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At least 865 records · Page 48Linked to original sources
PubMed1995

Incentives and disincentives to participate in prophylactic HIV vaccine research.

An anonymous cross-sectional paper-and-pencil survey was used to assess incentives and disincentives to participate in a Phase I preventive human immunodeficiency virus (HIV) vaccine trial in a potential Thai target population. A total of 255 persons employed in health care service and research settings completed questionnaires after attending informational briefings regarding the proposed vaccine product and the planned trial procedures. Willingness to participate was related to self-perceived benefits from joining a preventive vaccine trial, as well as to concerns about product safety and social discrimination that might result from participation. The distinction between positive results of enzyme-linked immunosorbent assay from vaccine administration and positivity from HIV infection was unclear for many participants. Men were more willing to participate than women, and there was a trend toward greater willingness to participate in those who were less educated. Preparations for preventive vaccine trials may be more successful if they emphasize personal benefits of trial participation, clearly address safety issues, and consider ways to prevent social discrimination against participants.

AIDS Vaccines↗
PubMed1995

Programming for family care of elderly dependents: mandates, incentives, and service rationing.

In response to a demographic imperative, many countries have established policies to increase family involvement in the care of their dependent elderly relatives. Reflecting fiscal constraints and cultural norms, these policies are often designed to place the burden of care on family rather than government. This article offers a survey and critique of three approaches to increasing family care of elderly people: filial support legislation, incentives for family caregivers, and service rationing provisions. Drawing in part on the results of a survey with respondents from 33 countries, it concludes that policies that require or encourage relatives to provide care may have adverse consequences for elderly people and their families. Human services advocates should support policies and interventions that provide universal access to a continuum of care alternatives that facilitate rational health care decision making by families and that empower and sustain family members who choose to care for elderly relatives.

Aged↗
PubMed1994

Hospital cost incentives in a fragmented health care system.

During the mid-1980s, hospital prospective payment regulation was associated with major changes in medical practice, resulting in initially significant reductions in the rate of growth of inpatient costs. More recently, the rate of growth of hospital costs has returned to historic levels, yet most hospitals have been reluctant to intensify their economic monitoring of physicians. Using data from a large teaching hospital in the Midwest, this article presents a model of marginal profitability by payor and by relative physician costliness. The results illustrate the mixed incentives for hospitals to reduce costly medical practice variations.

Accounting↗
PubMed1993

Single-incentive selective associations produced solely as a function of compound-stimulus conditioning context.

Barpressing was maintained in a tone-plus-light (TL) condition in 2 groups of rats by shock-related contingencies and in 2 other groups by food-related contingencies. Responding ceased in TL absence (TL). Contingency arrangements made TL hedonically positive, relative to TL, for 1 shock group and for 1 food group and hedonically negative for 1 shock group and for 1 food group. In a stimulus-element test, the visual modality was dominant when TL was hedonically positive, whereas auditory control increased when TL was negative, irrespective of the reinforcers involved. Within-incentive contingency manipulations produced selective associations hitherto ascribed to stimulus-reinforcer interactions, suggesting that biological constraints on learning may operate at the level of conditioned psychological states.

Animals↗
PubMed1996

[Ambulatory surgery and incentives].

Day surgery is more cost-effective than in-patient surgical treatment and, for certain categories of patients is also a better quality form of care. It can often replace the traditional surgical treatment of patients, i.e. an operation with hospitalisation. For this reason, day surgery should become a more common form of treatment, also in Norway. This makes it necessary to create incentives that will encourage it. This cannot be done without first developing methods for collecting data on this activity.

Adult↗
PubMed1996

Allocation of emergency ward patients to medicine departments: increasing physicians' incentive to shorten length of stay.

BACKGROUND: Duration of hospital stay is one of the major determinants of hospital cost. In addition, high bed occupancy, especially in internal medicine departments, can delay the admission of patients from the emergency ward. OBJECTIVE: To shorten average hospital stay and hasten admission of patients from the emergency room to the medicine department. DESIGN: Patients from the emergency ward were assigned to internal medicine departments according to a quota system that insured that each department received a similar share of these admissions. Outcome measures for the year following this administrative change were compared to the two prior years in the same hospital and to a similar public hospital during the study period. SETTING: A major public hospital. MAIN OUTCOME MEASURES: Length of hospital stay (LOS), occupancy rate, number of admissions, number of readmissions, and mortality. RESULTS: The average length of stay in the internal medicine departments was shortened from 8 +/- 8 days in 1987 and 1988 to 6.3 +/- 6.8 days in 1989 (p = 0.0001). Occupancy rate was also reduced from 94% in 1987 and 1988 to 88% in 1989 (p = 0.002). The number of admissions increased by 19.2%, with a higher rate of readmissions within 30 days of discharge from the index hospitalization (12.5% and 13.4%, respectively in 1987 and 1988, versus 16.4% in 1989, p = 0.0001). In-hospital as well as 6-month mortality were unchanged. Case mix was similar during the study period to that in the previous two years. Length of stay, occupancy rate, and number of admissions were unchanged during the same period at a similar hospital without a corresponding patient allocation system. CONCLUSION: A relatively simple administrative intervention influenced physician incentive and significantly decreased hospital length of stay.

Emergency Service, Hospital↗
PubMedDate not supplied

Effective intervention to reduce occupational injuries in Alberta: a case study of financial incentives.

High injury rates in particular industries in Alberta, Canada were the impetus for government initiatives to control injury frequency and severity. Safety associations, a financial incentives program, research projects, and safety demonstrations substantially decreased injury rates within 5 years. Since then, companies manage their own performance, but undergo periodic audits.

Accidents, Occupational↗
PubMed2004

Will changes in primary care improve health outcomes? Modelling the impact of financial incentives introduced to improve quality of care in the UK.

OBJECTIVES: To estimate the total health gain from improving the quality of care among patients with cardiovascular disease in line with the quality indicator targets in the new contract for general practitioners (GPs) in the UK. DESIGN: Statistical modelling, applying population impact measures to estimate cardiovascular health gains from achieving treatment targets in the GP contract, taking into account current levels of treatment and control. MAIN OUTCOME MEASURES: Number of events prevented in the population over 5 years applied to a national general practice population of 10,000. RESULTS: The greatest health gain in those aged 45-84 years would come from reaching cholesterol reduction targets. This could prevent 15 events in people with coronary heart disease, seven events in those with a history of stroke, and seven events in those with diabetes. Achieving blood pressure control targets in hypertensive patients without the above conditions could prevent 15 cardiovascular events, with further benefits from reducing blood pressure in patients with high blood pressure and coronary heart disease, stroke, or diabetes. Achieving other targets would have smaller impacts because high levels of care are already being achieved or because of the low prevalence of conditions or associated event risk. CONCLUSION: It is possible to quantify the health gain to a practice population of achieving quality targets such as those set in the new GP contract. The amount of health gain is sensitive to current quality of care, prevalence of conditions, and risk factors, and to the size of change anticipated. Nevertheless, it appears that significant health gains could result from achieving the proposed quality targets.

Aged↗
PubMed2006

Developing and testing an instrument for identifying performance incentives in the Greek health care sector.

BACKGROUND: In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity. METHODS: A methodological exploratory design was employed in three phases: a) content development and assessment, which resulted in a 28-item instrument, b) pilot testing (N = 74) and c) field testing (N = 353). Internal consistency reliability was tested via Cronbach's alpha coefficient and factor analysis was used to identify the underlying constructs. Tests of scaling assumptions, according to the Multitrait-Multimethod Matrix, were used to confirm the hypothesized component structure. RESULTS: Four components, referring to intrinsic individual needs and external job-related aspects, were revealed and explain 59.61% of the variability. They were subsequently labeled: job attributes, remuneration, co-workers and achievement. Nine items not meeting item-scale criteria were removed, resulting in a 19-item instrument. Scale reliability ranged from 0.782 to 0.901 and internal item consistency and discriminant validity criteria were satisfied. CONCLUSION: Overall, the instrument appears to be a promising tool for hospital administrations in their attempt to identify job-related factors, which motivate their employees. The psychometric properties were good and warrant administration to a larger sample of employees in the Greek healthcare system.

Adult↗
PubMed1990

Economic incentives for ethical and courteous behavior in medicine. A proposal.

Several current and proposed structural features of medical reimbursement are intended to alter the behavior of health care providers. I propose adding a structure to make physician behavior more ethical. The structure's design would be complex, but its core would be reminiscent of how a patron tips waiters. My proposal would apply the truism that society's reward systems should foster rather than undermine social goals. This idea draws on features of medicine's social background and on a theory of behavior. It challenges the taboo against the physician's financial interests being clearly present in the doctor-patient relationship and it challenges the overly pure characterization of medical ethical dilemmas that currently dominates. Detailed sketches of necessary mechanisms, such as anonymous forms for patients to complete, are offered, and connections to the insights of George Bernard Shaw are made.

Ethics, Medical↗