, potentially, primary care groups, have a role in equalising the opportunities for education and development between practices in east London.

Analysis of Variance↗

PubMed2000

Predictors of smoking cessation in an incentive-based community intervention.

The Quit and Win Challenge, an incentive-based intervention, was implemented in two counties in Eastern Ontario to encourage adult smokers to quit smoking. Participants (n = 231) were compared with adult smokers selected at random (n = 385) from a larger, four-county area. Baseline characteristics were assessed by telephone interview, including socio-demographic and smoking-related factors. Follow-up interviews were also conducted by telephone. Initial and follow-up response rates were high (over 84%) in both groups. Compared with the random survey group, Quit and Win participants tended to be younger, more educated, employed and heavier smokers, with fewer friends or co-workers who smoked. After one year, 19.5% of them reported that they were smoke-free, whereas less than 1% of the random group had achieved cessation. This translates into an impact rate of 0.17%, affecting 1 in 588 adult smokers. With the exception of the smokers' baseline "stage of change," none of the socio-demographic or smoking factors was predictive of cessation. We conclude that this intervention achieved only limited success and attracted certain sectors of the community disproportionately, i.e. smokers who were highly motivated to quit. We argue that increased access to proven cessation therapies would improve the impact of such interventions.

Adult↗

PubMed1999

Using contact capitation to align payment incentives among specialists.

Contact capitation is a means of paying specialists based on the number of patients managed rather than on the number of services provided or procedures performed. Payments to physicians are disbursed from budgets, or risk pools, which are established by specialty and product line (e.g., commercial coverage, Medicare). Each specialist is credited with managing a patient for a specified time period (usually 12 months) following the patient's initial visit. To ensure payments are equitable to all physicians, regardless of specialty or subspecialty, the system may be adjusted by using different contact weights for certain diagnoses or procedures, creating subpools for selected subspecialties and/or procedures, establishing separate capitation rates for different age segments, and setting aside certain specialties as fee-for-service carve-outs. Contact capitation has advantages over traditional specialist capitation of removing physicians' financial incentives to overutilize and allowing for a broad physician specialty panel. Challenges to implementing contact capitation include getting physicians to alter habitual practice patterns and managing the system's administrative complexity.

Capitation Fee↗

PubMed2001

To solve a deadly shortage: economic incentives for human organ donation.

In this article Dr. Harris and attorney Alcorn propose the establishment of a governmentally regulated, posthumous organ market, with economic incentives for the donors, in order to increase the supply of transplantable organs. The authors review transplant technology, provide a short history of donation and sale of organs, tissues, and cells, discuss the various legislative approaches that have been made to increase the supply of organs, and analyze the problems with the open market approach. They conclude with a proposal for a regulated posthumous organ market.

Altruism↗

PubMed2003

Striatal cell type-specific overexpression of DeltaFosB enhances incentive for cocaine.

The transcription factor DeltaFosB accumulates in substance P-dynorphin-containing striatal neurons with repeated cocaine use. Here, we show that inducible transgenic DeltaFosB overexpression in this same striatal cell type facilitates acquisition of cocaine self-administration at low-threshold doses, consistent with increased sensitivity to the pharmacological effects of the drug. Importantly, DeltaFosB also enhances the degree of effort mice will exert to maintain self-administration of higher doses on a progressive ratio schedule of reinforcement, whereas levels of cocaine intake are not altered on less demanding fixed-ratio schedules. Acquisition and extinction of behavior reinforced by food pellets is not altered in DeltaFosB-overexpressing mice, indicating that DeltaFosB does not alter the capacity to learn an instrumental response or cause response perseveration in the absence of reinforcement. These data suggest that accumulation of DeltaFosB contributes to drug addiction by increasing the incentive properties of cocaine, an effect that could increase the risk for relapse long after cocaine use ceases.

Animals↗

PubMed2003

Leapfrog finalizing new incentive plans.

Incentives to be realigned for facilities meeting recommendations. Each practice brings different potential savings and costs, based on payer mix. Leapfrog will provide hospitals with a formula for calculating savings.

Cost Savings↗

PubMedDate not supplied

One state's response to the malpractice insurance crisis: North Carolina's Rural Obstetrical Care Incentive Program.

In the period 1985-89, there was a severe drop in obstetrical services in rural areas of North Carolina, partly because of rising malpractice insurance rates. The State government responded with the Rural Obstetrical Care Incentive (ROCI) Program that provides a malpractice insurance subsidy of up to $6,500 per participating physician per year. Enacted into law in 1988, the ROCI Program was expanded in 1991, making certified nurse midwives eligible to receive subsidies of up to $3,000 per year. To participate, practitioners must provide obstetrical care to all women, regardless of their ability to pay for services. Total funding for the program has increased from $240,000 to $840,000, in spite of extreme budgetary constraints faced by the State. The program and how its implementation has maintained or increased access to obstetrical care in participating counties are described on the basis of site visits to local health departments in participating counties and data from the North Carolina Division of Maternal and Child Health. The program is of significance to policy makers nationwide as both a response to rising malpractice insurance rates and reduced access to obstetrical care in rural areas, and as an innovative, nontraditional State program in which the locus of decision making is at the county level.

Female↗