DOE Office of Scientific and Technical Information (OSTI.GOV)

Milostan, Catharina; Levin, Todd; Muehleisen, Ralph T.

Many electric utilities operate energy efficiency incentive programs that encourage increased dissemination and use of energy-efficient (EE) products in their service territories. The programs can be segmented into three broad categories—downstream incentive programs target product end users, midstream programs target product distributors, and upstream programs target product manufacturers. Traditional downstream programs have had difficulty engaging Small Business/Small Portfolio (SBSP) audiences, and an opportunity exists to expand Commercial Midstream Incentive Programs (CMIPs) to reach this market segment instead.

Policy options for the split incentive: Increasing energy efficiency for low-income renters.

PubMed

Bird, Stephen; Hernández, Diana

2012-09-01

The split incentive problem concerns the lack of appropriate incentives to implement energy efficiency measures. In particular, low income tenants face a phenomenon of energy poverty in which they allocate significantly more of their household income to energy expenditures than other renters. This problem is substantial, affecting 1.89% of all United States' energy use. If effectively addressed, it would create a range of savings between 4 and 11 billion dollars per year for many of the nation's poorest residents. We argue that a carefully designed program of incentives for participants (including landlords) in conjunction with a unique type of utility-managed on-bill financing mechanism has significant potential to solve many of the complications. We focus on three kinds of split incentives, five concerns inherent to addressing split incentive problems (scale, endurance, incentives, savings, political disfavor), and provide a detailed policy proposal designed to surpass those problems, with a particular focus on low-income tenants in a U.S.

Policy options for the split incentive: Increasing energy efficiency for low-income renters

PubMed Central

Bird, Stephen; Hernández, Diana

2016-01-01

The split incentive problem concerns the lack of appropriate incentives to implement energy efficiency measures. In particular, low income tenants face a phenomenon of energy poverty in which they allocate significantly more of their household income to energy expenditures than other renters. This problem is substantial, affecting 1.89% of all United States' energy use. If effectively addressed, it would create a range of savings between 4 and 11 billion dollars per year for many of the nation's poorest residents. We argue that a carefully designed program of incentives for participants (including landlords) in conjunction with a unique type of utility-managed on-bill financing mechanism has significant potential to solve many of the complications. We focus on three kinds of split incentives, five concerns inherent to addressing split incentive problems (scale, endurance, incentives, savings, political disfavor), and provide a detailed policy proposal designed to surpass those problems, with a particular focus on low-income tenants in a U.S. context. PMID:27053828

Efficiency, ownership, and financing of hospitals: the case of Austria.

PubMed

Czypionka, Thomas; Kraus, Markus; Mayer, Susanne; Röhrling, Gerald

2014-12-01

While standard economic theory posits that privately owned hospitals are more efficient than their public counterparts, no clear conclusion can yet be drawn for Austria in this regard. As previous Austrian efficiency studies rely on data from the 1990s only and are based on small hospital samples, the generalizability of these results is questionable. To examine the impact of ownership type on efficiency, we apply a Data Envelopment Analysis which extends the existing literature in two respects: first, it evaluates the efficiency of the Austrian acute care sector, using data on 128 public and private non-profit hospitals from the year 2010; second, it additionally focusses on the inpatient sector alone, thus increasing the comparability between hospitals. Overall, the results show that in Austria, private non-profit hospitals outperform public hospitals in terms of technical efficiency. A multiple regression analysis confirms the significant association between efficiency and ownership type. This conclusive result contrasts some international evidence and can most likely be attributed to differences in financial incentives for public and private non-profit hospitals in Austria. Therefore, by drawing on the example of the Austrian acute care hospital sector and existing literature on the German acute care hospital sector, we also discuss the impact of hospital financing systems and their incentives on efficiency. This paper thus also aims at providing a proof of principle, pointing out the importance of the respective market conditions when internationally comparing hospital efficiency by ownership type.

United States petroleum pipelines: An empirical analysis of pipeline sizing

NASA Astrophysics Data System (ADS)

Coburn, L. L.

1980-12-01

The undersizing theory hypothesizes that integrated oil companies have a strong economic incentive to size the petroleum pipelines they own and ship over in a way that means that some of the demand must utilize higher cost alternatives. The DOJ theory posits that excess or monopoly profits are earned due to the natural monopoly characteristics of petroleum pipelines and the existence of market power in some pipelines at either the upstream or downstream market. The theory holds that independent petroleum pipelines owned by companies not otherwise affiliated with the petroleum industry (independent pipelines) do not have these incentives and all the efficiencies of pipeline transportation are passed to the ultimate consumer. Integrated oil companies on the other hand, keep these cost efficiencies for themselves in the form of excess profits.

A Truthful Incentive Mechanism for Online Recruitment in Mobile Crowd Sensing System

PubMed Central

Chen, Xiao; Liu, Min; Zhou, Yaqin; Li, Zhongcheng; Chen, Shuang; He, Xiangnan

2017-01-01

We investigate emerging mobile crowd sensing (MCS) systems, in which new cloud-based platforms sequentially allocate homogenous sensing jobs to dynamically-arriving users with uncertain service qualities. Given that human beings are selfish in nature, it is crucial yet challenging to design an efficient and truthful incentive mechanism to encourage users to participate. To address the challenge, we propose a novel truthful online auction mechanism that can efficiently learn to make irreversible online decisions on winner selections for new MCS systems without requiring previous knowledge of users. Moreover, we theoretically prove that our incentive possesses truthfulness, individual rationality and computational efficiency. Extensive simulation results under both real and synthetic traces demonstrate that our incentive mechanism can reduce the payment of the platform, increase the utility of the platform and social welfare. PMID:28045441

The Application of Incentives and the Defense Business Operations Fund

DTIC Science & Technology

1993-12-01

The Defense Business Operations Fund (DBOF) is an attempt to incorporate private sector business incentives into the public sector. Truly efficient...or resources are missing an organization will not become more cost effective and efficient. The private sector goal is profit maximization. This goal

Theory and Practice in the Design of Physician Payment Incentives

PubMed Central

Robinson, James C.

2001-01-01

Combining the economic literature on principal-agent relationships with examples of marketplace innovations allows analysis of the evolution of methods for paying physicians. Agency theory and the economic principles of performance-based compensation are applied in the context of imperfect information, risk aversion, multiple interrelated tasks, and team production efficiencies. Fee-for-service and capitation are flawed methods of motivating physicians to achieve specific goals. Payment innovations that blend elements of fee-for-service, capitation, and case rates can preserve the advantages and attenuate the disadvantages of each. These innovations include capitation with fee-for-service carve-outs, department budgets with individual fee-for-service or “contact” capitation, and case rates for defined episodes of illness. The context within which payment incentives are embedded, includes such nonprice mechanisms as screening and monitoring and such organizational relationships as employment and ownership. The analysis has implications for health services research and public policy with respect to physician payment incentives. PMID:11439463

A Proposed Research Program for Hospital-Medical Care

PubMed Central

Feldman, Paul

1967-01-01

This proposal for a federal government program of health services research, written in spring of 1966, played a key role in development of the National Center for Health Services Research and Development, announced by the President early this year. The paper points to the lack of economic incentives for development of cost-saving innovations for hospitals compared to incentives to develop innovations improving the quality of care. It indicates the analytic procedure which, if followed, would lead to an efficient program of research, and points out several aspects of the analysis that are critical requirements for its successful application. PMID:4964151

Incentive pricing and cost recovery at the basin scale.

PubMed

Ward, Frank A; Pulido-Velazquez, Manuel

2009-01-01

Incentive pricing programs have potential to promote economically efficient water use patterns and provide a revenue source to compensate for environmental damages. However, incentive pricing may impose disproportionate costs and aggravate poverty where high prices are levied for basic human needs. This paper presents an analysis of a two-tiered water pricing system that sets a low price for subsistence needs, while charging a price equal to marginal cost, including environmental cost, for discretionary uses. This pricing arrangement can promote efficient and sustainable water use patterns, goals set by the European Water Framework Directive, while meeting subsistence needs of poor households. Using data from the Rio Grande Basin of North America, a dynamic nonlinear program, maximizes the basin's total net economic and environmental benefits subject to several hydrological and institutional constraints. Supply costs, environmental costs, and resource costs are integrated in a model of a river basin's hydrology, economics, and institutions. Three programs are compared: (1) Law of the River, in which water allocations and prices are determined by rules governing water transfers; (2) marginal cost pricing, in which households pay the full marginal cost of supplying treated water; (3) two-tiered pricing, in which households' subsistence water needs are priced cheaply, while discretionary uses are priced at efficient levels. Compared to the Law of the River and marginal cost pricing, two-tiered pricing performs well for efficiency and adequately for sustainability and equity. Findings provide a general framework for formulating water pricing programs that promote economically and environmentally efficient water use programs while also addressing other policy goals.

Tenure and Asymmetric Information: An Analysis of an Incentive Institution for Faculty Development in Research Universities

ERIC Educational Resources Information Center

Song, Jing

2008-01-01

From the perspective of asymmetric information, a principal-agent model is used to put forward a new theoretical explanation for the validity and effectiveness of tenure. Furthermore, through an analysis of the conditions of implementing an effective tenure system, it is argued that such a system is more efficient in research universities. Based…

A data envelopment analysis approach to compare the environmental efficiency of energy technologies and countries

USDA-ARS?s Scientific Manuscript database

Due to increasing financial and environmental concerns, governmental rules, regulations and incentives alternative energy sources are soon expected to grow at a much faster pace than conventional sources of energy. However, the current body of research providing comparative decision making models fo...

Energy Efficiency Under Alternative Carbon Policies. Incentives, Measurement, and Interregional Effects

DOE Office of Scientific and Technical Information (OSTI.GOV)

Steinberg, Daniel C.; Boyd, Erin

2015-08-28

In this report, we examine and compare how tradable mass-based polices and tradable rate-based policies create different incentives for energy efficiency investments. Through a generalized demonstration and set of examples, we show that as a result of the output subsidy they create, traditional rate-based policies, those that do not credit energy savings from efficiency measures, reduce the incentive for investment in energy efficiency measures relative to an optimally designed mass-based policy or equivalent carbon tax. We then show that this reduced incentive can be partially addressed by modifying the rate-based policy such that electricity savings from energy efficiency measures aremore » treated as a source of zero-carbon generation within the framework of the standard, or equivalently, by assigning avoided emissions credit to the electricity savings at the rate of the intensity target. These approaches result in an extension of the output subsidy to efficiency measures and eliminate the distortion between supply-side and demand-side options for GHG emissions reduction. However, these approaches do not address electricity price distortions resulting from the output subsidy that also impact the value of efficiency measures. Next, we assess alternative approaches for crediting energy efficiency savings within the framework of a rate-based policy. Finally, we identify a number of challenges that arise in implementing a rate-based policy with efficiency crediting, including the requirement to develop robust estimates of electricity savings in order to assess compliance, and the requirement to track the regionality of the generation impacts of efficiency measures to account for their interstate effects.« less

Pay as You Speed, ISA with incentive for not speeding: results and interpretation of speed data.

PubMed

Lahrmann, Harry; Agerholm, Niels; Tradisauskas, Nerius; Berthelsen, Kasper K; Harms, Lisbeth

2012-09-01

To simulate a market introduction of Intelligent Speed Adaptation (ISA) and to study the effect of a Pay as You Speed (PAYS) concept, a field trial with 153 drivers was conducted during 2007-2009. The participants drove under PAYS conditions for a shorter or a longer period. The PAYS concept consisted of informative ISA linked with economic incentive for not speeding, measured through automatic count of penalty points whenever the speed limit was exceeded. The full incentive was set to 30% of a participant's insurance premium. The participants were exposed to different treatments, with and without incentive crossed with informative ISA present or absent. The results showed that ISA is an efficient tool for reducing speeding particularly on rural roads. The analysis of speed data demonstrated that the proportion of distance driven above the speed where the ISA equipment responded (PDA) was a sensitive measure for reflecting the effect of ISA, whereas mean free flow speed and the 85th percentile speed, were less sensitive to ISA effects. The PDA increased a little over time but still remained at a low level; however, when ISA was turned off, the participants' speeding relapsed to the baseline level. Both informative ISA and incentive ISA reduced the PDA, but there was no statistically significant interaction. Informative reduced it more than the incentive. Copyright © 2011 Elsevier Ltd. All rights reserved.

OpenStudio: A Platform for Ex Ante Incentive Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roth, Amir; Brackney, Larry; Parker, Andrew

Many utilities operate programs that provide ex ante (up front) incentives for building energy conservation measures (ECMs). A typical incentive program covers two kinds of ECMs. ECMs that deliver similar savings in different contexts are associated with pre-calculated 'deemed' savings values. ECMs that deliver different savings in different contexts are evaluated on a 'custom' per-project basis. Incentive programs often operate at less than peak efficiency because both deemed ECMs and custom projects have lengthy and effort-intensive review processes--deemed ECMs to gain confidence that they are sufficiently context insensitive, custom projects to ensure that savings are claimed appropriately. DOE's OpenStudio platformmore » can be used to automate ex ante processes and help utilities operate programs more efficiently, consistently, and transparently, resulting in greater project throughput and energy savings. A key concept of the platform is the OpenStudio Measure, a script that queries and transforms building energy models. Measures can be simple or surgical, e.g., applying different transformations based on space-type, orientation, etc. Measures represent ECMs explicitly and are easier to review than ECMs that are represented implicitly as the difference between a with-ECM and without-ECM models. Measures can be automatically applied to large numbers of prototype models--and instantiated from uncertainty distributions--facilitating the large scale analysis required to develop deemed savings values. For custom projects, Measures can also be used to calibrate existing building models, to automatically create code baseline models, and to perform quality assurance screening.« less

City of San Antonio, Texas Better Buildings Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meyer, Liza C.; Hammer, Mary C.

2014-06-30

The San Antonio Better Buildings Program is a unified single-point-of-service energy efficiency delivery mechanism targeting residential, commercial, institutional, industrial and public buildings. This comprehensive and replicable energy efficiency program is designed to be an effective demand side management initiative to provide a seamless process for program participants to have turn-key access to expert analysis, support and incentives to improve the performance of their in-place energy using systems, while reducing electrical energy use and demand.

Efficient and Competitive Rationing

DTIC Science & Technology

1988-05-01

that state S enterprises can organize markets that implement priority service efficiently. In Section 5 we study the operation of competitive markets ...exposition.) 5. COMPETITIVE RATIONING We examine next the incentives for profit-maximizing firms in competitive markets to offer priority service. Our...importantly, those equilibria that do exist show that firms have an incentive not to differentiate. It seems clear, 59 therefore, that in competitive markets

Comparing the cost-effectiveness of water conservation policies in a depleting aquifer:A dynamic analysis of the Kansas High Plains

USDA-ARS?s Scientific Manuscript database

This research analyzes two groundwater conservation policies in the Kansas High Plains located within the Ogallala aquifer: 1) cost-share assistance to increase irrigation efficiency; and 2) incentive payments to convert irrigated crop production to dryland crop production. To compare the cost-effec...

Energy Market and Economic Impacts of S.2191, the Lieberman-Warner Climate Security Act of 2007

EIA Publications

2008-01-01

This report responds to a request from Senators Lieberman and Warner for an analysis of S.2191, the Lieberman-Warner Climate Security Act of 2007. S.2191 is a complex bill regulating emissions of greenhouse gases through market- based mechanisms, energy efficiency programs, and economic incentives.

Energy Market and Economic Impacts of the American Power Act of 2010

EIA Publications

2010-01-01

This report responds to a request from Senators Kerry, Graham, and Lieberman for an analysis of the American Power Act of 2010 (APA). APA, as released by Senators Kerry and Lieberman on May 12, 2010, regulates emissions of greenhouse gases through market-based mechanisms, efficiency programs, and other economic incentives.

Effectiveness of incentives for agri-environment measure in Mediterranean degraded and eroded vineyards

NASA Astrophysics Data System (ADS)

Galati, Antonino; Gristina, Luciano; Crescimanno, Maria; Barone, Ettore; Novara, Agata

2015-04-01

The evaluation of the economic damage caused by soil erosion assumes great importance. It serves to increase awareness of the problem among farmers and policy makers. Moreover, it can promote the implementation of conservative measures at the field and basin level by spurring the development of more sustainable soil management practices. In the present study we have developed a new approach to evaluate the incentive for the adoption of Agri-Environment Measure (AEM) in Mediterranean degraded and eroded vineyards. In order to estimate this incentive, the replacement cost and the loss of income are calculated under two different soil management such as Conventional Tillage (CT) and Cover crop (AEM). Our findings show that the incentive could range between the loss of income due to AEM adoption and ecosystem service benefit (RCCT - RC AEM). In the case of study the incentive ranged between 315 € ha-1 (loss of income) and 1,087.86 € ha-1 (Ecosystem service benefit). Within this range, the incentive amount is determined according to efficiency criteria taking into account the morphological conditions of the territory in which operate the farms. Moreover, a conceptual model on the public spending efficiency has been developed to allocate the incentives where the economic return in term of ecosystem service is higher.

Efficiency in the United States electric industry: Transaction costs, deregulation, and governance structures

NASA Astrophysics Data System (ADS)

Peterson, Carl

Transaction costs economics (TCE) posits that firms have an incentive to bypass the market mechanisms in situations where the cost of using the market is prohibitive. Vertical integration, among other governance mechanisms, can be used to minimize the transactions costs associated with the market mechanism. The study analyses different governance mechanisms, which range from complete vertical integration to the use of market mechanisms, for firms in the US electric sector. This sector has undergone tremendous change in the past decade including the introduction of retail competition in some jurisdictions. As a result of the push toward deregulation of the industry, vertically integration, while still significant in the sector, has steadily been replaced by alternative governance structures. Using a sample of 136 investor-owned electric utilities that reported data the US Federal Energy Regulatory Commission between 1996 and 2002, this study estimates firm level efficiency using Data Envelopment Analysis (DEA) and relates these estimates to governance structure and public policies. The analysis finds that vertical integration is positively related to firm efficiency, although in a non-linear fashion suggesting that hybrid governance structures tend to be associated with lower efficiency scores. In addition, while some evidence is found for negative short-term effects on firm efficiency from the choice to deregulate, this result is sensitive to DEA model choice. Further, competition in retail markets is found to be positively related to firm level efficiency, but the retreat from deregulation, which occurred after 2000, is negatively associated with firm-level efficiency. These results are important in the ongoing academic and public policy debates concerning deregulation of the electric section and indicate that vertical economies remain in the industry, but that competition has provided incentives for improving firm level efficiency.

Financial Incentives and Physician Practice Participation in Medicare's Value-Based Reforms.

PubMed

Markovitz, Adam A; Ramsay, Patricia P; Shortell, Stephen M; Ryan, Andrew M

2017-07-26

To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013). We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures. We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey. There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p < .001) and a 0.8 percentage-point increase in the probability of participating in Meaningful Use (SE, 0.1, p < .001), controlling for practice characteristics. Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data (SE, 0.1, p < .001). Physicians organizations' prior experience and success with performance incentives were related to participation in Medicare ACO arrangements and participation in the meaningful use criteria but not to participation in Physician Compare. We conclude that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale. © Health Research and Educational Trust.

Economic Incentives in Content-Centric Networking: Implications for Protocol Design and Public Policy

ERIC Educational Resources Information Center

Agyapong, Parick Kwadwo

2013-01-01

Content-centric networking (CCN) has emerged as a dominant paradigm for future Internet architecture design due to its efficient support for content dissemination, which currently dominates Internet use. This dissertation shows how economic and social welfare analysis can be used to inform the design of a CCN architecture that provides network…

Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice.

PubMed

Eckermann, Simon; Coelli, Tim

2013-01-01

Evidence based medicine supports net benefit maximising therapies and strategies in processes of health technology assessment (HTA) for reimbursement and subsidy decisions internationally. However, translation of evidence based medicine to practice is impeded by efficiency measures such as cost per case-mix adjusted separation in hospitals, which ignore health effects of care. In this paper we identify a correspondence method that allows quality variables under control of providers to be incorporated in efficiency measures consistent with maximising net benefit. Including effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is shown to enable efficiency measures consistent with maximising net benefit under a one to one correspondence. The method combines advantages of radial properties with an appropriate objective of maximising net benefit to overcome problems of inappropriate objectives implicit with alternative methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying correspondence method are also shown to provide a robust framework for preventing cost-shifting and cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and risk adjustment where these conditions are not satisfied. Comparison on the cost-disutility plane has previously been shown to have distinct advantages in comparing multiple strategies in HTA, which this paper naturally extends to a robust method and framework for comparing efficiency of health care providers in practice. Consequently, the proposed approach provides a missing link between HTA and practice, to allow active incentives for evidence based net benefit maximisation in practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

Connected Traveler

DOE Office of Scientific and Technical Information (OSTI.GOV)

2016-06-01

The Connected Traveler framework seeks to boost the energy efficiency of personal travel and the overall transportation system by maximizing the accuracy of predicted traveler behavior in response to real-time feedback and incentives. It is anticipated that this approach will establish a feedback loop that 'learns' traveler preferences and customizes incentives to meet or exceed energy efficiency targets by empowering individual travelers with information needed to make energy-efficient choices and reducing the complexity required to validate transportation system energy savings. This handout provides an overview of NREL's Connected Traveler project, including graphics, milestones, and contact information.

Case study on incentive mechanism of energy efficiency retrofit in coal-fueled power plant in China.

PubMed

Yuan, Donghai; Guo, Xujing; Cao, Yuan; He, Liansheng; Wang, Jinggang; Xi, Beidou; Li, Junqi; Ma, Wenlin; Zhang, Mingshun

2012-01-01

An ordinary steam turbine retrofit project is selected as a case study; through the retrofit, the project activities will generate emission reductions within the power grid for about 92,463 tCO(2)e per annum. The internal rate of return (IRR) of the project is only -0.41% without the revenue of carbon credits, for example, CERs, which is much lower than the benchmark value of 8%. Only when the unit price of carbon credit reaches 125 CNY/tCO(2), the IRR could reach the benchmark and an effective carbon tax needs to increase the price of carbon to 243 CNY/tce in order to make the project financially feasible. Design of incentive mechanism will help these low efficiency enterprises improve efficiency and reduce CO(2) emissions, which can provide the power plants sufficient incentive to implement energy efficiency retrofit project in existing coal-fuel power generation-units, and we hope it will make a good demonstration for the other low efficiency coal-fueled power generation units in China.

Case Study on Incentive Mechanism of Energy Efficiency Retrofit in Coal-Fueled Power Plant in China

PubMed Central

Yuan, Donghai; Guo, Xujing; Cao, Yuan; He, Liansheng; Wang, Jinggang; Xi, Beidou; Li, Junqi; Ma, Wenlin; Zhang, Mingshun

2012-01-01

An ordinary steam turbine retrofit project is selected as a case study; through the retrofit, the project activities will generate emission reductions within the power grid for about 92,463 tCO2e per annum. The internal rate of return (IRR) of the project is only −0.41% without the revenue of carbon credits, for example, CERs, which is much lower than the benchmark value of 8%. Only when the unit price of carbon credit reaches 125 CNY/tCO2, the IRR could reach the benchmark and an effective carbon tax needs to increase the price of carbon to 243 CNY/tce in order to make the project financially feasible. Design of incentive mechanism will help these low efficiency enterprises improve efficiency and reduce CO2 emissions, which can provide the power plants sufficient incentive to implement energy efficiency retrofit project in existing coal-fuel power generation-units, and we hope it will make a good demonstration for the other low efficiency coal-fueled power generation units in China. PMID:23365532

An analysis of structural incentives in the Arizona Health Care Cost-Containment System

PubMed Central

Vogel, Ronald J.

1984-01-01

This article analyzes the financial structures of the prevailing public and private health insurance mechanisms. Based on this analysis, it was concluded that the financial structures of health insurance mechanisms are deficient in that they neither produce efficiency in the consumption of health services, nor generate efficiency in the production of health services. On the other hand, closed-end systems of finance, such as the health maintenance organization (HMO) or the new Arizona Health Care Cost-Containment System (AHCCCS), give more promise of achieving such efficiencies. The AHCCCS represents an important innovation in the public financing of health care, and, for policy purposes, should be considered a viable national alternative for the reform of Medicare and Medicaid. PMID:10310943

What is the optimal task difficulty for reinforcement learning of brain self-regulation?

PubMed

Bauer, Robert; Vukelić, Mathias; Gharabaghi, Alireza

2016-09-01

The balance between action and reward during neurofeedback may influence reinforcement learning of brain self-regulation. Eleven healthy volunteers participated in three runs of motor imagery-based brain-machine interface feedback where a robot passively opened the hand contingent to β-band modulation. For each run, the β-desynchronization threshold to initiate the hand robot movement increased in difficulty (low, moderate, and demanding). In this context, the incentive to learn was estimated by the change of reward per action, operationalized as the change in reward duration per movement onset. Variance analysis revealed a significant interaction between threshold difficulty and the relationship between reward duration and number of movement onsets (p<0.001), indicating a negative learning incentive for low difficulty, but a positive learning incentive for moderate and demanding runs. Exploration of different thresholds in the same data set indicated that the learning incentive peaked at higher thresholds than the threshold which resulted in maximum classification accuracy. Specificity is more important than sensitivity of neurofeedback for reinforcement learning of brain self-regulation. Learning efficiency requires adequate challenge by neurofeedback interventions. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Decision Support Tool Prototype for the Enlistment Incentive Review Board: Phase 2

DTIC Science & Technology

2014-07-01

was conducted by the U.S. Military Academy (USMA) to assess which preferences of youth could be influenced by incentives (Joles, Charbonneau , & Barr...to designing more effective and more efficient incentive strategies. In an attempt to provide this information, Joles, Charbonneau , and Barr (1998...Military Academy. Joles, J., Charbonneau , S., & Barr, D. (1998, February). An enlistment bonus distribution model. West Point, NY: United States

Financial incentives for exercise adherence in adults: systematic review and meta-analysis.

PubMed

Mitchell, Marc S; Goodman, Jack M; Alter, David A; John, Leslie K; Oh, Paul I; Pakosh, Maureen T; Faulkner, Guy E

2013-11-01

Less than 5% of U.S. adults accumulate the required dose of exercise to maintain health. Behavioral economics has stimulated renewed interest in economic-based, population-level health interventions to address this issue. Despite widespread implementation of financial incentive-based public health and workplace wellness policies, the effects of financial incentives on exercise initiation and maintenance in adults remain unclear. A systematic search of 15 electronic databases for RCTs reporting the impact of financial incentives on exercise-related behaviors and outcomes was conducted in June 2012. A meta-analysis of exercise session attendance among included studies was conducted in April 2013. A qualitative analysis was conducted in February 2013 and structured along eight features of financial incentive design. Eleven studies were included (N=1453; ages 18-85 years and 50% female). Pooled results favored the incentive condition (z=3.81, p<0.0001). Incentives also exhibited significant, positive effects on exercise in eight of the 11 included studies. One study determined that incentives can sustain exercise for longer periods (>1 year), and two studies found exercise adherence persisted after the incentive was withdrawn. Promising incentive design feature attributes were noted. Assured, or "sure thing," incentives and objective behavioral assessment in particular appear to moderate incentive effectiveness. Previously sedentary adults responded favorably to incentives 100% of the time (n=4). The effect estimate from the meta-analysis suggests that financial incentives increase exercise session attendance for interventions up to 6 months in duration. Similarly, a simple count of positive (n=8) and null (n=3) effect studies suggests that financial incentives can increase exercise adherence in adults in the short term (<6 months). © 2013 American Journal of Preventive Medicine.

An incentive-based source separation model for sustainable municipal solid waste management in China.

PubMed

Xu, Wanying; Zhou, Chuanbin; Lan, Yajun; Jin, Jiasheng; Cao, Aixin

2015-05-01

Municipal solid waste (MSW) management (MSWM) is most important and challenging in large urban communities. Sound community-based waste management systems normally include waste reduction and material recycling elements, often entailing the separation of recyclable materials by the residents. To increase the efficiency of source separation and recycling, an incentive-based source separation model was designed and this model was tested in 76 households in Guiyang, a city of almost three million people in southwest China. This model embraced the concepts of rewarding households for sorting organic waste, government funds for waste reduction, and introducing small recycling enterprises for promoting source separation. Results show that after one year of operation, the waste reduction rate was 87.3%, and the comprehensive net benefit under the incentive-based source separation model increased by 18.3 CNY tonne(-1) (2.4 Euros tonne(-1)), compared to that under the normal model. The stakeholder analysis (SA) shows that the centralized MSW disposal enterprises had minimum interest and may oppose the start-up of a new recycling system, while small recycling enterprises had a primary interest in promoting the incentive-based source separation model, but they had the least ability to make any change to the current recycling system. The strategies for promoting this incentive-based source separation model are also discussed in this study. © The Author(s) 2015.

Incentive schemes in development of socio-economic systems

NASA Astrophysics Data System (ADS)

Grachev, V. V.; Ivushkin, K. A.; Myshlyaev, L. P.

2018-05-01

The paper is devoted to the study of incentive schemes when developing socio-economic systems. The article analyzes the existing incentive schemes. It is established that the traditional incentive mechanisms do not fully take into account the specifics of the creation of each socio-economic system and, as a rule, are difficult to implement. The incentive schemes based on the full-scale simulation approach, which allow the most complete information from the existing projects of creation of socio-economic systems to be extracted, are proposed. The statement of the problem is given, the method and algorithm of the full-scale simulation study of the efficiency of incentive functions is developed. The results of the study are presented. It is shown that the use of quadratic and piecewise linear functions of incentive allows the time and costs for creating social and economic systems to be reduced by 10%-15%.

Cost-effectiveness of health research study participant recruitment strategies: a systematic review.

PubMed

Huynh, Lynn; Johns, Benjamin; Liu, Su-Hsun; Vedula, S Swaroop; Li, Tianjing; Puhan, Milo A

2014-10-01

A large fraction of the cost of conducting clinical trials is allocated to recruitment of participants. A synthesis of findings from studies that evaluate the cost and effectiveness of different recruitment strategies will inform investigators in designing cost-efficient clinical trials. To systematically identify, assess, and synthesize evidence from published comparisons of the cost and yield of strategies for recruitment of participants to health research studies. We included randomized studies in which two or more strategies for recruitment of participants had been compared. We focused our economic evaluation on studies that randomized participants to different recruitment strategies. We identified 10 randomized studies that compared recruitment strategies, including monetary incentives (cash or prize), direct contact (letters or telephone call), and medical referral strategies. Only two of the 10 studies compared strategies for recruiting participants to clinical trials. We found that allocating additional resources to recruit participants using monetary incentives or direct contact yielded between 4% and 23% additional participants compared to using neither strategy. For medical referral, recruitment of prostate cancer patients by nurses was cost-saving compared to recruitment by consultant urologists. For all underlying study designs, monetary incentives cost more than direct contact with potential participants, with a median incremental cost per recruitment ratio of Int$72 (Int$-International dollar, a theoretical unit of currency) for monetary incentive strategy compared to Int$28 for direct contact strategy. Only monetary incentives and source of referral were evaluated for recruiting participants into clinical trials. We did not review studies that presented non-monetary cost or lost opportunity cost. We did not adjust for the number of study recruitment sites or the study duration in our economic evaluation analysis. Systematic and explicit reporting of cost and effectiveness of recruitment strategies from randomized comparisons is required to aid investigators to select cost-efficient strategies for recruiting participants to health research studies including clinical trials. © The Author(s) 2014.

Malaysia Country Analysis Brief

EIA Publications

2017-01-01

Malaysia's energy industry is a critical sector of growth for the entire economy, and it makes up almost 20% of the total gross domestic product. New tax and investment incentives, starting in 2010, aim to promote oil and natural gas exploration and development in the country's deepwater and marginal fields as well as promote energy efficiency measures and use of alternative energy sources. These fiscal incentives are part of the country's economic transformation program to leverage its resources and geographic location to be one of Asia's top energy players by 2020. Another key pillar in Malaysia's energy strategy is to become a regional oil and natural gas storage, trading, and development hub that will attract technical expertise and downstream services that can compete in Asia.

Incentivizing Blood Donation: Systematic Review and Meta-Analysis to Test Titmuss’ Hypotheses

PubMed Central

2013-01-01

Objectives: Titmuss hypothesized that paying blood donors would reduce the quality of the blood donated and would be economically inefficient. We report here the first systematic review to test these hypotheses, reporting on both financial and nonfinancial incentives. Method: Studies deemed eligible for inclusion were peer-reviewed, experimental studies that presented data on the quantity (as a proxy for efficiency) and quality of blood donated in at least two groups: those donating blood when offered an incentive, and those donating blood with no offer of an incentive. The following were searched: MEDLINE, EMBASE and PsycINFO using OVID SP, CINAHL via EBSCO and CENTRAL, the Cochrane Library, Econlit via EBSCO, JSTOR Health and General Science Collection, and Google. Results: The initial search yielded 1100 abstracts, which resulted in 89 full papers being assessed for eligibility, of which seven studies, reported in six papers, met the inclusion criteria. The included studies involved 93,328 participants. Incentives had no impact on the likelihood of donation (OR = 1.22 CI 95% 0.91–1.63; p = .19). There was no difference between financial and nonfinancial incentives in the quantity of blood donated. Of the two studies that assessed quality of blood, one found no effect and the other found an adverse effect from the offer of a free cholesterol test (β = 0.011 p < .05). Conclusion: The limited evidence suggests that Titmuss’ hypothesis of the economic inefficiency of incentives is correct. There is insufficient evidence to assess their likely impact on the quality of the blood provided. PMID:24001244

Nuclear techniques for the on-line bulk analysis of carbon in coal-fired power stations.

PubMed

Sowerby, B D

2009-09-01

Carbon trading schemes usually require large emitters of CO(2), such as coal-fired power stations, to monitor, report and be audited on their CO(2) emissions. The emission price provides a significant additional incentive for power stations to improve efficiency. In the present paper, previous work on the bulk determination of carbon in coal is reviewed and assessed. The most favourable method is that based on neutron inelastic scattering. The potential role of on-line carbon analysers in improving boiler efficiency and in carbon accounting is discussed.

Economic incentives to promote innovation in healthcare delivery.

PubMed

Luft, Harold S

2009-10-01

Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare's approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.

Aligning Utility Incentives with Investment in Energy Efficiency

EPA Pesticide Factsheets

Describes the financial effects on a utility of its spending on energy efficiency programs, how those effects could constitute barriers to more aggressive and sustained utility investment in energy efficiency.

Effectiveness of UK provider financial incentives on quality of care: a systematic review.

PubMed

Mandavia, Rishi; Mehta, Nishchay; Schilder, Anne; Mossialos, Elias

2017-11-01

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency. To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care. Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as 'positive', those that were 'intermediate' showed improvement in some measures, and those classified as 'negative' showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist. Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points. The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives - if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK. © British Journal of General Practice 2017.

Using a new incentive mechanism to improve wastewater sector performance: the case study of Italy.

PubMed

De Gisi, Sabino; Petta, Luigi; Farina, Roberto; De Feo, Giovanni

2014-01-01

The system of "Service Objectives", introduced by the Italian National Strategic Framework 2007-2013, is an innovative results-oriented programme concerning 4 thematic areas (education, care for the elderly and children, management of municipal solid wastes and integrated water service) in which the Ministry of Economic Development and eight Southern Italy districts are involved. The system was initially associated to an incentive mechanism which provided subsidies for a total amount of EUR 3 billion from the national Underdeveloped Areas Fund, according to the achievement of specific targets set for 11 service indicators in 2013. The indicators used for the integrated water service refer to the efficiency in water supply service as well as the coverage of wastewater treatment service. The aim of the study is to describe the activities carried out in Italy by the ENEA Agency in order to define a new performance indicator for wastewater treatment service taking into account the appropriateness and efficiency of existing plants equipment and, consequently, evaluating economic incentives. The proposed procedure takes into account both wastewater treatment demand and quality of wastewater treatment service offered to citizens. Input data, provided by the National Institute of Statistics (ISTAT), were elaborated in order to define appropriate parameters, with a multi-criteria analysis being used to define the new performance indicator. The applicability of the proposed procedure was verified considering all the 8 Southern Italy and Island districts (Abruzzo, Molise, Campania, Apulia, Basilicata, Calabria, Sicily and Sardinia) involved in the programme. The obtained results show that the quality of municipal wastewater may influence the calculation of the incentive amount. The performance indicators defined in this work might be conveniently extended to other contexts similar to the assessed geographical area (Southern Italy and Islands). Copyright © 2013 Elsevier Ltd. All rights reserved.

Energy Efficiency Appliance Standards: Where do we stand, how far can we go and how do we get there? An analysis across several economies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Letschert, Virginie E.; de la Rue du Can, Stephane; McNeil, Michael A.

This paper analyses several potential savings scenarios for minimum energy performance standard (MEPS) and comparable programs for governments participating i n the Super-efficient Equipment and Appliance Deployment (SEAD) Initiative, of the Clean Energy Ministerial, which represent over 60% of primary energy consumption in the world. We compare projected energy savings from the main end uses in the residential sector using three energy efficiency scenarios: (1) recent achievements, (2) cost-effective saving potential, and (3) energy efficiency technical potential. The recent achievement scenario (1) evaluates the future impact of MEPS enacted or under development between 2010 and 2012. The cost-effective potential scenariomore » (2) identifies the maximum potential for energy efficiency that results in net benefits to the consumer. The best available technology scenario (3) re presents the full potential of energy efficiency considering best available technologies as candidates for MEPS and incentive programs. We use the Bottom Up Energy Analysis System (BUENAS), developed by Lawrence Berkeley National Laboratory in collaboration with the Collaborative Labelling and Appliances Standards Program (CLASP), to provide a consistent methodology to com pare the different scenarios. This paper focuses on the main end uses in the residential sector. The comparison of the three scenarios for each economy provides possible opportunities for scaling up current policies or implementing additional policies. This comparison across economies reveals country best practices as well as end uses that present the greatest additional potential savings. The paper describes areas where methodologies and additional policy instruments can increase penetration of energy efficient technologies. First , we summarize the barriers and provide remedial policy tools/best practices, such as techno-economic analysis, in response to each barriers that prevent economies from capturing the full cost-effective potentials of MEPS (Scenario 1 to 2). Then, we consider the possible complementary policy options, such as incentive pro grams, to reach the full technical potential of energy efficiency in the residential sector (Scenario 2 to 3).« less

48 CFR 719.273-3 - Incentives for prime contractor participation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... INTERNATIONAL DEVELOPMENT SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS The U.S. Agency for International...) Under the Small Business Act, 15 U.S.C. 637(d)(4)(E), USAID is authorized to provide appropriate incentives to encourage subcontracting opportunities for small business consistent with the efficient and...

50 CFR 600.330 - National Standard 5-Efficiency.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Efficiency. In theory, an efficient fishery would harvest the OY with the minimum use of economic inputs such... techniques of harvesting, processing, or marketing, and should avoid creating strong incentives for excessive...

Birth weight differences between those offered financial voucher incentives for verified smoking cessation and control participants enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), employing an intuitive approach and a Complier Average Causal Effects (CACE) analysis.

PubMed

McConnachie, Alex; Haig, Caroline; Sinclair, Lesley; Bauld, Linda; Tappin, David M

2017-07-20

The Cessation in Pregnancy Incentives Trial (CPIT), which offered financial incentives for smoking cessation during pregnancy showed a clinically and statistically significant improvement in cessation. However, infant birth weight was not seen to be affected. This study re-examines birth weight using an intuitive and a complier average causal effects (CACE) method to uncover important information missed by intention-to-treat analysis. CPIT offered financial incentives up to £400 to pregnant smokers to quit. With incentives, 68 women (23.1%) were confirmed non-smokers at primary outcome, compared to 25 (8.7%) without incentives, a difference of 14.3% (Fisher test, p < 0.0001). For this analysis, randomised groups were split into three theoretical sub-groups: independent quitters - quit without incentives, hardened smokers - could not quit even with incentives and potential quitters - required the addition of financial incentives to quit. Viewed in this way, the overall birth weight gain with incentives is attributable only to potential quitters. We compared an intuitive approach to a CACE analysis. Mean birth weight of potential quitters in the incentives intervention group (who therefore quit) was 3338 g compared with potential quitters in the control group (who did not quit) 3193 g. The difference attributable to incentives, was 3338 - 3193 = 145 g (95% CI -617, +803). The mean difference in birth weight between the intervention and control groups was 21 g, and the difference in the proportion who managed to quit was 14.3%. Since the intervention consisted of the offer of incentives to quit smoking, the intervention was received by all women in the intervention group. However, "compliance" was successfully quitting with incentives, and the CACE analysis yielded an identical result, causal birth weight increase 21 g ÷ 0.143 = 145 g. Policy makers have great difficulty giving pregnant women money to stop smoking. This study indicates that a small clinically insignificant improvement in average birth weight is likely to hide an important clinically significant increase in infants born to pregnant smokers who want to stop but cannot achieve smoking cessation without the addition of financial voucher incentives. ISRCTN Registry, ISRCTN87508788 . Registered on 1 September 2011.

Energy conservation, energy efficiency and energy savings regulatory hypotheses - taxation, subsidies and underlying economics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Trumpy, T.

1995-12-01

More efficient use of energy resources can be promoted by various regulatory means, i.e., taxation, subsidies, and pricing. Various incentives can be provided by income and revenue tax breaks-deductible energy audit fees, energy saving investment credits, breaks for energy saving entrepreneurs, and energy savings accounts run through utility accounts. Value added and excise taxes can also be adjusted to reward energy saving investments and energy saving entrepreneurial activity. Incentives can be provided in the form of cash refunds, including trade-in-and-scrap programs and reimbursements or subsidies on audit costs and liability insurance. Pricing incentives include lower rates for less energy use,more » prepayment of deposit related to peak load use, electronically dispatched multiple tariffs, savings credits based on prior peak use, and subsidized {open_quotes}leasing{close_quotes} of more efficient appliances and lights. Credits, with an emphasis on pooling small loans, and 5-year energy savings contracts are also discussed.« less

Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

ERIC Educational Resources Information Center

Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

2010-01-01

Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

Safety belt and motorcycle helmet use in Virginia : results of the 1993 survey to qualify for incentive funds under ISTEA, Section 153.

DOT National Transportation Integrated Search

1993-01-01

Section 153 of the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA) established an incentive grant program to support states in adopting and implementing laws requiring the use of safety belts and motorcycle helmets. Having such laws ...

Safety belt and motorcycle helmet use in Virginia : results of the 1992 survey to qualify for incentive funds under ISTEA, section 153.

DOT National Transportation Integrated Search

1993-01-01

Section 153 of the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA) established an incentive grant program to support states in adopting and implementing laws requiring the use of safety belts and motorcycle helmets. Having such laws ...

43 CFR 418.36 - Incentives for additional long term conservation.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) There is a deficit created and remaining in Lahontan Reservoir from operations penalties in a prior year... expected efficiency, the District may store in Lahontan Reservoir two-thirds (2/3) of the additional water... reduced diversions to Lahontan Reservoir). This water will be considered incentive water saved from the...

43 CFR 418.36 - Incentives for additional long term conservation.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) There is a deficit created and remaining in Lahontan Reservoir from operations penalties in a prior year... expected efficiency, the District may store in Lahontan Reservoir two-thirds (2/3) of the additional water... reduced diversions to Lahontan Reservoir). This water will be considered incentive water saved from the...

Energy Education Incentives: Evaluating the Impact of Consumer Energy Kits

ERIC Educational Resources Information Center

Kirby, Sarah D.; Guin, Autumn; Langham, Laura

2015-01-01

Measuring the energy and environmental impact of residential energy education efforts is difficult. The E-Conservation residential energy management program uses consumer energy kits to document the impact of energy-efficient improvements. The consumer energy kit provides an incentive for individuals attending energy education workshop, helps…

Improving medicaid health incentives programs: lessons from substance abuse treatment research.

PubMed

Hand, Dennis J; Heil, Sarah H; Sigmon, Stacey C; Higgins, Stephen T

2014-06-01

This commentary addresses the efforts of Medicaid programs in several US states to employ financial incentives to increase healthy behavior among their beneficiaries. While these Medicaid incentive programs have been successful at boosting rates of less effortful behaviors, like semiannual dental visits, they have fallen short in promoting more complex behaviors, like smoking cessation, drug abstinence, and weight management. Incentives have been extensively studied as a treatment for substance use disorders for over 20years, with good success. We identify two variables shown by meta-analysis to moderate the efficacy of incentive interventions in substance abuse treatment, the immediacy of incentive delivery and size (or magnitude) of the incentive, that are lacking in current Medicaid incentive program. We also offer some guidance on how these moderating variables could be addressed within Medicaid programs. This is a critical time for such analysis, as more than 10 states are employing incentives in their Medicaid programs, and some are currently reevaluating their incentive strategies. Copyright © 2014 Elsevier Inc. All rights reserved.

Assessing Incentives for Service-Level Selection In Private Health Insurance Exchanges

PubMed Central

McGuire, Thomas G.; Newhouse, Joseph P.; Normand, Sharon-Lise; Shi, Julie; Zuvekas, Samuel

2014-01-01

Even with open enrollment and mandated purchase, incentives created by adverse selection may undermine the efficiency of service offerings by plans in the new health insurance Exchanges created by the Affordable Care Act. Using data on persons likely to participate in Exchanges drawn from five waves of the Medical Expenditure Panel Survey, we measure plan incentives in two ways. First, we construct predictive ratios, improving on current methods by taking into account the role of premiums in financing plans. Second, relying on an explicit model of plan profit maximization, we measure incentives based on the predictability and predictiveness of various medical diagnoses. Among the chronic diseases studied, plans have the greatest incentive to skimp on care for cancer, and mental health and substance abuse. PMID:24603443

Motivation for Participating in a Weight Loss Program and Financial Incentives: An Analysis from a Randomized Trial

PubMed Central

Crane, Melissa M.; Tate, Deborah F.; Finkelstein, Eric A.; Linnan, Laura A.

2012-01-01

This analysis investigated if changes in autonomous or controlled motivation for participation in a weight loss program differed between individuals offered a financial incentive for weight loss compared to individuals not offered an incentive. Additionally, the same relationships were tested among those who lost weight and either received or did not receive an incentive. This analysis used data from a year-long randomized worksite weight loss program that randomly assigned employees in each worksite to either a low-intensity weight loss program or the same program plus small financial incentives for weight loss ($5.00 per percentage of initial weight lost). There were no differences in changes between groups on motivation during the study, however, increases in autonomous motivation were consistently associated with greater weight losses. This suggests that the small incentives used in this program did not lead to increases in controlled motivation nor did they undermine autonomous motivation. Future studies are needed to evaluate the magnitude and timing of incentives to more fully understand the relationship between incentives and motivation. PMID:22577524

Portfolio-Scale Optimization of Customer Energy Efficiency Incentive and Marketing: Cooperative Research and Development Final Report, CRADA Number CRD-13-535

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brackney, Larry J.

North East utility National Grid (NGrid) is developing a portfolio-scale application of OpenStudio designed to optimize incentive and marketing expenditures for their energy efficiency (EE) programs. NGrid wishes to leverage a combination of geographic information systems (GIS), public records, customer data, and content from the Building Component Library (BCL) to form a JavaScript Object Notation (JSON) input file that is consumed by an OpenStudio-based expert system for automated model generation. A baseline model for each customer building will be automatically tuned using electricity and gas consumption data, and a set of energy conservation measures (ECMs) associated with each NGrid incentivemore » program will be applied to the model. The simulated energy performance and return on investment (ROI) will be compared with customer hurdle rates and available incentives to A) optimize the incentive required to overcome the customer hurdle rate and B) determine if marketing activity associated with the specific ECM is warranted for that particular customer. Repeated across their portfolio, this process will enable NGrid to substantially optimize their marketing and incentive expenditures, targeting those customers that will likely adopt and benefit from specific EE programs.« less

Energy and Environment Guide to Action - Chapter 4.2: Energy Efficiency Programs

EPA Pesticide Factsheets

Provides guidance and recommendations for designing, funding, and implementing effective energy efficiency programs, which provide a range of financial and other incentives to encourage investments in energy-efficient technologies and behavior change.

Aligning Utility Incentives with Investment in Energy Efficiency

EPA Pesticide Factsheets

Learn more about the financial effects on a utility of its spending on energy efficiency programs, how those effects could constitute barriers to utility investment in energy efficiency, and how various policies can reduce these barriers.

Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration.

PubMed

Banks, D; Parker, E; Wendel, J

2001-03-01

Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed. Copyright 2001 John Wiley & Sons, Ltd.

Teacher Incentive Systems, Final Report. Policy Research Initiative: Haiti, Liberia, Somalia, Yemen Arab Republic.

ERIC Educational Resources Information Center

Kemmerer, Frances; Thiagarajan, Sivasailam

Findings of a study that examined the implementation of a teacher incentives initiative in four countries--Haiti, Liberia, Somalia, and Yemen--are presented in this paper. The countries are participating in a 10-year initiative founded in 1984, Improving the Efficiency of Educational Systems (IEES). Methodology involved interviews with…

Grades and Incentives: Assessing Competing Grade Point Average Measures and Postgraduate Outcomes

ERIC Educational Resources Information Center

Bailey, Michael A.; Rosenthal, Jeffrey S.; Yoon, Albert H.

2016-01-01

In many educational settings, students may have an incentive to take courses where high grades are easier to achieve, potentially corroding student learning, evaluation of student achievement, and the fairness and efficiency of post-graduation labor outcomes. A grading system that takes into account heterogeneity of teacher standards and student…

Implementation and Incentive of Education Policies: Experience from the High School Admissions Quota Allocation Policy

ERIC Educational Resources Information Center

Shiyue, Wang

2017-01-01

Improving administrative efficiency is the core problem in administrative governance. This case study of quota allocation policy implementation in City A reveals that a set of education policy implementation and incentive mechanisms revolving around responsibility contracts and target evaluations has already taken shape, to guarantee effective…

Extended producer responsibility for consumer waste: the gap between economic theory and implementation.

PubMed

Dubois, Maarten

2012-09-01

Although economic theory supports the use of extended producer responsibility (EPR) to stimulate prevention and recycling of waste, EPR systems implemented in Europe are often criticized as a result of weak incentives for prevention and green product design. Using a stylized economic model, this article evaluates the efficiency of European EPR systems. The model reveals that the introduction of static collection targets creates a gap between theory and implementation. Static targets lead to inefficient market outcomes and weak incentives for prevention and green product design. The minimum collection targets should be complemented with a tax on producers for the non-collected waste fraction. Because such a tax internalizes the cost of waste disposal, more efficient price signals will lead to better incentives for waste management in a complex and dynamic market.

Incentives and provider payment methods.

PubMed

Barnum, H; Kutzin, J; Saxenian, H

1995-01-01

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

Design and analysis of electricity markets

NASA Astrophysics Data System (ADS)

Sioshansi, Ramteen Mehr

Restructured competitive electricity markets rely on designing market-based mechanisms which can efficiently coordinate the power system and minimize the exercise of market power. This dissertation is a series of essays which develop and analyze models of restructured electricity markets. Chapter 2 studies the incentive properties of a co-optimized market for energy and reserves that pays reserved generators their implied opportunity cost---which is the difference between their stated energy cost and the market-clearing price for energy. By analyzing the market as a competitive direct revelation mechanism we examine the properties of efficient equilibria and demonstrate that generators have incentives to shade their stated costs below actual costs. We further demonstrate that the expected energy payments of our mechanism is less than that in a disjoint market for energy only. Chapter 3 is an empirical validation of a supply function equilibrium (SFE) model. By comparing theoretically optimal supply functions and actual generation offers into the Texas spot balancing market, we show the SFE to fit the actual behavior of the largest generators in market. This not only serves to validate the model, but also demonstrates the extent to which firms exercise market power. Chapters 4 and 5 examine equity, incentive, and efficiency issues in the design of non-convex commitment auctions. We demonstrate that different near-optimal solutions to a central unit commitment problem which have similar-sized optimality gaps will generally yield vastly different energy prices and payoffs to individual generators. Although solving the mixed integer program to optimality will overcome such issues, we show that this relies on achieving optimality of the commitment---which may not be tractable for large-scale problems within the allotted timeframe. We then simulate and compare a competitive benchmark for a market with centralized and self commitment in order to bound the efficiency losses stemming from coordination losses (cost of anarchy) in a decentralized market.

Social values and the corruption argument against financial incentives for healthy behaviour

PubMed Central

Brown, Rebecca C H

2017-01-01

Financial incentives may provide a way of reducing the burden of chronic diseases by motivating people to adopt healthy behaviours. While it is still uncertain how effective such incentives could be for promoting health, some argue that, even if effective, there are ethical objections that preclude their use. One such argument is made by Michael Sandel, who suggests that monetary transactions can have a corrupting effect on the norms and values that ordinarily regulate exchange and behaviour in previously non-monetised contexts. In this paper, I outline Sandel's corruption argument and consider its validity in the context of health incentives. I distinguish between two forms of corruption that are implied by Sandel's argument: efficiency corruption and value corruption. While Sandel's thought-provoking discussion provides a valuable contribution to debates about health policies generally and health incentives specifically, I suggest the force of his criticism of health incentives is limited: further empirical evidence and theoretical reasoning are required to support the suggestion that health incentives are an inappropriate tool for promoting health. While I do not find Sandel's corruption argument compelling, this only constitutes a partial defence of health incentives, since other criticisms relating to their use may prove more successful. PMID:27738254

State Clean Energy Policies Analysis (SCEPA): State Tax Incentives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lantz, E.; Doris, E.

As a policy tool, state tax incentives can be structured to help states meet clean energy goals. Policymakers often use state tax incentives in concert with state and federal policies to support renewable energy deployment or reduce market barriers. This analysis used case studies of four states to assess the contributions of state tax incentives to the development of renewable energy markets. State tax incentives that are appropriately paired with complementary state and federal policies generally provide viable mechanisms to support renewable energy deployment. However, challenges to successful implementation of state tax incentives include serving project owners with limited statemore » tax liability, assessing appropriate incentive levels, and differentiating levels of incentives for technologies with different costs. Additionally, state tax incentives may result in moderately higher federal tax burdens. These challenges notwithstanding, state tax incentives that consider certain policy design characteristics can support renewable energy markets and state clean energy goals.The scale of their impact though is directly related to the degree to which they support the renewable energy markets for targeted sectors and technologies. This report highlights important policy design considerations for policymakers using state tax incentives to meet clean energy goals.« less

Cost-Effectiveness of Rural Incentive Packages for Graduating Medical Students in Lao PDR

PubMed Central

Keuffel, Eric; Jaskiewicz, Wanda; Theppanya, Khampasong; Tulenko, Kate

2017-01-01

Background: The dearth of health workers in rural settings in Lao People’s Democratic Republic (PDR) and other developing countries limits healthcare access and outcomes. In evaluating non-wage financial incentive packages as a potential policy option to attract health workers to rural settings, understanding the expected costs and effects of the various programs ex ante can assist policy-makers in selecting the optimal incentive package. Methods: We use discrete choice experiments (DCEs), costing analyses and recent empirical results linking health worker density and health outcomes to estimate the future location decisions of physicians and determine the cost-effectiveness of 15 voluntary incentives packages for new physicians in Lao PDR. Our data sources include a DCE survey completed by medical students (n = 329) in May 2011 and secondary cost, economic and health data. Mixed logit regressions provide the basis for estimating how each incentive package influences rural versus urban location choice over time. We estimate the expected rural density of physicians and the cost-effectiveness of 15 separate incentive packages from a societal perspective. In order to generate the cost-effectiveness ratios we relied on the rural uptake probabilities inferred from the DCEs, the costing data and prior World Health Organization (WHO) estimates that relate health outcomes to health worker density. Results: Relative to no program, the optimal voluntary incentive package would increase rural physician density by 15% by 2016 and 65% by 2041. After incorporating anticipated health effects, seven (three) of the 15 incentive packages have anticipated average cost-effectiveness ratio less than the WHO threshold (three times gross domestic product [GDP] per capita) over a 5-year (30 year) period. The optimal package’s incremental cost-effectiveness ratio is $1454/QALY (quality-adjusted life year) over 5 years and $2380/QALY over 30 years. Capital intensive components, such as housing or facility improvement, are not efficient. Conclusion: Conditional on using voluntary incentives, Lao PDR should emphasize non-capital intensive options such as advanced career promotion, transport subsidies and housing allowances to improve physician distribution and rural health outcomes in a cost-effective manner. Other countries considering voluntary incentive programs can implement health worker/trainee DCEs and costing surveys to determine which incentive bundles improve rural uptake most efficiently but should be aware of methodological caveats. PMID:28812834

Efficient Windows Collaborative

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nils Petermann

2010-02-28

The project goals covered both the residential and commercial windows markets and involved a range of audiences such as window manufacturers, builders, homeowners, design professionals, utilities, and public agencies. Essential goals included: (1) Creation of 'Master Toolkits' of information that integrate diverse tools, rating systems, and incentive programs, customized for key audiences such as window manufacturers, design professionals, and utility programs. (2) Delivery of education and outreach programs to multiple audiences through conference presentations, publication of articles for builders and other industry professionals, and targeted dissemination of efficient window curricula to professionals and students. (3) Design and implementation of mechanismsmore » to encourage and track sales of more efficient products through the existing Window Products Database as an incentive for manufacturers to improve products and participate in programs such as NFRC and ENERGY STAR. (4) Development of utility incentive programs to promote more efficient residential and commercial windows. Partnership with regional and local entities on the development of programs and customized information to move the market toward the highest performing products. An overarching project goal was to ensure that different audiences adopt and use the developed information, design and promotion tools and thus increase the market penetration of energy efficient fenestration products. In particular, a crucial success criterion was to move gas and electric utilities to increase the promotion of energy efficient windows through demand side management programs as an important step toward increasing the market share of energy efficient windows.« less

Efficiency of incentives to jointly increase carbon sequestration and species conservation on a landscape

Treesearch

Erik Nelson; Stephen Polasky; David J. Lewis; Andrew J. Plantinga; Eric Lonsdorf; Denis White; David Bael; Joshua Lawler

2008-01-01

We develop an integrated model to predict private land-use decisions in response to policy incentives designed to increase the provision of carbon sequestration and species conservation across heterogeneous landscapes. Using data from the Willamette Basin, Oregon, we compare the provision of carbon sequestration and species conservation under five simple policies that...

Energy Market and Economic Impacts of H.R. 2454, the American Clean Energy and Security Act of 2009

EIA Publications

2009-01-01

This report responds to a request from Chairman Henry Waxman and Chairman Edward Markey for an analysis of H.R. 2454, the American Clean Energy and Security Act of 2009 (ACESA). ACESA, as passed by the House of Representatives on June 26, 2009, is a complex bill that regulates emissions of greenhouse gases through market-based mechanisms, efficiency programs, and economic incentives.

Study on government's optimal incentive intensity of intellectual property rights

NASA Astrophysics Data System (ADS)

Yang, Chengbin; Sun, Shengxiang; Wei, Hua

2018-05-01

The integration of military and civilian technology in the development stage of weapon equipment is an inherent requirement for the development of the deep integration of the military and the civilian. In order to avoid repeated development of existing technology and improve the efficiency of weaponry development, the government should take effective measures to encourage development institutions to actively adopt existing intellectual property technology in the process of equipment development. According to the theory of utility function and the characteristics of practical problems, the utility function of government and weapon equipment development units is constructed, and the optimization model of incentive strength for national defense intellectual property is established. According to the numerical simulation, the conclusion is, to improve the development efficiency, and at the same time, to encourage innovation, thre government need to make a trade-off in incentive policy making, to achieve a high level in intellectual property rights' innovation and application.

[Efficiency of human resources for health: an approach to its analysis in Mexico].

PubMed

Nigenda, Gustavo; Alcalde-Rabanal, Jaqueline; González-Robledo, Luz María; Serván-Mori, Edson; García-Saiso, Sebastián; Lozano, Rafael

2016-01-01

To analyze efficiency indicators of human resources working at Mexico's Ministry of Health. Three dimensions of efficiency were explored: a) labor wastage, b) distribution of human resources (HR) across levels of care, and c) productivity. Health workers present significant levels of unemployment and underemployment; distribution does not meet international recommendations, and heterogeneous levels of productivity were found among states. Health and educational authorities should develop and implement a HR plan that takes into consideration the needs and demands of the covered population, and includes a clearly defined set of measures to regulate the future production of HR as well as their distribution among and within state health systems, and that allocates incentives to improve performance.

Incentives, Program Configuration, and Employee Uptake of Workplace Wellness Programs.

PubMed

Huang, Haijing; Mattke, Soeren; Batorsky, Benajmin; Miles, Jeremy; Liu, Hangsheng; Taylor, Erin

2016-01-01

The aim of this study was to determine the effect of wellness program configurations and financial incentives on employee participation rate. We analyze a nationally representative survey on workplace wellness programs from 407 employers using cluster analysis and multivariable regression analysis. Employers who offer incentives and provide a comprehensive set of program offerings have higher participation rates. The effect of incentives differs by program configuration, with the strongest effect found for comprehensive and prevention-focused programs. Among intervention-focused programs, incentives are not associated with higher participation. Wellness programs can be grouped into distinct configurations, which have different workplace health focuses. Although monetary incentives can be effective in improving employee participation, the magnitude and significance of the effect is greater for some program configurations than others.

Public and Private Incentives for Investment in Higher Education: Are They Sufficient, Especially for Black Males?

ERIC Educational Resources Information Center

Appiah, Elizabeth N.

2013-01-01

The institutional costs of higher education have been rising. With diminishing public support per student, tuition and fees private costs have also been rising. But so have the real earnings of college graduates. Are there still sufficient incentives on efficiency grounds for additional public investment in higher education? And in particular,…

An alternative incentive structure for wildfire management on national forest land.

Treesearch

Geoffrey H. Donovan; Thomas C. Brown

2005-01-01

Wildfire suppression expenditures on national forest land have increased over the last 35 years, exceeding US $l billion in 2000 and 2002. These increases in expenditure have been attributed, in part, to a century of aggressive wildfire suppression, resulting in a buildup of fuel on the nation's forests. The efficiency of the current incentive structure faced by...

How Do Patients and Providers React to Different Incentives in the Chinese Multiple Health Security Systems?

PubMed Central

Zhang, Chun-Yu; Hashimoto, Hideki

2015-01-01

Background: China has achieved universal health insurance coverage. This study examined how patients and hospitals react to the different designs of the plans and to monitoring of patients by the local authority in the Chinese multiple health security schemes. Methods: The sample for analysis consisted of 1006 orthopedic inpatients who were admitted between January and December 2011 at a tertiary teaching hospital located in Beijing. We conducted general linear regression analyses to investigate whether medical expenditure and length of stay differed according to the different incentives. Results: Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates. Under plans with an annual ceiling for insurance coverage, patients spent significantly more in the second half of the year than in the first half of the year. The length of stay was shorter among patients when there were government monitoring and a penalty to the hospital service provider. Conclusions: Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers. Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use. PMID:25698195

How do patients and providers react to different incentives in the Chinese multiple health security systems?

PubMed

Zhang, Chun-Yu; Hashimoto, Hideki

2015-03-05

China has achieved universal health insurance coverage. This study examined how patients and hospitals react to the different designs of the plans and to monitoring of patients by the local authority in the Chinese multiple health security schemes. The sample for analysis consisted of 1006 orthopedic inpatients who were admitted between January and December 2011 at a tertiary teaching hospital located in Beijing. We conducted general linear regression analyses to investigate whether medical expenditure and length of stay differed according to the different incentives. Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates. Under plans with an annual ceiling for insurance coverage, patients spent significantly more in the second half of the year than in the first half of the year. The length of stay was shorter among patients when there were government monitoring and a penalty to the hospital service provider. Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers. Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.

Cost-Effectiveness of Rural Incentive Packages for Graduating Medical Students in Lao PDR.

PubMed

Keuffell, Eric; Jaskiewicz, Wanda; Theppanya, Khampasong; Tulenko, Kate

2016-10-29

The dearth of health workers in rural settings in Lao People's Democratic Republic (PDR) and other developing countries limits healthcare access and outcomes. In evaluating non-wage financial incentive packages as a potential policy option to attract health workers to rural settings, understanding the expected costs and effects of the various programs ex ante can assist policy-makers in selecting the optimal incentive package. We use discrete choice experiments (DCEs), costing analyses and recent empirical results linking health worker density and health outcomes to estimate the future location decisions of physicians and determine the cost-effectiveness of 15 voluntary incentives packages for new physicians in Lao PDR. Our data sources include a DCE survey completed by medical students (n = 329) in May 2011 and secondary cost, economic and health data. Mixed logit regressions provide the basis for estimating how each incentive package influences rural versus urban location choice over time. We estimate the expected rural density of physicians and the cost-effectiveness of 15 separate incentive packages from a societal perspective. In order to generate the cost-effectiveness ratios we relied on the rural uptake probabilities inferred from the DCEs, the costing data and prior World Health Organization (WHO) estimates that relate health outcomes to health worker density. Relative to no program, the optimal voluntary incentive package would increase rural physician density by 15% by 2016 and 65% by 2041. After incorporating anticipated health effects, seven (three) of the 15 incentive packages have anticipated average cost-effectiveness ratio less than the WHO threshold (three times gross domestic product [GDP] per capita) over a 5-year (30 year) period. The optimal package's incremental cost-effectiveness ratio is $1454/QALY (quality-adjusted life year) over 5 years and $2380/QALY over 30 years. Capital intensive components, such as housing or facility improvement, are not efficient. Conditional on using voluntary incentives, Lao PDR should emphasize non-capital intensive options such as advanced career promotion, transport subsidies and housing allowances to improve physician distribution and rural health outcomes in a cost-effective manner. Other countries considering voluntary incentive programs can implement health worker/trainee DCEs and costing surveys to determine which incentive bundles improve rural uptake most efficiently but should be aware of methodological caveats. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Financial Incentives, Targeting, and Utilization of Child Health Services: Experimental Evidence from Zambia.

PubMed

Fink, Günther; Rockers, Peter C

2017-10-01

To address untreated infections in children, routine health checkups have increasingly been incentivized as part of conditional cash transfer programs targeted at the poor. We conducted a field experiment in Zambia to assess the elasticity of demand for checkups as well as the associated health benefits. We find that relatively small incentives induce substantial increases in uptake among non-farming households and households living farther away from clinics, but not among households in the top wealth quintile. These results suggest that small financial incentives may be an efficient way to target poor populations. However, given the weak socioeconomic gradient in infections observed, small incentives will miss a substantial fraction of exposed children. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Policies, economic incentives and the adoption of modern irrigation technology in China

NASA Astrophysics Data System (ADS)

Cremades, R.; Wang, J.; Morris, J.

2015-07-01

The challenges China faces in terms of water availability in the agricultural sector are exacerbated by the sector's low irrigation efficiency. To increase irrigation efficiency, promoting modern irrigation technology has been emphasized by policy makers in the country. The overall goal of this paper is to understand the effect of governmental support and economic incentives on the adoption of modern irrigation technology in China, with a focus on household-based irrigation technology and community-based irrigation technology. Based on a unique data set collected at household and village levels from seven provinces, the results indicated that household-based irrigation technology has become noticeable in almost every Chinese village. In contrast, only about half of Chinese villages have adopted community-based irrigation technology. Despite the relatively high adoption level of household-based irrigation technology at the village level, its actual adoption in crop sown areas was not high, even lower for community-based irrigation technology. The econometric analysis results revealed that governmental support instruments like subsidies and extension services policies have played an important role in promoting the adoption of modern irrigation technology. Strikingly, the present irrigation pricing policy has played a significant but contradictory role in promoting the adoption of different types of modern irrigation technology. Irrigation pricing showed a positive impact on household-based irrigation technology, and a negative impact on community-based irrigation technology, possibly related to the substitution effect that is, the higher rate of adoption of household-based irrigation technology leads to lower incentives for investment in community-based irrigation technology. The paper finally concludes and discusses some policy implications.

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis.

PubMed

Haff, Nancy; Patel, Mitesh S; Lim, Raymond; Zhu, Jingsan; Troxel, Andrea B; Asch, David A; Volpp, Kevin G

2015-01-01

To evaluate the use of behavioral economics to design financial incentives to promote health behavior change and to explore associations with demographic characteristics. Studies performed by the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania published between January 2006 and March 2014. Randomized, controlled trials with available participant-level data. Studies that did not use financial incentives to promote health behavior change were excluded. Participant-level data from seven studies were pooled. Meta-analysis on the pooled sample using a random-effects model with interaction terms to examine treatment effects and whether they varied by incentive structure or demographic characteristics. The pooled study sample comprised 1403 participants, of whom 35% were female, 70% were white, 24% were black, and the mean age was 48 years (standard deviation 11.2 years). In the fully adjusted model, participants offered financial incentives had higher odds of behavior change (odds ratio [OR]: 3.96; p < .01) when compared to control. There were no significant interactions between financial incentives and gender, age, race, income, or education. When further adjusting for incentive structure, blacks had higher odds than whites of achieving behavior change (OR: 1.67; p < .05) with a conditional payment. Compared to lower-income participants, higher-income participants had lower odds of behavior change (OR: 0.46; p = .01) with a regret lottery. Financial incentives designed using concepts from behavioral economics were effective for promoting health behavior change. There were no large and consistent relationships between the effectiveness of financial incentives and observable demographic characteristics. Second-order examinations of incentive structure suggest potential relationships among the effectiveness of financial incentives, incentive structure, and the demographic characteristics of race and income.

Community opioid treatment perspectives on contingency management: Perceived feasibility, effectiveness, and transportability of social and financial incentives

PubMed Central

Hartzler, Bryan; Rabun, Carl

2013-01-01

Treatment community reluctance toward contingency management (CM) may be better understood by eliciting views of its feasibility, effectiveness, and transportability when social vs. financial incentives are utilized. This mixed method study involved individual staff interviews representing three personnel tiers (an executive, clinical supervisor, and two front-line clinicians) at 16 opiate treatment programs. Interviews included Likert ratings of feasibility, effectiveness, and transportability of each incentive type, and content analysis of corresponding interviewee narrative. Multi-level modeling analyses indicated that social incentives were perceived more feasible, more effective, and more transportable than financial incentives, with results pervading personnel tier. Content analysis suggested the more positive perception of social incentives was most often due to expected logistical advantages, positive impacts on patient quality-of-life, and philosophical congruence among staff. Weaker perception of financial incentives was most often influenced by concerns about costs, patient dissatisfaction, and staff philosophical incongruence. Implications for CM dissemination are discussed. PMID:23506780

The Impact of Region, Nitrogen Use Efficiency, and Grower Incentives on Greenhouse Gas Mitigation in Canola (Brassica napus) Production

NASA Astrophysics Data System (ADS)

Hammac, W. A.; Pan, W.; Koenig, R. T.; McCracken, V.

2012-12-01

The Environmental Protection Agency (EPA) has mandated through the second renewable fuel standard (RFS2) that biodiesel meet a minimum threshold requirement (50% reduction) for greenhouse gas (GHG) emission reduction compared to fossil diesel. This designation is determined by life cycle assessment (LCA) and carries with it potential for monetary incentives for biodiesel feedstock growers (Biomass Crop Assistance Program) and biodiesel processors (Renewable Identification Numbers). A national LCA was carried out for canola (Brassica napus) biodiesel feedstock by the EPA and it did meet the minimum threshold requirement. However, EPA's national LCA does not provide insight into regional variation in GHG mitigation. The authors propose for full GHG reduction potential of biofuels to be realized, LCA results must have regional specificity and should inform incentives for growers and processors on a regional basis. The objectives of this work were to determine (1) variation in biofuel feedstock production related GHG emissions between three agroecological zones (AEZs) in eastern Washington State (2) the impact of nitrogen use efficiency (NUE) on GHG mitigation potential for each AEZ and (3) the impact of incentives on adoption of oilseed production. Results from objective (1) revealed there is wide variability in range for GHG estimates both across and within AEZs based on variation in farming practices and environment. It is expected that results for objective (2) will show further GHG mitigation potential due to minimizing N use and therefore fertilizer transport and soil related GHG emission while potentially increasing biodiesel production per hectare. Regional based incentives may allow more timely achievement of goals for bio-based fuels production. Additionally, incentives may further increase GHG offsetting by promoting nitrogen conserving best management practices implementation. This research highlights the need for regional assessment/incentive based strategies for maximizing GHG mitigation potential of biofuel feedstocks.

Value-Added and Other Methods for Measuring School Performance: An Analysis of Performance Measurement Strategies in Teacher Incentive Fund Proposals. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

In "Value-Added and Other Methods for Measuring School Performance: An Analysis of Performance Measurement Strategies in Teacher Incentive Fund Proposals"--a paper presented at the February 2008 National Center on Performance Incentives research to policy conference--Robert Meyer and Michael Christian examine select performance-pay plans…

Utility Incentives for Combined Heat and Power

EPA Pesticide Factsheets

This report describes the results of EPA's research and analysis into utility incentives for CHP. It provides information about utility-initiated policies, programs, and incentives for CHP systems, and includes case studies and tools and resources.

Design of price incentives for adjunct policy goals in formula funding for hospitals and health services

PubMed Central

Duckett, Stephen J

2008-01-01

Background Hospital policy involves multiple objectives: efficiency of service delivery, pursuit of high quality care, promoting access. Funding policy based on hospital casemix has traditionally been considered to be only about promoting efficiency. Discussion Formula-based funding policy can be (and has been) used to pursue a range of policy objectives, not only efficiency. These are termed 'adjunct' goals. Strategies to incorporate adjunct goals into funding design must, implicitly or explicitly, address key decision choices outlined in this paper. Summary Policy must be clear and explicit about the behaviour to be rewarded; incentives must be designed so that all facilities with an opportunity to improve have an opportunity to benefit; the reward structure is stable and meaningful; and the funder monitors performance and gaming. PMID:18384694

Payment reform to finance a medical home: comment on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".

PubMed

McGuire, Thomas G

2010-01-01

This commentary on R. F. Averill et al. (2010) addresses their idea of risk and quality adjusting fee-for-service payments to primary care physicians in order to improve the efficiency of primary care and take a step toward financing a "medical home"for patients. I show how their idea can create incentives for efficient practice styles. Pairing this with an active beneficiary choice of primary care physician with an enrollment fee would make the idea easier to implement and provide an incentive and the financing for elements of service not covered by procedure-based fees.

Characterizing incentives: an investigation of wildfire response and environmental entry policy

Treesearch

Jude Bayham

2013-01-01

Policy makers face complex situations involving the analysis and weighting of multiple incentives that complicate the design of natural resource and environmental policy. The objective of this dissertation is to characterize policy makers’ incentives, and to investigate the consequences of those incentives on environmental and economic outcomes in the context of...

Social values and the corruption argument against financial incentives for healthy behaviour.

PubMed

Brown, Rebecca C H

2017-03-01

Financial incentives may provide a way of reducing the burden of chronic diseases by motivating people to adopt healthy behaviours. While it is still uncertain how effective such incentives could be for promoting health, some argue that, even if effective, there are ethical objections that preclude their use. One such argument is made by Michael Sandel, who suggests that monetary transactions can have a corrupting effect on the norms and values that ordinarily regulate exchange and behaviour in previously non-monetised contexts. In this paper, I outline Sandel's corruption argument and consider its validity in the context of health incentives. I distinguish between two forms of corruption that are implied by Sandel's argument: efficiency corruption and value corruption While Sandel's thought-provoking discussion provides a valuable contribution to debates about health policies generally and health incentives specifically, I suggest the force of his criticism of health incentives is limited: further empirical evidence and theoretical reasoning are required to support the suggestion that health incentives are an inappropriate tool for promoting health. While I do not find Sandel's corruption argument compelling, this only constitutes a partial defence of health incentives, since other criticisms relating to their use may prove more successful. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis.

PubMed

Mantzari, Eleni; Vogt, Florian; Shemilt, Ian; Wei, Yinghui; Higgins, Julian P T; Marteau, Theresa M

2015-06-01

Uncertainty remains about whether personal financial incentives could achieve sustained changes in health-related behaviors that would reduce the fast-growing global non-communicable disease burden. This review aims to estimate whether: i. financial incentives achieve sustained changes in smoking, eating, alcohol consumption and physical activity; ii. effectiveness is modified by (a) the target behavior, (b) incentive value and attainment certainty, (c) recipients' deprivation level. Multiple sources were searched for trials offering adults financial incentives and assessing outcomes relating to pre-specified behaviors at a minimum of six months from baseline. Analyses included random-effects meta-analyses and meta-regressions grouped by timed endpoints. Of 24,265 unique identified articles, 34 were included in the analysis. Financial incentives increased behavior-change, with effects sustained until 18months from baseline (OR: 1.53, 95% CI 1.05-2.23) and three months post-incentive removal (OR: 2.11, 95% CI 1.21-3.67). High deprivation increased incentive effects (OR: 2.17; 95% CI 1.22-3.85), but only at >6-12months from baseline. Other assessed variables did not independently modify effects at any time-point. Personal financial incentives can change habitual health-related behaviors and help reduce health inequalities. However, their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal. Copyright © 2015. Published by Elsevier Inc.

Incentive program to strengthen motivation for increasing physical activity via conjoint analysis.

PubMed

Matsushita, Munehiro; Harada, Kazuhiro; Arao, Takashi

2017-01-01

Objectives　Promoting physical activity is a key public health issue. Incentive programs have attracted attention as a technique for promoting physical activity. For the use of effective incentives, there is a need to clarify the most effective incentive program conditions for the promotion of physical activity. Therefore, the present study used the conjoint analysis to examine the effective incentive program conditions for strengthening the motivation to increase physical activity.Methods　Data on 1,998 subjects (aged 40-74) were analyzed. The main variables in this study were physical activity (IPAQ-Short Form) and the strengthening of motivation to increase physical activity. The incentive programs that were implemented, comprised four factors: 1) cash equivalents (1,000 yen, 2,000 yen, and 3,000 yen); 2) duration between increase in physical activity and receipt of the incentive (1, 2, or 3 months); 3) method to record the physical activity (recording sheet, recording website, and automatic pedometer recording); and 4) lottery (yes or no). Eleven incentive programs were created, which was the minimum number required for comparison of these factors and levels. The average importance of each of the four factors was calculated to compare their contributions to the strengthening of the motivation to increase physical activity. The utility of each level was also calculated to compare their contributions to the strengthening of motivation. All statistics were stratified by age (≤65 years and 65+ years) and physical activity (<150 min/week, 150+ min/week) for additional analysis.Results　Cash incentives and the lottery ranked equally on average importance, followed by duration and recording methods. Utility was higher for each factor, as follows: 1) more valuable cash incentives, 2) shorter duration, 3) automatic pedometer recording, and 4) no lottery. There was no notable difference in the average importance and utility of age and physical activity.Conclusions　The results of this study suggest that no lottery and more valuable incentives were important for improving the effectiveness of incentive programs in increasing physical activity. Moreover, these two factors would be important regardless of age and physical activity levels. Further intervention studies on incentive programs for increasing physical activity considering the present results are needed.

Efficiency of U.S. Dialysis Centers: An Updated Examination of Facility Characteristics That Influence Production of Dialysis Treatments

PubMed Central

Shreay, Sanatan; Ma, Martin; McCluskey, Jill; Mittelhammer, Ron C; Gitlin, Matthew; Stephens, J Mark

2014-01-01

Objective To explore the relative efficiency of dialysis facilities in the United States and identify factors that are associated with efficiency in the production of dialysis treatments. Data Sources/Study Setting Medicare cost report data from 4,343 free-standing dialysis facilities in the United States that offered in-center hemodialysis in 2010. Study Design A cross-sectional, facility-level retrospective database analysis, utilizing data envelopment analysis (DEA) to estimate facility efficiency. Data Collection/Extraction Methods Treatment data and cost and labor inputs of dialysis treatments were obtained from 2010 Medicare Renal Cost Reports. Demographic data were obtained from the 2010 U.S. Census. Principal Findings Only 26.6 percent of facilities were technically efficient. Neither the intensity of market competition nor the profit status of the facility had a significant effect on efficiency. Facilities that were members of large chains were less likely to be efficient. Cost and labor savings due to changes in drug protocols had little effect on overall dialysis center efficiency. Conclusions The majority of free-standing dialysis facilities in the United States were functioning in a technically inefficient manner. As payment systems increasingly employ capitation and bundling provisions, these institutions will need to evaluate their efficiency to remain competitive. PMID:24237043

Financial incentives linked to self-assessment of prescribing patterns: a new approach for quality improvement of drug prescribing in primary care.

PubMed

Wettermark, Björn; Pehrsson, Ake; Juhasz-Haverinen, Maria; Veg, Aniko; Edlert, Maria; Törnwall-Bergendahl, Gunilla; Almkvist, Henrik; Godman, Brian; Granath, Fredrik; Bergman, Ulf

2009-01-01

Financial incentives have been suggested to be effective in increasing the quality and efficiency of drug prescribing. Concern has been raised in relation to potential negative consequences on the quality of care. To describe and analyse the impact of an incentives model linking payment with adherence to drug and therapeutics committee (DTC) guidelines and self-reflection of prescribing pattern in a 'prescribing quality report'. The study was performed in the county of Stockholm, Sweden, with 139 (out of 154) primary healthcare centres (PHCs) participating in the project and 15 PHCs not participating. The study consisted of two parts: a quantitative observational study of prescribing patterns and a qualitative analysis of the submitted prescribing quality reports. All prescriptions issued from PHCs and dispensed at pharmacies during October to December 2005 and October to December 2006 were analysed, using adherence to the regional DTC guidelines as the main outcome measure. Adherence was assessed using the drug utilisation 90% methodology, i.e. focusing on drugs constituting 90% of the prescribed volume and the proportion of drugs included in the guidelines. The qualitative analysis focused on reports on the quality of drug prescribing submitted by each PHC in early 2007. The 139 PHCs participating in the programme accounted for 85% of all prescriptions issued in primary care during October to December 2006. Mean adherence to guidelines increased among participating practices by 3.3 percentage units (95% confidence interval (CI) 2.9-3.7%) to 83% (82.6-83.7%) during the year. The adherence among practices not participating increased by 3.1 percentage units (95% CI 1.7-4.4%) to 78.8% (95% CI 76.7-80.9%). The higher adherence achieved during the year corresponded to savings estimated at five times greater than the cost of running the programme including the financial incentives. In addition, many areas for improving prescribing were identified, such as limiting the prescribing of drugs with uncertain safety profiles and documentation as well as reporting adverse drug reactions. Although no causal effect can be attributed without a control group, we have shown the feasibility of a model linking payment to DTC adherence. This approach with its own quality assessment and goal setting offers an example to other regions and countries of how to increase the quality and efficiency of drug prescribing within limited resources.

LightForce Photon-Pressure Collision Avoidance: Updated Efficiency Analysis Utilizing a Highly Parallel Simulation Approach

DTIC Science & Technology

2014-09-01

simulation time frame from 30 days to one year. This was enabled by porting the simulation to the Pleiades supercomputer at NASA Ames Research Center, a...including the motivation for changes to our past approach. We then present the software implementation (3) on the NASA Ames Pleiades supercomputer...significantly updated since last year’s paper [25]. The main incentive for that was the shift to a highly parallel approach in order to utilize the Pleiades

Incentive Pass-through for Residential Solar Systems in California

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dong, C. G.; Wiser, Ryan; Rai, Varun

2014-10-01

The deployment of solar photovoltaic (PV) systems has grown rapidly over the last decade, partly because of various government incentives. In the United States, among the largest and longest-running incentives have been those established in California. Building on past research, this report addresses the still-unanswered question: to what degree have the direct PV incentives in California been passed through from installers to consumers? This report helps address this question by carefully examining the residential PV market in California (excluding a certain class of third-party-owned PV systems) and applying both a structural-modeling approach and a reduced-form regression analysis to estimate themore » incentive pass-through rate. The results suggest an average pass-through rate of direct incentives of nearly 100%, though with regional differences among California counties. While these results could have multiple explanations, they suggest a relatively competitive market and well-functioning subsidy program. Further analysis is required to determine whether similar results broadly apply to other states, to other customer segments, to all third-party-owned PV systems, or to all forms of financial incentives for solar (considering not only direct state subsidies, but also utility electric bill savings and federal tax incentives).« less

Cost-effectiveness analysis and innovation.

PubMed

Jena, Anupam B; Philipson, Tomas J

2008-09-01

While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency.

Energy-Efficiency Retrofits in Small-Scale Multifamily Rental Housing: A Business Model

NASA Astrophysics Data System (ADS)

DeChambeau, Brian

The goal of this thesis to develop a real estate investment model that creates a financial incentive for property owners to perform energy efficiency retrofits in small multifamily rental housing in southern New England. The medium for this argument is a business plan that is backed by a review of the literature and input from industry experts. In addition to industry expertise, the research covers four main areas: the context of green building, efficient building technologies, precedent programs, and the Providence, RI real estate market for the business plan. The thesis concludes that the model proposed can improve the profitability of real estate investment in small multifamily rental properties, though the extent to which this is possible depends partially on utility-run incentive programs and the capital available to invest in retrofit measures.

Intrinsic motivation and extrinsic incentives jointly predict performance: a 40-year meta-analysis.

PubMed

Cerasoli, Christopher P; Nicklin, Jessica M; Ford, Michael T

2014-07-01

More than 4 decades of research and 9 meta-analyses have focused on the undermining effect: namely, the debate over whether the provision of extrinsic incentives erodes intrinsic motivation. This review and meta-analysis builds on such previous reviews by focusing on the interrelationship among intrinsic motivation, extrinsic incentives, and performance, with reference to 2 moderators: performance type (quality vs. quantity) and incentive contingency (directly performance-salient vs. indirectly performance-salient), which have not been systematically reviewed to date. Based on random-effects meta-analytic methods, findings from school, work, and physical domains (k = 183, N = 212,468) indicate that intrinsic motivation is a medium to strong predictor of performance (ρ = .21-45). The importance of intrinsic motivation to performance remained in place whether incentives were presented. In addition, incentive salience influenced the predictive validity of intrinsic motivation for performance: In a "crowding out" fashion, intrinsic motivation was less important to performance when incentives were directly tied to performance and was more important when incentives were indirectly tied to performance. Considered simultaneously through meta-analytic regression, intrinsic motivation predicted more unique variance in quality of performance, whereas incentives were a better predictor of quantity of performance. With respect to performance, incentives and intrinsic motivation are not necessarily antagonistic and are best considered simultaneously. Future research should consider using nonperformance criteria (e.g., well-being, job satisfaction) as well as applying the percent-of-maximum-possible (POMP) method in meta-analyses. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Analysis of the Effect of Zero-Emission Vehicle Policies: State-Level Incentives and the California Zero-Emission Vehicle Regulations

EIA Publications

2017-01-01

The U.S. Energy Information Administration (EIA) contracted with Leidos to analyze the effect of California zero-emission vehicle regulations (ZEVR) and state-level incentives on zero-emission and plug-in hybrid vehicle sales. Leidos worked to review the effect of state-level incentives by: *Conducting a review on the available incentives on zero-emission vehicles and related transitional vehicle types such has plug-in hybrid electric vehicles *Quantifying the effective monetary value of these different incentives *Evaluating the combined values of these incentives in each state on an example sale of a Nissan Leaf and Chevrolet Volt

Breaking the Change Barrier: A 40 Year Analysis of Air Force Pilot Retention Solutions

DTIC Science & Technology

national defense. A problem/solution research methodology using the organizational management theory of path dependence explored the implications of the...exodus is to start the incentive process earlier in the career and prior to the final decision to separate. Path dependent analysis indicates all prior... incentive options and personal involvement in the overall process. The Air Force can annually budget and forecast incentive requirements and personnel

The current state of electronic health record (EHR) use in Oklahoma.

PubMed

Khaliq, Amir A; Mwachofi, Ari K; Hughes, Danny R; Broyles, Robert W; Wheeler, Denna; Roswell, Robert H

2013-02-01

There is ample evidence of the positive impact of electronic health records (EHR) on operational efficiencies and quality of care. Yet, growth in the adoption of EHR and sharing of information among providers has been slow. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides financial incentives for eligible providers to adopt and implement EHR. Until now, little information was available regarding the use of EHR in Oklahoma. Sponsored by the Oklahoma Health Information Exchange Trust (OHIET), this study reveals that the frequency of use of EHR among Oklahoma providers is near the national average. Although a large number of Oklahoma physicians have received Medicaid incentive payments for planned adoption, implementation, or upgrade of EHR systems, relatively few eligible providers in Oklahoma have been certified to receive Medicare incentive payments through the Centers for Medicare and Medicaid Services (CMS) and even fewer have actually received these incentive payments.

Motivational incentives modulate age differences in visual perception.

PubMed

Spaniol, Julia; Voss, Andreas; Bowen, Holly J; Grady, Cheryl L

2011-12-01

This study examined whether motivational incentives modulate age-related perceptual deficits. Younger and older adults performed a perceptual discrimination task in which bicolored stimuli had to be classified according to their dominating color. The valent color was associated with either a positive or negative payoff, whereas the neutral color was not associated with a payoff. Effects of incentives on perceptual efficiency and response bias were estimated using the diffusion model (Ratcliff, 1978). Perception of neutral stimuli showed age-related decline, whereas perception of valent stimuli, both positive and negative, showed no age difference. This finding is interpreted in terms of preserved top-down control over the allocation of perceptual processing resources in healthy aging.

Implementing health care reform in Israel: organizational response to perceived incentives.

PubMed

Gross, Revital

2003-08-01

Devising new incentives was a main element of health care reform in Israel, which created a regulated market that embodies many principles of managed competition. This study examined sick fund directors' perceptions of the new incentives and their strategic responses to these incentives, enabling the testing of how managed competition works in practice. The methodology used was a multiple case study of Israel's four sick funds. Data were gathered through in-depth interviews with 160 senior officials, analysis of national health insurance legislation, and analysis of published and unpublished archival documents, newspaper articles, public statements of senior managers, and other published data on the sick funds' behavior. The study revealed discrepancies between planned and perceived incentives and highlighted the effect of the latter on strategy formulation. Analysis of sick fund strategies showed that their responses to managed competition incentives deviated from theoretical expectations, compromising some of the objectives of the reform. The study also shows that contextual features account for the specific model of managed competition that was implemented and for the specific strategies employed by the sick funds. The study concludes by highlighting the need to build a process that will enable policy makers to consider local contextual factors when planning and implementing reform, involving health care providers in designing incentives, continuously monitoring processes and outcomes in the reformed system, and allowing for flexibility in policy making.

Incentives as connectors: insights into a breastfeeding incentive intervention in a disadvantaged area of North-West England

PubMed Central

2012-01-01

Background Incentive or reward schemes are becoming increasingly popular to motivate healthy lifestyle behaviours. In this paper, insights from a qualitative and descriptive study to investigate the uptake, impact and meanings of a breastfeeding incentive intervention integrated into an existing peer support programme (Star Buddies) are reported. The Star Buddies service employs breastfeeding peer supporters to support women across the ante-natal, intra-partum and post-partum period. Methods In a disadvantaged area of North West England, women initiating breastfeeding were recruited by peer supporters on the postnatal ward or soon after hospital discharge to participate in an 8 week incentive (gifts and vouchers) and breastfeeding peer supporter intervention. In-depth interviews were conducted with 26 women participants who engaged with the incentive intervention, and a focus group was held with the 4 community peer supporters who delivered the intervention. Descriptive analysis of routinely collected data for peer supporter contacts and breastfeeding outcomes before and after the incentive intervention triangulated and retrospectively provided the context for the qualitative thematic analysis. Results A global theme emerged of 'incentives as connectors', with two sub-themes of 'facilitating connections' and 'facilitating relationships and wellbeing'. The incentives were linked to discussion themes and gift giving facilitated peer supporter access for proactive weekly home visits to support women. Regular face to face contacts enabled meaningful relationships and new connections within and between the women, families, peer supporters and care providers to be formed and sustained. Participants in the incentive scheme received more home visits and total contact time with peer supporters compared to women before the incentive intervention. Full participation levels and breastfeeding rates at 6-8 weeks were similar for women before and after the incentive intervention. Conclusion The findings suggest that whilst the provision of incentives might not influence women's intentions or motivations to breastfeed, the connections forged provided psycho-social benefits for both programme users and peer supporters. PMID:22458841

Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach.

PubMed

Agyepong, Irene A; Aryeetey, Geneieve C; Nonvignon, Justice; Asenso-Boadi, Francis; Dzikunu, Helen; Antwi, Edward; Ankrah, Daniel; Adjei-Acquah, Charles; Esena, Reuben; Aikins, Moses; Arhinful, Daniel K

2014-08-05

Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects.

Marine Corps Pay Incentives

DTIC Science & Technology

Marines from 2000 to 2017. The thesis includes a literature review on economic theory related to pay incentives in the Department of Defense, a...The purpose of this thesis to provide the Marine Corps with a comprehensive report on pay incentive programs and special pay that were available to...summarization of pay incentive categories, a data analysis on take-up rates and average annual amounts at the end of each fiscal year, and a program review

Agency Theory, Incentives, and Student Loans.

ERIC Educational Resources Information Center

Rudner, Lawrence M.

Using agency theory, this paper analyzes schools, particularly career schools, in the Stafford Loan Program for student incentive to graduate and pay off their loans. Agency theory focuses on the roles of information and incentives when a principal and an agent cooperate with respect to the utilization of resources. The analysis examines the…

Case-mix specialization in the market for hospital services.

PubMed Central

Farley, D E; Hogan, C

1990-01-01

Historically, cost-based reimbursement encouraged hospitals to compete on the basis of quality, leading to duplication of services and other inefficient behavior. More recently, prospective payment, selective contracting, and other innovations in reimbursement have strengthened incentives for more efficient hospital operations. In principle, hospitals may be able to reduce their costs by limiting the array of services they provide, but there has been little empirical evidence that U.S. hospitals are moving toward greater specialization or that specialization leads to cost savings. This article explores recent changes in case-mix specialization and the relationship of these changes to hospital costs. It first describes an index of specialization derived from Information Theory and shows that this index provides intuitively reasonable results in characterizing patterns of specialization across hospitals. The analysis then demonstrates that specialization, as measured by this index, in fact increased from 1980 through 1985; that specialization can indeed lower hospital costs; and that increases in specialization have been largest in those hospitals with the greatest incentives to reduce costs. PMID:2123838

Expert Game experiment predicts emergence of trust in professional communication networks.

PubMed

Bendtsen, Kristian Moss; Uekermann, Florian; Haerter, Jan O

2016-10-25

Strong social capital is increasingly recognized as an organizational advantage. Better knowledge sharing and reduced transaction costs increase work efficiency. To mimic the formation of the associated communication network, we propose the Expert Game, where each individual must find a specific expert and receive her help. Participants act in an impersonal environment and under time constraints that provide short-term incentives for noncooperative behavior. Despite these constraints, we observe cooperation between individuals and the self-organization of a sustained trust network, which facilitates efficient communication channels with increased information flow. We build a behavioral model that explains the experimental dynamics. Analysis of the model reveals an exploitation protection mechanism and measurable social capital, which quantitatively describe the economic utility of trust.

Aligning provider incentives to improve primary healthcare delivery in the United States

PubMed Central

DeVoe, JE; Stenger, R

2016-01-01

Background The United States (US) is reforming primary care delivery systems, including the implementation of ‘patient-centered medical homes.’ Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms. Methods This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create ‘prisoner’s dilemmas’ that have stalled past reform efforts. It then uses this framework to illustrate, hypothetically, how advantages from different models could be blended together to encourage cooperation and improve the quality of primary care services delivered, thus providing an escape from current prisoner’s dilemmas faced by providers. Findings Improvements in primary care delivery will largely hinge on blended payment mechanisms that can effectively combine the advantageous elements of fee-for-service, capitation, and incentive payments into a balanced equation that enables providers to escape the perverse financial incentives of current payment mechanisms and overcome collective action problems. Conclusions If balanced appropriately, a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved. PMID:27942388

iTunes song-gifting is a low-cost, efficient recruitment tool to engage high-risk MSM in internet research.

PubMed

Holland, Christine M; Ritchie, Natalie D; Du Bois, Steve N

2015-10-01

This brief report describes methodology and results of a novel, efficient, and low-cost recruitment tool to engage high-risk MSM in online research. We developed an incentivization protocol using iTunes song-gifting to encourage participation of high-risk MSM in an Internet-based survey of HIV status, childhood sexual abuse, and adult behavior and functioning. Our recruitment methodology yielded 489 participants in 4.5 months at a total incentive cost of $1.43USD per participant. The sample comprised a critically high-risk group of MSM, including 71.0 % who reported recent condomless anal intercourse. We offer a "how-to" guide to aid future investigators in using iTunes song-gifting incentives.

Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

PubMed

Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard

2016-04-01

The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.

76 FR 72923 - Pool Corporation; Analysis To Aid Public Comment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-28

...Corp is the only distributor. New entrants could not offer any economic incentive to manufacturers that... were unable to provide any economic incentive to manufacturers that could offset the risk posed by Pool... exclusionary when it ``created a strong economic incentive for dealers to reject competing lines in favor of...

43 CFR 418.28 - Conditions of delivery.

Code of Federal Regulations, 2010 CFR

2010-10-01

... particulars including the known or estimated location and amounts; (3) The amount will not be included as a valid headgate delivery for purposes of computing the Project efficiency and resultant incentive credit... treated directly as a debit to Lahontan storage in the same manner as an efficiency debit. (b) District...

Normative regulation of material incentives for workers in the sphere of high-rise construction

NASA Astrophysics Data System (ADS)

Kopytova, Anna; Matys, Elena; Zotkina, Natalia; Reshetnikova, Irina; Meller, Natalia; Nekrasova, Inna

2018-03-01

The article is devoted to the problem of normative and legal regulation of incentives for workers of the building companies. The company considered is engaged in high-rise construction. The part of the document "Regulations for the incentives of employees of the enterprise" is presented. This document is introduced into the practical activities of the Tyumen enterprise. The presented part of the document regulates the issues of material incentives for employees of the enterprise. The document "Regulations for the incentives of employees of the enterprise" is developed in accordance with the approach proposed by author. The document was developed, after the authors had carried out an analysis of the scheme of incentives at the enterprise.

Surgical Procedures in Health Professional Shortage Areas: Impact of a Surgical Incentive Payment Plan.

PubMed

Diaz, Adrian; Merath, Katiuscha; Bagante, Fabio; Chen, Qinyu; Akgul, Ozgur; Beal, Eliza; Idrees, Jay; Olsen, Griffin; Gani, Faiz; Pawlik, Timothy M

2018-05-15

The Affordable Care Act established a Center for Medicare/Medicaid Services based 10% reimbursement bonus for general surgeons in Health Professional Shortage Areas. We sought to assess the impact of the Affordable Care Act Surgery Incentive Payment on surgical procedures performed in Health Professional Shortage Areas. Hospital utilization data from the California Office of Statewide Health Planning and Development between January 1, 2006, and December 31, 2015, were used to categorize hospitals according to Health Professional Shortage Area location. A difference-in-differences analysis measured the effect of the Surgery Incentive Payment on year-to-year differences for inpatient and outpatient surgical procedures by hospital type pre- (2006-2010) versus post- (2011-2015) Surgery Incentive Payment implementation. Among 409 unique hospitals that performed surgical procedures for at least 1 year of the study period, 2 performed surgery in a designated Health Professional Shortage Area. The two Health Professional Shortage Area -designated hospitals were located in a rural area, were non-teaching hospitals, and had 196 and 202 hospital beds, respectively. After the enactment of the Surgery Incentive Payment, while non- Health Professional Shortage Areas had only a modest relative decrease in total inpatient procedures (Pre-Surgery Incentive Payment: 4,666,938 versus Post-Surgery Incentive Payment: 4,451,612; Δ-4.6%), the proportional decrease in inpatient surgical procedures at Health Professional Shortage Area hospitals was more marked (Pre-Surgery Incentive Payment: 25,830 versus Post-Surgery Incentive Payment: 21,503; Δ-16.7%). In contrast, Health Professional Shortage Area hospitals proportionally had a greater increase in total outpatient procedures (Pre-Surgery Incentive Payment: 17,840 versus Post-Surgery Incentive Payment: 22,375: Δ+25.4%) versus non- Health Professional Shortage Area hospitals (Pre-Surgery Incentive Payment: 5,863,300 versus Post-Surgery Incentive Payment: 6,156,138; Δ+4.9%). Based on the difference-in-differences analysis, the increase in the trend of surgical procedures at Health Professional Shortage Area hospitals was much more notable after Surgery Incentive Payment implementation (Δ+75.2%). The Medicare Surgery Incentive Payment program was associated with an increase in the number of surgical procedures performed at Health Professional Shortage Area hospitals relative to non-Health Professional Shortage Area hospitals during the study period, reversing the trend from negative to positive. Copyright © 2018 Elsevier Inc. All rights reserved.

Student Participation and Performance on Advanced Placement Exams: Do State-Sponsored Incentives Make a Difference?

ERIC Educational Resources Information Center

Jeong, Dong Wook

2009-01-01

Many states provide incentives to students, teachers, and schools for the participation and success of students on Advanced Placement (AP) examinations administered by the College Board. The purpose of this article is to examine whether these incentives help students enroll and succeed in AP exams. An analysis of nationally representative AP exam…

Results of a State Incentive Program on the Supply and Distribution of National Board Certified Teachers

ERIC Educational Resources Information Center

Elfers, Ana M.; Plecki, Margaret L.

2014-01-01

Investment in state incentive policies to support National Board Certified Teachers (NBCTs) prompt consideration of their distribution and retention. This study examines the results of a state's incentive program for NBCTs, including a targeted bonus for those working in high-poverty schools. A quantitative analysis was conducted of state data…

CSR: Constrained Selfish Routing in Ad-Hoc Networks

NASA Astrophysics Data System (ADS)

Bassem, Christine; Bestavros, Azer

Routing protocols for ad-hoc networks assume that the nodes forming the network are either under a single authority, or else that they would be altruistically forwarding data for other nodes with no expectation of a return. These assumptions are unrealistic since in ad-hoc networks, nodes are likely to be autonomous and rational (selfish), and thus unwilling to help unless they have an incentive to do so. Providing such incentives is an important aspect that should be considered when designing ad-hoc routing protocols. In this paper, we propose a dynamic, decentralized routing protocol for ad-hoc networks that provides incentives in the form of payments to intermediate nodes used to forward data for others. In our Constrained Selfish Routing (CSR) protocol, game-theoretic approaches are used to calculate payments (incentives) that ensure both the truthfulness of participating nodes and the fairness of the CSR protocol. We show through simulations that CSR is an energy efficient protocol and that it provides lower communication overhead in the best and average cases compared to existing approaches.

Benefit design innovations: implications for consumer-directed health care.

PubMed

Tu, Ha T; Ginsburg, Paul B

2007-02-01

Current health insurance benefit designs that simply rely on higher, one-size-fits-all patient cost sharing have limited potential to curb rapidly rising costs, but innovations in benefit design can potentially make cost sharing a more effective tool, according to a new study by the Center for Studying Health System Change (HSC). Innovative benefit designs include incentives to encourage healthy behaviors; incentives that vary by service type, patient condition or enrollee income; and incentives to use efficient providers. But most applications of these innovative designs are not widespread, suggesting that any significant cost impact is many years off. Moreover, regulations governing high-deductible, consumer-directed health plans eligible for health savings accounts (HSAs) preclude some promising benefit design innovations and dilute the incentives in others. A movement away from a one-size-fits-all HSA benefit structure toward a more flexible design might broaden the appeal of HSA plans and enable them to incorporate features that promote cost-effective care.

The Influence of Different Kinds of Incentives on Decision-Making and Cognitive Control in Adolescent Development: A Review of Behavioral and Neuroscientific Studies

PubMed Central

Kray, Jutta; Schmitt, Hannah; Lorenz, Corinna; Ferdinand, Nicola K.

2018-01-01

A number of recent hypothetical models on adolescent development take a dual-systems perspective and propose an imbalance in the maturation of neural systems underlying reward-driven and control-related behavior. In particular, such models suggest that the relative dominance of the early emerging subcortical reward system over the later emerging prefrontal-guided control system leads to higher risk-taking and sensation-seeking behavior in mid-adolescents. Here, we will review recent empirical evidence from behavioral and neuroscientific studies examining interactions between these systems and showing that empirical evidence in support for the view of a higher sensitivity to rewards in mid-adolescents is rather mixed. One possible explanation for this may be the use of different kinds and amounts of incentives across studies. We will therefore include developmental studies comparing the differential influence of primary and secondary incentives, as well as those investigating within the class of secondary incentives the effects of monetary, cognitive, or social incentives. We hypothesized that the value of receiving sweets or sours, winning or losing small or large amounts of money, and being accepted or rejected from a peer group may also changes across development, and thereby might modulate age differences in decision-making and cognitive control. Our review revealed that although developmental studies directly comparing different kinds of incentives are rather scarce, results of various studies rather consistently showed only minor age differences in the impact of incentives on the behavioral level. In tendency, adolescents were more sensitive to higher amounts of incentives and larger uncertainty of receiving them, as well as to social incentives such as the presence of peers observing them. Electrophysiological studies showed that processing efficiency was enhanced during anticipation of incentives and receiving them, irrespective of incentive type. Again, we found no strong evidence for interactions with age across studies. Finally, functional brain imaging studies revealed evidence for overlapping brain regions activated during processing of primary and secondary incentives, as well as social and non-social incentives. Adolescents recruited similar reward-related and control-related brain regions as adults did, but to a different degree. Implications for future research will be discussed. PMID:29875720

The Influence of Different Kinds of Incentives on Decision-Making and Cognitive Control in Adolescent Development: A Review of Behavioral and Neuroscientific Studies.

PubMed

Kray, Jutta; Schmitt, Hannah; Lorenz, Corinna; Ferdinand, Nicola K

2018-01-01

A number of recent hypothetical models on adolescent development take a dual-systems perspective and propose an imbalance in the maturation of neural systems underlying reward-driven and control-related behavior. In particular, such models suggest that the relative dominance of the early emerging subcortical reward system over the later emerging prefrontal-guided control system leads to higher risk-taking and sensation-seeking behavior in mid-adolescents. Here, we will review recent empirical evidence from behavioral and neuroscientific studies examining interactions between these systems and showing that empirical evidence in support for the view of a higher sensitivity to rewards in mid-adolescents is rather mixed. One possible explanation for this may be the use of different kinds and amounts of incentives across studies. We will therefore include developmental studies comparing the differential influence of primary and secondary incentives, as well as those investigating within the class of secondary incentives the effects of monetary, cognitive, or social incentives. We hypothesized that the value of receiving sweets or sours, winning or losing small or large amounts of money, and being accepted or rejected from a peer group may also changes across development, and thereby might modulate age differences in decision-making and cognitive control. Our review revealed that although developmental studies directly comparing different kinds of incentives are rather scarce, results of various studies rather consistently showed only minor age differences in the impact of incentives on the behavioral level. In tendency, adolescents were more sensitive to higher amounts of incentives and larger uncertainty of receiving them, as well as to social incentives such as the presence of peers observing them. Electrophysiological studies showed that processing efficiency was enhanced during anticipation of incentives and receiving them, irrespective of incentive type. Again, we found no strong evidence for interactions with age across studies. Finally, functional brain imaging studies revealed evidence for overlapping brain regions activated during processing of primary and secondary incentives, as well as social and non-social incentives. Adolescents recruited similar reward-related and control-related brain regions as adults did, but to a different degree. Implications for future research will be discussed.

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis.

PubMed

Misra-Hebert, Anita D; Hu, Bo; Taksler, Glen; Zimmerman, Robert; Rothberg, Michael B

2016-08-01

Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse. To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals. Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008-December 2012. Employee patients with diabetes covered by the organization's self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance. Financial incentives for employer-sponsored disease management program participation and achieving goals. Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight. A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p < 0.001). Longitudinal mixed modeling demonstrated improved diabetes and cardiovascular risk factor control in employees vs. non-employees [HbA1c yearly change -0.05 employees vs. 0.00 non-employees, difference in change (DIC) p <0.001]. In their first participation year, employees had larger declines in HbA1c and weight vs. non-employees (0.33 vs. 0.14, DIC p = 0.04) and (2.3 kg vs. 0.1 kg, DIC p < 0.001), respectively. Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p > 0.05). Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.

Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

PubMed

Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

2016-01-01

Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

Understanding the Relationship Between Incentive Design and Participation in U.S. Workplace Wellness Programs.

PubMed

Batorsky, Benjamin; Taylor, Erin; Huang, Crystal; Liu, Hangsheng; Mattke, Soeren

2016-01-01

We aimed to understand how employer characteristics relate to the use of incentives to promote participation in wellness programs and to explore the relationship between incentive type and participation rates. A cross-sectional analysis of nationally representative survey data combined with an administrative business database was employed. Random sampling of U.S. companies within strata based on industry and number of employees was used to determine a final sample of 3000 companies. Of these, 19% returned completed surveys. The survey asked about employee participation rate, incentive type, and gender composition of employees. Incentive types included any incentives, high-value rewards, and rewards plus penalties. Logistic regressions of incentive type on employer characteristics were used to determine what types of employers are more likely to offer which type of incentives. A generalized linear model of participation rate was used to determine the relationship between incentive type and participation. Employers located in the Northeast were 5 to 10 times more likely to offer incentives. Employers with a large number of employees, particularly female employees, were up to 1.25 times more likely to use penalties. Penalty and high-value incentives were associated with participation rates of 68% and 52%, respectively. Industry or regional characteristics are likely determinants of incentive use for wellness programs. Penalties appear to be effective, but attention should be paid to what types of employees they affect.

The use of financial incentives in Australian general practice.

PubMed

Kecmanovic, Milica; Hall, Jane P

2015-05-18

To examine the uptake of financial incentive payments in general practice, and identify what types of practitioners are more likely to participate in these schemes. Analysis of data on general practitioners and GP registrars from the Medicine in Australia - Balancing Employment and Life (MABEL) longitudinal panel survey of medical practitioners in Australia, from 2008 to 2011. Income received by GPs from government incentive schemes and grants and factors associated with the likelihood of claiming such incentives. Around half of GPs reported receiving income from financial incentives in 2008, and there was a small fall in this proportion by 2011. There was considerable movement into and out of the incentives schemes, with more GPs exiting than taking up grants and payments. GPs working in larger practices with greater administrative support, GPs practising in rural areas and those who were principals or partners in practices were more likely to use grants and incentive payments. Administrative support available to GPs appears to be an increasingly important predictor of incentive use, suggesting that the administrative burden of claiming incentives is large and not always worth the effort. It is, therefore, crucial to consider such costs (especially relative to the size of the payment) when designing incentive payments. As market conditions are also likely to influence participation in incentive schemes, the impact of incentives can change over time and these schemes should be reviewed regularly.

Incentive-compatible demand-side management for smart grids based on review strategies

NASA Astrophysics Data System (ADS)

Xu, Jie; van der Schaar, Mihaela

2015-12-01

Demand-side load management is able to significantly improve the energy efficiency of smart grids. Since the electricity production cost depends on the aggregate energy usage of multiple consumers, an important incentive problem emerges: self-interested consumers want to increase their own utilities by consuming more than the socially optimal amount of energy during peak hours since the increased cost is shared among the entire set of consumers. To incentivize self-interested consumers to take the socially optimal scheduling actions, we design a new class of protocols based on review strategies. These strategies work as follows: first, a review stage takes place in which a statistical test is performed based on the daily prices of the previous billing cycle to determine whether or not the other consumers schedule their electricity loads in a socially optimal way. If the test fails, the consumers trigger a punishment phase in which, for a certain time, they adjust their energy scheduling in such a way that everybody in the consumer set is punished due to an increased price. Using a carefully designed protocol based on such review strategies, consumers then have incentives to take the socially optimal load scheduling to avoid entering this punishment phase. We rigorously characterize the impact of deploying protocols based on review strategies on the system's as well as the users' performance and determine the optimal design (optimal billing cycle, punishment length, etc.) for various smart grid deployment scenarios. Even though this paper considers a simplified smart grid model, our analysis provides important and useful insights for designing incentive-compatible demand-side management schemes based on aggregate energy usage information in a variety of practical scenarios.

Barriers to Energy Efficiency and the Uptake of Green Revolving Funds in Canadian Universities

ERIC Educational Resources Information Center

Maiorano, John; Savan, Beth

2015-01-01

Purpose: The purpose of this paper is to investigate the barriers to the implementation of energy efficiency projects in Canadian universities, including access to capital, bounded rationality, hidden costs, imperfect information, risk and split incentives. Methods to address these barriers are investigated, including evaluating the efficacy of…

Strengthening Building Retrofit Markets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Templeton, Mary; Jackson, Robert

2014-04-15

The Business Energy Financing (BEF) program offered commercial businesses in Michigan affordable financing options and other incentives designed to support energy efficiency improvements. We worked through partnerships with Michigan utilities, lenders, building contractors, trade associations, and other community organizations to offer competitive interest rates and flexible financing terms to support energy efficiency projects that otherwise would not have happened. The BEF program targeted the retail food market, including restaurants, grocery stores, convenience stores, and wholesale food vendors, with the goal of achieving energy efficiency retrofits for 2 percent of the target market. We offered low interest rates, flexible payments, easymore » applications and approval processes, and access to other incentives and rebates. Through these efforts, we sought to help customers strive for energy savings retrofits that would save 20 percent or more on their energy use. This program helped Michigan businesses reduce costs by financing energy efficient lighting, heating and cooling systems, insulation, refrigeration, equipment upgrades, and more. Businesses completed the upgrades with the help of our authorized contractors, and, through our lending partners, we provided affordable financing options.« less

Regulatory Incentives and Disincentives for Utility Investments in Grid Modernization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kihm, Steve; Beecher, Janice; Lehr, Ronald L.

Electric power is America's most capital-intensive industry, with more than $100 billion invested each year in energy infrastructure. Investment needs are likely to grow as electric utilities make power systems more reliable and resilient, deploy advanced digital technologies, and facilitate new services to meet some consumers' expectations for greater choice and control. But do current regulatory approaches provide the appropriate incentives for grid modernization investments? This report presents three perspectives: -Financial analyst Steve Kihm begins by explaining that any major investor-owned electric utility that wants to raise capital today can do so at a reasonable cost. The question is whethermore » utility managers want to raise capital for grid modernization. Specifically, they look for investments that create the most value for their existing shareholders. In cases where grid modernization investments are not the best choice in terms of shareholder value, Kihm describes shareholder incentive mechanisms that regulators could consider to encourage such investments when they are in the public interest. -From an institutional perspective, Dr. Janice Beecher finds that the traditional rate-base/rate of return regulatory model provides powerful incentives for utilities to pursue investments, cost control, efficiency and even innovation, and it is well suited to the policy objectives of grid modernization. Prudence of grid modernization investments (fair returns) depends on careful evaluation of the specific asset, and any special incentives (bonus returns) should be used only if they promote economic efficiency consistent with the core goals of economic regulation. According to Beecher, realizing the promises of grid modernization depends on effective implementation of the traditional regulatory model and ratemaking tools to serve the public interest. -Conversely, former commissioner and clean energy consultant Ron Lehr says that rapid electric industry changes require a better alignment of utility investment incentives with changes challenging the electricity sector, emerging grid modernization options and benefits, and public policies. For example, investor-owned utilities typically have an incentive to make capital investments, but rarely to employ expense-based solutions, since utilities do not earn profits on expenses. Further, Lehr cites a variety of factors that stand in the way of creating well targeted and well aligned utility incentives, including litigated regulatory processes. These may be a poor choice for finding the right balance among competing interests, establishing rules of prospective application, justifying demonstrations of new technologies and approaches to meeting emerging consumer demands, and keeping pace with rapid change.« less

Do Incentive-Based Programs Improve Teacher Quality and Student Achievement? An Analysis of Implementation in 12 Urban Charter Schools

ERIC Educational Resources Information Center

Kaimal, Girija; Jordan, Will J.

2016-01-01

Context: Policymakers have increasingly advocated for incentive-based approaches for improving urban schools. Purpose of the study: Few studies have examined the implementation of incentive based approaches in the urban charter school context. This paper presents research findings from a 4-year longitudinal study of the implementation of a…

The Influence of Differing the Paths to an Incentive on Third Graders' Reading Achievement and Attitudes

ERIC Educational Resources Information Center

Fawson, Parker C.; Reutzel, D. Ray; Read, Sylvia; Smith, John A.; Moore, Sharon A.

2009-01-01

The purpose of this study was to examine the impact of four incentive paths on third graders' reading vocabulary and comprehension achievement and recreational and academic reading attitude. One hundred and twenty third-grade students were assigned to one of four incentive path treatment conditions. Data were analyzed using analysis of covariance…

Regulating the Behavior of Nursing Homes through Positive Incentives: An Analysis of Illinois' Quality Incentive Program (QUIP).

ERIC Educational Resources Information Center

Geron, Scott Miyake

1991-01-01

Nursing homes in Illinois Quality Incentive Program receive separate bonus payment per Medicaid day for achieving each of six quality standards. Of 809 participating homes (1985-88), over 90 percent of eligible facilities chose to participate annually. Success in achieving bonus payments in multiple standards increased over time, with 27 percent…

State - Level Regulation's Effectiveness in Addressing Global Climate Change and Promoting Solar Energy Deployment

NASA Astrophysics Data System (ADS)

Peterman, Carla Joy

Paper 1, Local Solutions to Global Problems: Climate Change Policies and Regulatory Jurisdiction, considers the efficacy of various types of environmental regulations when they are applied locally to pollutants whose damages extend beyond the jurisdiction of the local regulators. Local regulations of a global pollutant may be ineffective if producers and consumers can avoid them by transacting outside the reach of the local regulator. In many cases, this may involve the physical relocation of the economic activity, a problem often referred to as "leakage." This paper highlights another way in which local policies can be circumvented: through the shuffling of who buys from whom. The paper maintains that the problems of reshuffling are exacerbated when the options for compliance with the regulations are more flexible. Numerical analyses is presented demonstrating that several proposed policies to limit greenhouse gas emissions from the California electricity sector may have very little effect on carbon emissions if they are applied only within that state. Paper 1 concludes that although local subsidies for energy efficiency, renewable electricity, and transportation biofuels constitute attempts to pick technology winners, they may be the only mechanisms that local jurisdictions, acting alone, have at their disposal to address climate change. Paper 2, Pass-Through of Solar PV Incentives to Consumers: The Early Years of California's Solar PV Incentives, examines the pass through of incentives to California solar PV system owners. The full post-subsidy price consumers pay for solar power is a key metric of the success of solar PV incentive programs and of overall PV market performance. This study examines the early years of California's most recent wave of distributed solar PV incentives (2000-2008) to determine the pass-through of incentives. Examination of this period is both intellectually and pragmatically important due to the high level of incentives provided and subsequent high cost to ratepayers; policymakers' expectations that price declines accrue to consumers; and market structure characteristics that might contribute to incomplete pass-through. This analysis shows that incentive passthrough in the California residential solar PV programs was incomplete. Consumer prices declined 54 cents for every additional dollar of incentive received. A large share of the incentive is captured by the solar PV contractor or other actors in the solar PV supply chain. The finding of incomplete pass-through is persistent across specifications. The analysis also identifies a lower degree of incentive pass-through for consumers in the highest income zip codes. Whether expectations of incentives' pass-through align with reality is critically important in the beginning years of emerging clean energy technology programs since this can affect the likelihood of future government investments and public support. Given the often-held policy assumption that consumer prices are declining in response to incentives, it is useful for policymakers to understand the circumstances under which such an assumption may not hold. Paper 3, Testing the Boundaries of the Solar Photovoltaic Learning System, tests how the choice of experience curves' geographic and technology assumptions affect solar PV experience curve results. Historically, solar PV experience curves have assumed one experience curve represents both module and non-module learning and that this learning happens at a global scale. These assumptions may be inaccurate for solar PV since the learning system, and technology and geographic boundaries, are likely different between PV modules and non-module components. Using 2004 to 2008 PV system price data from 13 states, and a longer time series of PV price data for California, some evidence is found that cumulative capacity at the state level is a better predictor of non-module costs than U.S. or global capacity. This paper explores, but is unable to significantly determine, how knowledge spillovers from neighboring states can influence a state's non-module costs. Given data limitations, and limitations to the two-factor experience model methodology itself, it is not possible to conclusively determine the correct geographic boundary for the non-module learning system. Throughout the paper ways in which the experience curve model and data can be augmented to achieve a better estimation are discussed. 2.

Managing carbon emissions in China through building energy efficiency.

PubMed

Li, Jun; Colombier, Michel

2009-06-01

This paper attempts to analyse the role of building energy efficiency (BEE) in China in addressing climate change mitigation. It provides an analysis of the current situation and future prospects for the adoption of BEE technologies in Chinese cities. It outlines the economic and institutional barriers to large-scale deployment of the sustainable, low-carbon, and even carbon-free construction techniques. Based on a comprehensive overview of energy demand characteristics and development trends driven by economic and demographic growth, different policy tools for cost-effective CO(2) emission reduction in the Chinese construction sector are described. We propose a comprehensive approach combining building design and construction, and the urban planning and building material industries, in order to drastically improve BEE during this period of rapid urban development. A coherent institutional framework needs to be established to ensure the implementation of efficiency policies. Regulatory and incentive options should be integrated into the policy portfolios of BEE to minimise the efficiency gap and to realise sizeable carbon emissions cuts in the next decades. We analyse in detail several policies and instruments, and formulate relevant policy proposals fostering low-carbon construction technology in China. Specifically, Our analysis shows that improving building energy efficiency can generate considerable carbon emissions reduction credits with competitive price under the CDM framework.

Combined heat and power systems: economic and policy barriers to growth.

PubMed

Kalam, Adil; King, Abigail; Moret, Ellen; Weerasinghe, Upekha

2012-04-23

Combined Heat and Power (CHP) systems can provide a range of benefits to users with regards to efficiency, reliability, costs and environmental impact. Furthermore, increasing the amount of electricity generated by CHP systems in the United States has been identified as having significant potential for impressive economic and environmental outcomes on a national scale. Given the benefits from increasing the adoption of CHP technologies, there is value in improving our understanding of how desired increases in CHP adoption can be best achieved. These obstacles are currently understood to stem from regulatory as well as economic and technological barriers. In our research, we answer the following questions: Given the current policy and economic environment facing the CHP industry, what changes need to take place in this space in order for CHP systems to be competitive in the energy market? We focus our analysis primarily on Combined Heat and Power Systems that use natural gas turbines. Our analysis takes a two-pronged approach. We first conduct a statistical analysis of the impact of state policies on increases in electricity generated from CHP system. Second, we conduct a Cost-Benefit analysis to determine in which circumstances funding incentives are necessary to make CHP technologies cost-competitive. Our policy analysis shows that regulatory improvements do not explain the growth in adoption of CHP technologies but hold the potential to encourage increases in electricity generated from CHP system in small-scale applications. Our Cost-Benefit analysis shows that CHP systems are only cost competitive in large-scale applications and that funding incentives would be necessary to make CHP technology cost-competitive in small-scale applications. From the synthesis of these analyses we conclude that because large-scale applications of natural gas turbines are already cost-competitive, policy initiatives aimed at a CHP market dominated primarily by large-scale (and therefore already cost-competitive) systems have not been effectively directed. Our recommendation is that for CHP technologies using natural gas turbines, policy focuses should be on increasing CHP growth in small-scale systems. This result can be best achieved through redirection of state and federal incentives, research and development, adoption of smart grid technology, and outreach and education.

Aligning incentives in supply chains.

PubMed

Narayanan, V G; Raman, Ananth

2004-11-01

Most companies don't worry about the behavior of their supply chain partners. Instead, they expect the supply chain to work efficiently without interference, as if guided by Adam Smith's famed invisible hand. In their study of more than 50 supply networks, V.G. Narayanan and Ananth Raman found that companies often looked out for their own interests and ignored those of their network partners. Consequently, supply chains performed poorly. Those results aren't shocking when you consider that supply chains extend across several functions and many companies, each with its own priorities and goals. Yet all those functions and firms must pull in the same direction for a chain to deliver goods and services to consumers quickly and cost-effectively. According to the authors, a supply chain works well only if the risks, costs, and rewards of doing business are distributed fairly across the network. In fact, misaligned incentives are often the cause of excess inventory, stock-outs, incorrect forecasts, inadequate sales efforts, and even poor customer service. The fates of all supply chain partners are interlinked: If the firms work together to serve consumers, they will all win. However, they can do that only if incentives are aligned. Companies must acknowledge that the problem of incentive misalignment exists and then determine its root cause and align or redesign incentives. They can improve alignment by, for instance, adopting revenue-sharing contracts, using technology to track previously hidden information, or working with intermediaries to build trust among network partners. It's also important to periodically reassess incentives, because even top-performing networks find that changes in technology or business conditions alter the alignment of incentives.

75 FR 27165 - Conservation Reserve Program; Transition Incentives Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... resource base; (iii) Use nonrenewable resources efficiently; and (iv) Sustain the economic viability of... available from the contact information listed above. Summary of Economic Impacts The 2008 Farm Bill...

The effectiveness of financial incentives for health behaviour change: systematic review and meta-analysis.

PubMed

Giles, Emma L; Robalino, Shannon; McColl, Elaine; Sniehotta, Falko F; Adams, Jean

2014-01-01

Financial incentive interventions have been suggested as one method of promoting healthy behaviour change. To conduct a systematic review of the effectiveness of financial incentive interventions for encouraging healthy behaviour change; to explore whether effects vary according to the type of behaviour incentivised, post-intervention follow-up time, or incentive value. Searches were of relevant electronic databases, research registers, www.google.com, and the reference lists of previous reviews; and requests for information sent to relevant mailing lists. Controlled evaluations of the effectiveness of financial incentive interventions, compared to no intervention or usual care, to encourage healthy behaviour change, in non-clinical adult populations, living in high-income countries, were included. The Cochrane Risk of Bias tool was used to assess all included studies. Meta-analysis was used to explore the effect of financial incentive interventions within groups of similar behaviours and overall. Meta-regression was used to determine if effect varied according to post-intervention follow up time, or incentive value. Seventeen papers reporting on 16 studies on smoking cessation (n = 10), attendance for vaccination or screening (n = 5), and physical activity (n = 1) were included. In meta-analyses, the average effect of incentive interventions was greater than control for short-term (≤ six months) smoking cessation (relative risk (95% confidence intervals): 2.48 (1.77 to 3.46); long-term (>six months) smoking cessation (1.50 (1.05 to 2.14)); attendance for vaccination or screening (1.92 (1.46 to 2.53)); and for all behaviours combined (1.62 (1.38 to 1.91)). There was not convincing evidence that effects were different between different groups of behaviours. Meta-regression found some, limited, evidence that effect sizes decreased as post-intervention follow-up period and incentive value increased. However, the latter effect may be confounded by the former. The available evidence suggests that financial incentive interventions are more effective than usual care or no intervention for encouraging healthy behaviour change. PROSPERO CRD42012002393.

Developing and testing a positive theory of instrument choice: Renewable energy policy in the fifty American states

NASA Astrophysics Data System (ADS)

Ciocirlan, Cristina E.

The environmental economics literature consistently suggests that properly designed and implemented economic incentives are superior to command-and-control regulation in reducing pollution. Economic incentives, such as green taxes, cap-and-trade programs, tax incentives, are able to reduce pollution in a cost-effective manner, provide flexibility to industry and stimulate innovation in cleaner technologies. In the past few decades, both federal and state governments have shown increased use of economic incentives in environmental policy. Some states have embraced them in an active manner, while others have failed to do so. This research uses a three-step analysis. First, it asks why some states employ more economic incentives than others to stimulate consumption of renewable energy by the residential, commercial and industrial sectors. Second, it asks why some states employ stronger incentives than others. And third, it asks why certain states employ certain instruments, such as electricity surcharges, cap-and-trade programs, tax incentives or grants, while others do not. The first two analyses were conducted using factor analysis and multiple regression analysis, while the third analysis employed logistic regression models to analyze the data. Data for all three analyses were obtained from a combination of primary and secondary sources. To address these questions, a theory of instrument choice at the state level, which includes both internal and external determinants of policy-making, was developed and tested. The state level of analysis was chosen. States have proven to be pioneers in designing policies to address greenhouse gases (see, for instance, the recent cap-and-trade legislation passed in California). The theory was operationalized with the help of four models: needs/responsiveness, interest group influence, professionalism/capacity and innovation-and-diffusion. The needs/responsiveness model suggests that states tend to choose more and stronger economic incentives when they are more dependent on conventional sources of energy, such as coal, oil and gas or when they have the potential to produce renewable energy. The interest group influence model suggests that instrument choice is ultimately a political decision, most likely to benefit some groups more than others. The professionalism/capacity model posits that states with more professional legislatures, with legislators who make more use of policy analysis, with more capacity to generate nonpartisan policy research and with larger agencies tend to employ more and stronger instruments to stimulate renewable energy consumption and production. And last, the innovation-and-diffusion model suggests that states with a proven innovation record in climate change tend to employ more and stronger economic incentives than states without such record. Also, this model explains states' instrument choice decisions as a function of the choices made by their neighbors.

Do Self-Incentives and Self-Rewards Change Behavior? A Systematic Review and Meta-Analysis.

PubMed

Brown, Emma M; Smith, Debbie M; Epton, Tracy; Armitage, Christopher J

2018-01-01

Encouraging people to self-incentivize (i.e., to reward themselves in the future if they are successful in changing their behavior) or self-reward (i.e., prompt people to reward themselves once they have successfully changed their behavior) are techniques that are frequently embedded within complex behavior change interventions. However, it is not clear whether self-incentives or self-rewards per se are effective at bringing about behavior change. Nine databases were searched alongside manual searching of systematic reviews and online research registers. One thousand four hundred papers were retrieved, spanning a range of behaviors, though the majority of included papers were in the domain of "health psychology". Ten studies matched the inclusion criteria for self-incentive but no studies were retrieved for self-reward. The present systematic review and meta-analysis is therefore the first to evaluate the unique effect of self-incentives on behavior change. Effect sizes were retrieved from 7 of the 10 studies. Analysis of the 7 studies produced a very small pooled effect size for self-incentives (k = 7, N = 1,161), which was statistically significant, d + = 0.17, CI [0.06, 0.29]. The weak effect size and dearth of studies raises the question of why self-incentivizing is such a widely employed component of behavior change interventions. The present research opens up a new field of inquiry to establish: (a) whether or not self-incentivizing and self-rewarding are effective behavior change techniques, (b) whether self-incentives and self-rewards need to be deployed alongside other behavior change techniques, and, (c) when and for whom self-incentives and self-rewards could support effective behavior change. Copyright © 2017. Published by Elsevier Ltd.

The "common sense" of the nonprofit hospital tax exemption: a policy analysis.

PubMed

Sanders, S M

1995-01-01

Although rarely discussed prior to the 1985 Utah Supreme Court ruling against Intermountain Health Care Inc., the question of whether to grant tax exemptions to nonprofit hospitals is currently being debated by federal, state, and local legislators, and by the courts. Changes to current policy seem likely. This policy analysis: (1) presents the historical and legal background; (2) examines the economic, political, and organizational implications of current tax-exemption policy; and (3) offers three alternatives to this current policy. The analysis indicates that the current policy provides little incentive for nonprofit hospitals to make contributions of charity care. Of the alternatives, eliminating the exemption is not politically feasible at this time; regulating hospital operations and outputs portends an implementation nightmare; and tying tax subsidy levels to output levels of charity care--perhaps the strongest and most efficient incentive--would require an unlikely political consensus on what constitute valid and reliable measures of charity care. If there is a movement toward subsidies, then linking subsidy amounts to levels of charity care will depend on whether policy analysts can design satisfactory empirical measures. With the advent of universal health coverage, the demand for charity care will decrease. The problem for tax-exempt hospitals will then become justifying the exemption by demonstrating the extent to which they generate community benefits at no or reduced cost to society.

What incentives influence employers to engage in workplace health interventions?

PubMed

Martinsson, Camilla; Lohela-Karlsson, Malin; Kwak, Lydia; Bergström, Gunnar; Hellman, Therese

2016-08-23

To achieve a sustainable working life it is important to know more about what could encourage employers to increase the use of preventive and health promotive interventions. The objective of the study is to explore and describe the employer perspective regarding what incentives influence their use of preventive and health promotive workplace interventions. Semi-structured focus group interviews were carried out with 20 representatives from 19 employers across Sweden. The economic sectors represented were municipalities, government agencies, defence, educational, research, and development institutions, health care, manufacturing, agriculture and commercial services. The interviews were transcribed verbatim and the data were analysed using latent content analysis. Various incentives were identified in the analysis, namely: "law and provisions", "consequences for the workplace", "knowledge of worker health and workplace health interventions", "characteristics of the intervention", "communication and collaboration with the provider". The incentives seemed to influence the decision-making in parallel with each other and were not only related to positive incentives for engaging in workplace health interventions, but also to disincentives. This study suggests that the decision to engage in workplace health interventions was influenced by several incentives. There are those incentives that lead to a desire to engage in a workplace health intervention, others pertain to aspects more related to the intervention use, such as the characteristics of the employer, the provider and the intervention. It is important to take all incentives into consideration when trying to understand the decision-making process for workplace health interventions and to bridge the gap between what is produced through research and what is used in practice.

Behavioural incentive interventions for health behaviour change in young people (5-18 years old): A systematic review and meta-analysis.

PubMed

Corepal, Rekesh; Tully, Mark A; Kee, Frank; Miller, Sarah J; Hunter, Ruth F

2018-05-01

Physical inactivity, an unhealthy diet, smoking, and alcohol consumption are key determinants of morbidity and mortality. These health behaviours often begin at a young age and track into adulthood, emphasising a need for interventions in children and young people. Previous research has demonstrated the potential effectiveness of behavioural incentive (BI) interventions in adults. However, little is known about their effectiveness in children and adolescents. Eight bibliographic databases were searched. Eligibility criteria included controlled trials using behavioural incentives (rewards provided contingent on successful performance of the target behaviour) as an intervention component for health behaviour change in children and adolescents. Intervention effects (standardised mean differences or odds ratios) were calculated and pooled by health behaviour, using a random effects model. Twenty-two studies were included (of n = 8392 identified), 19 of which were eligible for meta-analysis: physical activity (n = 8); healthier eating (n = 3); and smoking (n = 8). There was strong evidence that behavioural incentives may encourage healthier eating behaviours, some evidence that behavioural incentives were effective for encouraging physical activity behaviour, and limited evidence to support the use of behavioural incentives for smoking cessation and prevention in adolescents. Findings suggest that behavioural incentives may encourage uptake and initiation of healthy eating and physical activity in young people. However, this is a limited evidence base and a wide range of incentive designs have yet to be explored. Future research should further investigate the acceptability of these intervention approaches for young people. Copyright © 2018 Elsevier Inc. All rights reserved.

Calculations of financial incentives for providers in a pay-for-performance program: Manual review versus data from structured fields in electronic health records

PubMed Central

Urech, Tracy H.; Woodard, LeChauncy D.; Virani, Salim S.; Dudley, R. Adams; Lutschg, Meghan Z.; Petersen, Laura A.

2015-01-01

Background Hospital report cards and financial incentives linked to performance require clinical data that are reliable, appropriate, timely, and cost-effective to process. Pay-for-performance plans are transitioning to automated electronic health record (EHR) data as an efficient method to generate data needed for these programs. Objective To determine how well data from automated processing of structured EHR fields (AP-EHR) reflect data from manual chart review and the impact of these data on performance rewards. Research Design Cross-sectional analysis of performance measures used in a cluster randomized trial assessing the impact of financial incentives on guideline-recommended care for hypertension. Subjects A total of 2,840 patients with hypertension assigned to participating physicians at 12 Veterans Affairs hospital-based outpatient clinics. Fifty-two physicians and 33 primary care personnel received incentive payments. Measures Overall, positive and negative agreement indices and Cohen's kappa were calculated for assessments of guideline-recommended antihypertensive medication use, blood pressure (BP) control, and appropriate response to uncontrolled BP. Pearson's correlation coefficient was used to assess how similar participants’ calculated earnings were between the data sources. Results By manual chart review data, 72.3% of patients were considered to have received guideline-recommended antihypertensive medications compared to 65.0% by AP-EHR review (k=0.51). Manual review indicated 69.5% of patients had controlled BP compared to 66.8% by AP-EHR review (k=0.87). Compared to 52.2% of patients per the manual review, 39.8% received an appropriate response by AP-EHR review (k=0.28). Participants’ incentive payments calculated using the two methods were highly correlated (r≥0.98). Using the AP-EHR data to calculate earnings, participants’ payment changes ranged from a decrease of $91.00 (−30.3%) to an increase of $18.20 (+7.4%) for medication use (IQR, −14.4% to 0%) and a decrease of $100.10 (−31.4%) to an increase of $36.40 (+15.4%) for BP control or appropriate response to uncontrolled BP (IQR, −11.9% to −6.1%). Conclusions Pay-for-performance plans that use only EHR data should carefully consider the measures and the structure of the EHR before data collection and financial incentive disbursement. For this study, we feel that a 10% difference in the total amount of incentive earnings disbursed based on AP-EHR data compared to manual review is acceptable given the time and resources required to abstract data from medical records. PMID:26340661

Incentives for breastfeeding and for smoking cessation in pregnancy: an exploration of types and meanings.

PubMed

Crossland, Nicola; Thomson, Gill; Morgan, Heather; Dombrowski, Stephan U; Hoddinott, Pat

2015-03-01

Financial or tangible incentives are a strategy for improving health behaviours. The mechanisms of action of incentives are complex and debated. Using a multidisciplinary integrated mixed methods study, with service-user collaboration throughout, we developed a typology of incentives and their meanings for initiating and sustaining smoking cessation in pregnancy and breastfeeding. The ultimate aim was to inform incentive intervention design by providing insights into incentive acceptability and mechanisms of action. Systematic evidence syntheses of incentive intervention studies for smoking cessation in pregnancy or breastfeeding identified incentive characteristics, which were developed into initial categories. Little published qualitative data on user perspectives and acceptability was available. Qualitative interviews and focus groups conducted in three UK regions with a diverse socio-demographic sample of 88 women and significant others from the target population, 53 service providers, 24 experts/decision makers, and conference attendees identified new potential incentives and providers, with and without experience of incentives. Identified incentives (published and emergent) were classified into eight categories: cash and shopping vouchers, maternal wellbeing, baby and pregnancy-related, behaviour-related, health-related, general utility, awards and certificates, and experiences. A typology was refined iteratively through concurrent data collection and thematic analysis to explore participants' understandings of 'incentives' and to compare and contrast meanings across types. Our typology can be understood in three dimensions: the degree of restriction, the extent to which each is hedonic and/or utilitarian, and whether each has solely monetary value versus monetary with added social value. The layers of autonomy, meanings and the social value of incentive types influence their acceptability and interact with structural, social, and personal factors. Dimensions of incentive meaning that go beyond the simple incentive description should inform incentive programme design and are likely to influence outcomes. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Mandatory high-risk pooling: an approach to reducing incentives for cream skimming.

PubMed

van Barneveld, E M; van Vliet, R C; van de Ven, W P

1996-01-01

Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in The Netherlands. Crude RACPs are inadequate, especially because they encourage insurers to select against people expected to be unprofitable--a practice called cream skimming. However, implementing improved RACPs does not appear to be straightforward. This paper analyzes an approach that, given a system of crude RACPs, reduces insurers' incentives for cream skimming in the market for individual health insurance, while preserving incentives for efficiency and cost containment. Under the proposed system of Mandatory High-Risk Pooling (MHRP), each insurer would be allowed to periodically predetermine a small fraction of its members whose costs would be (partially) pooled. The pool would be financed with mandatory, flat-rate contributions. The results suggest that MHRP is a promising supplement to RACPs.

Monetary incentives to reinforce engagement and achievement in a job-skills training program for homeless, unemployed adults.

PubMed

Koffarnus, Mikhail N; Wong, Conrad J; Fingerhood, Michael; Svikis, Dace S; Bigelow, George E; Silverman, Kenneth

2013-01-01

The current study examined whether monetary incentives could increase engagement and achievement in a job-skills training program for unemployed, homeless, alcohol-dependent adults. Participants (n=124) were randomized to a no-reinforcement group (n=39), during which access to the training program was provided but no incentives were given; a training reinforcement group (n=42), during which incentives were contingent on attendance and performance; or an abstinence and training reinforcement group (n=43), during which incentives were contingent on attendance and performance, but access was granted only if participants demonstrated abstinence from alcohol. abstinence and training reinforcement and training reinforcement participants advanced further in training and attended more hours than no-reinforcement participants. Monetary incentives were effective in promoting engagement and achievement in a job-skills training program for individuals who often do not take advantage of training programs. © Society for the Experimental Analysis of Behavior.

The Impact of Hybrid Electric Vehicles Incentives on Demand and the Determinants of Hybrid-Vehicle Adoption

NASA Astrophysics Data System (ADS)

Riggieri, Alison

According to the Energy Information Administration, transportation currently accounts for over 60% of U.S. oil demand (E.I.A. 2010). Improving automobile energy efficiency could therefore reduce oil consumption and the negative environmental effects of automobile use. Subsidies for energy-efficient technologies such as hybrid-electric vehicles have gained political popularity since their introduction into the market and therefore have been implemented with increasing frequency. After the introduction of hybrid-electric vehicles into the U.S. market, the federal government initially implemented a 2000 federal tax deduction for these vehicles (later increased to a 3500 credit). Many states followed, offering various exemptions, such as high-occupancy vehicle (HOV) lane use, and excise-tax, sales-tax, and income-tax exemptions. Because not all states have implemented these subsidies, this policy topic is an ideal candidate for an outcome evaluation using an observational study postulation. States adopt incentives for different reasons based on factors that make adoption more attractive, however, so it is first necessary to identify these differences that predict policy adoption. This allows for the evaluative work to control for self selection bias. Three classes of internal determinants of policy adoption, political context, problem severity, and institutional support, and one type of external diffusion factor, are tested using logistic regression. Results suggest that the number of neighboring states that have already adopted incentives are consistently a determinant of diffusion for all three types of incentives test, HOV lane exemptions, sales-tax exemptions, and income-tax exemptions. In terms of internal factors, constituent support, a type of political context, predicts, sale-tax, income-tax, and HOV lane exemptions, but that the other two classes of determinants, problem severity and institutional support, were not universally significant across types of incentives. Overall, these results suggest automobile manufacturing did not impact whether these policies were implemented, nor were they implemented to address air quality issues or gas price increases. Rather these policies were responses to popular support for hybrid vehicles. In addition, this dissertation identifies the average treatment effect of these incentives on state-level demand for hybrid vehicles. These effects are estimated using traditional parametric techniques, difference-in-difference regression, and fixed effects on two comparison groups: (1) the natural control group, states that did not adopt subsidies, and (2) a constructed control group, states that proposed subsidies during this same time period but did not adopt them. In addition to these parametric models, propensity score matching was used to construct a third comparison group using the models that identified determinants of the policy adoption. These findings were supplemented by exploratory analyses using the individual-level National Household Travel Survey. This multitude of evaluative analyses shows that overall, monetary hybrid incentives are not overwhelming effective in promoting the diffusion of this technology, but that HOV lane exemptions, however, if implemented in places with high traffic congestion, were found to impact aggregate demand and an individual's propensity to adopt a hybrid. The other two types of incentives, sales tax exemptions and income tax credits, were not found to be effective at the aggregate or the individual level. In addition, travel behavior was found to strongly predict adoption, more so than socioeconomic variables, stated attitudes, or characteristics of the built environment. The number of walking trips per month and the number of times a person used public transportation were found to be significant predictors of hybrid adoption, implying the decision to adopt a hybrid includes factors other than purely economic ones, such as environmental attitudes. These analyses provide insight into why states adopt certain policies and the circumstances in which these incentives are effective. Since people may be motivated by factors other than economic factors, creating effective incentives for energy efficiency technologies may be more challenging than just offsetting the price differential. Instead, customization to the local community's characteristics could help increase the efficacy of such policies.

Restructuring Primary Health Care Markets in New Zealand: from Welfare Benefits to Insurance Markets

PubMed Central

Howell, Bronwyn

2005-01-01

Background New Zealand's Primary Health Care Strategy (NZPHCS) was introduced in 2002. Its features are substantial increases in government funding delivered as capitation payments, and newly-created service-purchasing agencies. The objectives are to reduce health disparities and to improve health outcomes. Analysis The NZPHCS changes New Zealand's publicly-funded primary health care payments from targeted welfare benefits to universal, risk-rated insurance premium subsidies. Patient contributions change from fee-for-service top-ups to insurance premium top-ups, and are collected by service providers who, depending upon their contracts with purchasers, may also be either insurance agents or risk-bearing insurance companies. The change invokes the tensions associated with allocating risk-bearing amongst providers, patients and insurance companies that accompany all insurance-based funding instruments. These include increases in existing incentives for over-consumption and new incentives for insurers to limit their exposure to variations in patient health states by engaging in active patient pool selection. The New Zealand scheme is complex, but closely resembles United States insurance-based, risk-rated managed care schemes. The key difference is that unlike classic managed care models, where provider remuneration is determined by the insurer, the historic right for general practitioners to autonomously set patient charges alters the fiscal incentives normally available to managed care organisations. Consequently, the insurance role is being devolved to individual service providers with very small patient pools, who must recoup the premium top-ups from insured individuals. Premium top-ups are being collected only from those individuals consuming care, in proportion to the number of times care is sought. Co-payments thus constitute perfectly risk-rated premium levies set by inefficiently small insurers, raising questions about the efficiency and equity of a 'universal' insurance system pooling total population demands and costs. The efficacy of using financial incentives to constrain costs and encourage innovation when providers retain the right to arbitrarily recoup costs directly from patients, is also questioned. Results Initial evidence suggests that total costs are higher than initially expected, and prices to some patients have risen substantially under the NZPHCS. Limited competition and NZPHCS governance requirements mean current institutional arrangements are unlikely to facilitate efficiency improvements. System design changes therefore appear indicated. PMID:16144544

A business case for HIT adoption: effects of "meaningful use" EHR financial incentives on clinic revenue.

PubMed

Behkami, Nima A; Dorr, David A; Morrice, Stuart

2010-01-01

The goal of this study is to describe a framework that allows decision makers to efficiently evaluate factors that affect Electronic Health Record (EHR) adoption and test suitable interventions; specifically financial incentives. The United States healthcare delivery system is experiencing a transformation to improve population health. There is strong agreement that "meaningful use" of Health Information Technology (HIT) is a major enabler in this effort. However it's also understood that the high cost of implementing an EHR is an obstacle for adoption. To help understand these complexities we developed a simulation model designed to capture the dynamic nature of policy interventions that affect the adoption of EHR. We found that "Effective" use of HIT approaches break-even-point and larger clinic revenue many times faster that "average" or "poor" use of HIT. This study uses a systems perspective to the evaluate EHR adoption process through the "meaningful use" redesign as proposed in the American Reinvestment and Recovery Act 2009 in the United States healthcare industry by utilizing the System Dynamics methodology and Scenario Analysis.

Evaluating agricultural nonpoint-source pollution programs in two Lake Erie tributaries.

PubMed

Forster, D Lynn; Rausch, Jonathan N

2002-01-01

During the past three decades, numerous government programs have encouraged Lake Erie basin farmers to adopt practices that reduce water pollution. The first section of this paper summarizes these state and federal government agricultural pollution abatement programs in watersheds of two prominent Lake Erie tributaries, the Maumee River and Sandusky River. Expenditures are summarized for each program, total expenditures in each county are estimated, and cost effectiveness of program expenditures (i.e., cost per metric ton of soil saved) are analyzed. Farmers received nearly $143 million as incentive payments to implement agricultural nonpoint source pollution abatement programs in the Maumee and Sandusky River watersheds from 1987 to 1997. About 95% of these funds was from federal sources. On average, these payments totaled about $7000 per farm or about $30 per farm acre (annualized equivalent of $2 per acre) within the watersheds. Our analysis raises questions about how efficiently these incentive payments were allocated. The majority of Agricultural Conservation Program (ACP) funds appear to have been spent on less cost-effective practices. Also, geographic areas with relatively low (high) soil erosion rates received relatively large (small) funding.

The Price of Uncertainty in Security Games

NASA Astrophysics Data System (ADS)

Grossklags, Jens; Johnson, Benjamin; Christin, Nicolas

In the realm of information security, lack of information about other users' incentives in a network can lead to inefficient security choices and reductions in individuals' payoffs. We propose, contrast and compare three metrics for measuring the price of uncertainty due to the departure from the payoff-optimal security outcomes under complete information. Per the analogy with other efficiency metrics, such as the price of anarchy, we define the price of uncertainty as the maximum discrepancy in expected payoff in a complete information environment versus the payoff in an incomplete information environment. We consider difference, payoffratio, and cost-ratio metrics as canonical nontrivial measurements of the price of uncertainty. We conduct an algebraic, numerical, and graphical analysis of these metrics applied to different well-studied security scenarios proposed in prior work (i.e., best shot, weakest-link, and total effort). In these scenarios, we study how a fully rational expert agent could utilize the metrics to decide whether to gather information about the economic incentives of multiple nearsighted and naïve agents. We find substantial differences between the various metrics and evaluate the appropriateness for security choices in networked systems.

Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme – a systems approach

PubMed Central

2014-01-01

Background Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. Methods A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. Results There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. Conclusions As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects. PMID:25096303

Effect of Incentives and Mailing Features on Online Health Program Enrollment

PubMed Central

Alexander, Gwen L.; Divine, George W.; Couper, Mick P.; McClure, Jennifer B.; Stopponi, Melanie A.; Fortman, Kristine K.; Tolsma, Dennis D.; Strecher, Victor J.; Johnson, Christine Cole

2008-01-01

Background With the growing use of Internet-based interventions, strategies are needed to encourage broader participation. This study examined the effects of combinations of monetary incentives and mailing characteristics on enrollment, retention, and cost effectiveness for an online health program. Methods In 2004, a recruitment letter was mailed to randomly selected Midwestern integrated health system members aged 21–65 and stratified by gender and race/ethnicity; recipients were randomly pre-assigned to one of 24 combinations of incentives and various mailing characteristics. Enrollment and 3-month retention rates were measured by completion of online surveys. Analysis, completed in 2005, compared enrollment and retention factors using t tests and chi-square tests. Multivariate logistic regression modeling assessed the probability of enrollment and retention. Results Of 12,289 subjects, 531 (4.3%) enrolled online, ranging from 1% to 11% by incentive combination. Highest enrollment occurred with unconditional incentives, and responses varied by gender. Retention rates ranged from 0% to 100%, with highest retention linked to higher-value incentives. The combination of a $2 bill prepaid incentive and the promise of $20 for retention (10% enrollment and 71% retention) was optimal, considering per-subject recruitment costs ($32 enrollment, $70 retention) and equivalent enrollment by gender and race/ethnicity. Conclusions Cash incentives improved enrollment in an online health program. Men and women responded differently to mailing characteristics and incentives. Including a small prepaid monetary incentive ($2 or $5) and revealing the higher promised-retention incentive was cost effective and boosted enrollment. PMID:18407004

Player or referee? Aid effectiveness and the governance of health policy development: Lessons from Viet Nam.

PubMed

Dodd, Rebecca; Olivé, Jean-Marc

2011-01-01

Viet Nam is one of the brightest stars in the constellation of developing countries. Its remarkable achievements in reducing poverty and improving health and education outcomes are well known, and as a result it has enjoyed generous aid programmes. Viet Nam also has a reputation for taking a strong lead in disciplining its donors and pushing for more efficient and effective forms of aid delivery, both at home and internationally. This article discusses how efforts to improve the effectiveness of aid intersect with policy-making processes in the health sector. It presents a quantitative review of health aid flows in Viet Nam and a qualitative analysis of the aid environment using event analysis, participant observation and key informant interviews. The analysis reveals a complex and dynamic web of incentives influencing the implementation of the aid effectiveness agenda in the health sector. There are contradictory forces within the Ministry of Health, within government as a whole, within the donor community and between donors and government. Analytical frameworks drawn from the study of policy networks and governance can help explain these tensions. They suggest that governance of health aid in Viet Nam is characterised by multiple, overlapping 'policy networks' which cut across the traditional donor-government divide. The principles of aid effectiveness make sense for some of these communities, but for others they are irrational and may lead to a loss of influence and resources. However, sustained engagement combined with the building of strategic coalitions can overcome individual and institutional incentives. This article suggests that aid reform efforts should be understood not as a technocratic agenda but as a political process with all the associated tensions, perverse incentives and challenges. Partners thus need to recognise - and find new ways of making sense of - the complexity of forces affecting aid delivery.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haffner, Robert; Helmer, Dorine; van Til, Harry

Theoretical studies on the relationship between incentive regulation and investment in network industries generally point out that incentive regulation has a negative impact on investment. However, empirical evidence in this area is scarce. An analysis suggests that in the Dutch electricity and gas networks since 2001, incentive regulation has ensured a more rational and professional approach towards investments, with investment levels coming down somewhat at the start of the regulation but picking up later on. (author)

An Analysis of the California State University and Colleges Early Retirement Incentive Program: A Report Pursuant to Chapter 656 of the Statutes of 1979.

ERIC Educational Resources Information Center

Reinhard, Raymond M.

The California State University and Colleges' (CSUC) Early Retirement Incentive (ERI) Program is described, and information is presented of those who retire during a three-month period with an incentive bonus of two additional years of (unearned) retirement service credit. During the eligibility period 1,047 CSUC employees retired, and it appears…

Effect of modest pay-for-performance financial incentive on time-to-discharge summary dictation among medical residents.

PubMed

Wolk, Adam; Wang, Erwin; Horak, Bernard; Cloonan, Patricia; Adams, Michael; Moore, Eileen; Jaipaul, Chitra Komal; Brown, Gabrielle; Dasgupta, Dabanjan; Deluca, Danielle; Grossman, Mila

2013-01-01

Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents. Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees. Timely completion of discharge summaries is necessary for effective follow-up after hospitalization, and residents perform the majority of discharge summary dictations in academic medical centers. Medicine residents with the lowest average discharge-to-dictation time during their 1-month inpatient medicine ward rotation were rewarded with a $50 gift card. Discharge data were captured using an autopopulating electronic database. The average discharge-to-dictation time was reduced from 7.44 to 1.84 days, representing a 75.3% decrease. Almost 90% of discharge summary dictations were performed on the day of discharge. A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.

Incentivizing Verifiable Privacy-Protection Mechanisms for Offline Crowdsensing Applications

PubMed Central

Sun, Jiajun; Liu, Ningzhong

2017-01-01

Incentive mechanisms of crowdsensing have recently been intensively explored. Most of these mechanisms mainly focus on the standard economical goals like truthfulness and utility maximization. However, enormous privacy and security challenges need to be faced directly in real-life environments, such as cost privacies. In this paper, we investigate offline verifiable privacy-protection crowdsensing issues. We firstly present a general verifiable privacy-protection incentive mechanism for the offline homogeneous and heterogeneous sensing job model. In addition, we also propose a more complex verifiable privacy-protection incentive mechanism for the offline submodular sensing job model. The two mechanisms not only explore the private protection issues of users and platform, but also ensure the verifiable correctness of payments between platform and users. Finally, we demonstrate that the two mechanisms satisfy privacy-protection, verifiable correctness of payments and the same revenue as the generic one without privacy protection. Our experiments also validate that the two mechanisms are both scalable and efficient, and applicable for mobile devices in crowdsensing applications based on auctions, where the main incentive for the user is the remuneration. PMID:28869574

Incentivizing Verifiable Privacy-Protection Mechanisms for Offline Crowdsensing Applications.

PubMed

Sun, Jiajun; Liu, Ningzhong

2017-09-04

Incentive mechanisms of crowdsensing have recently been intensively explored. Most of these mechanisms mainly focus on the standard economical goals like truthfulness and utility maximization. However, enormous privacy and security challenges need to be faced directly in real-life environments, such as cost privacies. In this paper, we investigate offline verifiable privacy-protection crowdsensing issues. We firstly present a general verifiable privacy-protection incentive mechanism for the offline homogeneous and heterogeneous sensing job model. In addition, we also propose a more complex verifiable privacy-protection incentive mechanism for the offline submodular sensing job model. The two mechanisms not only explore the private protection issues of users and platform, but also ensure the verifiable correctness of payments between platform and users. Finally, we demonstrate that the two mechanisms satisfy privacy-protection, verifiable correctness of payments and the same revenue as the generic one without privacy protection. Our experiments also validate that the two mechanisms are both scalable and efficient, and applicable for mobile devices in crowdsensing applications based on auctions, where the main incentive for the user is the remuneration.

Do Countries Consistently Engage in Misinforming the International Community about Their Efforts to Combat Money Laundering? Evidence Using Benford’s Law

PubMed Central

2017-01-01

Indicators of compliance and efficiency in combatting money laundering, collected by EUROSTAT, are plagued with shortcomings. In this paper, I have carried out a forensic analysis on a 2003–2010 dataset of indicators of compliance and efficiency in combatting money laundering, that European Union member states self-reported to EUROSTAT, and on the basis of which, their efforts were evaluated. I used Benford’s law to detect any anomalous statistical patterns and found that statistical anomalies were also consistent with strategic manipulation. According to Benford’s law, if we pick a random sample of numbers representing natural processes, and look at the distribution of the first digits of these numbers, we see that, contrary to popular belief, digit 1 occurs most often, then digit 2, and so on, with digit 9 occurring in less than 5% of the sample. Without prior knowledge of Benford’s law, since people are not intuitively good at creating truly random numbers, deviations thereof can capture strategic alterations. In order to eliminate other sources of deviation, I have compared deviations in situations where incentives and opportunities for manipulation existed and in situations where they did not. While my results are not a conclusive proof of strategic manipulation, they signal that countries that faced incentives and opportunities to misinform the international community about their efforts to combat money laundering may have manipulated these indicators. Finally, my analysis points to the high potential for disruption that the manipulation of national statistics has, and calls for the acknowledgment that strategic manipulation can be an unintended consequence of the international community’s pressure on countries to put combatting money laundering on the top of their national agenda. PMID:28122058

Do Countries Consistently Engage in Misinforming the International Community about Their Efforts to Combat Money Laundering? Evidence Using Benford's Law.

PubMed

Deleanu, Ioana Sorina

2017-01-01

Indicators of compliance and efficiency in combatting money laundering, collected by EUROSTAT, are plagued with shortcomings. In this paper, I have carried out a forensic analysis on a 2003-2010 dataset of indicators of compliance and efficiency in combatting money laundering, that European Union member states self-reported to EUROSTAT, and on the basis of which, their efforts were evaluated. I used Benford's law to detect any anomalous statistical patterns and found that statistical anomalies were also consistent with strategic manipulation. According to Benford's law, if we pick a random sample of numbers representing natural processes, and look at the distribution of the first digits of these numbers, we see that, contrary to popular belief, digit 1 occurs most often, then digit 2, and so on, with digit 9 occurring in less than 5% of the sample. Without prior knowledge of Benford's law, since people are not intuitively good at creating truly random numbers, deviations thereof can capture strategic alterations. In order to eliminate other sources of deviation, I have compared deviations in situations where incentives and opportunities for manipulation existed and in situations where they did not. While my results are not a conclusive proof of strategic manipulation, they signal that countries that faced incentives and opportunities to misinform the international community about their efforts to combat money laundering may have manipulated these indicators. Finally, my analysis points to the high potential for disruption that the manipulation of national statistics has, and calls for the acknowledgment that strategic manipulation can be an unintended consequence of the international community's pressure on countries to put combatting money laundering on the top of their national agenda.

Alternative Fuels Data Center: Natural Gas Fueling Station Locations

Science.gov Websites

or ZIP code or along a route in the United States. Loading alternative fueling station locator Fleet Rightsizing System Efficiency Locate Stations Search by Location Map a Route Laws & Incentives

Personal financial incentives in health promotion: where do they fit in an ethic of autonomy?

PubMed Central

Ashcroft, Richard E.

2011-01-01

Abstract Aim  This paper reviews the ethical controversy concerning the use of monetary incentives in health promotion, focussing specifically on the arguments relating to the impact on personal autonomy of such incentives. Background  Offering people small amounts of money in the context of health promotion and medical care has been attempted in a number of settings in recent years. This use of personal financial incentives has attracted a degree of ethical controversy. One form of criticism is that such schemes interfere with the autonomy of the patient or citizen in an illegitimate way. Methods  This paper presents a thematic analysis of the main arguments concerning personal autonomy and the use of monetary incentives in behaviour change. Results  The main moral objections to the uses of incentives are that they may be in general or in specific instances paternalistic, coercive, involve bribery, or undermine the agency of the person. Conclusion  While incentive schemes may engage these problems on occasion, there is no good reason to think that they do so inherently and of necessity. We need better behavioural science evidence to understand how incentives work, in order to evaluate their moral effects in practice. PMID:21348904

Personal financial incentives in health promotion: where do they fit in an ethic of autonomy?

PubMed

Ashcroft, Richard E

2011-06-01

This paper reviews the ethical controversy concerning the use of monetary incentives in health promotion, focussing specifically on the arguments relating to the impact on personal autonomy of such incentives. Offering people small amounts of money in the context of health promotion and medical care has been attempted in a number of settings in recent years. This use of personal financial incentives has attracted a degree of ethical controversy. One form of criticism is that such schemes interfere with the autonomy of the patient or citizen in an illegitimate way. This paper presents a thematic analysis of the main arguments concerning personal autonomy and the use of monetary incentives in behaviour change. The main moral objections to the uses of incentives are that they may be in general or in specific instances paternalistic, coercive, involve bribery, or undermine the agency of the person. While incentive schemes may engage these problems on occasion, there is no good reason to think that they do so inherently and of necessity. We need better behavioural science evidence to understand how incentives work, in order to evaluate their moral effects in practice. © 2011 Blackwell Publishing Ltd.

Millon Clinical Multiaxial Inventory–III Subtypes of Opioid Dependence: Validity and Matching to Behavioral Therapies

PubMed Central

Ball, Samuel A.; Nich, Charla; Rounsaville, Bruce J.; Eagan, Dorothy; Carroll, Kathleen M.

2013-01-01

The concurrent and predictive validity of 2 different methods of Millon Clinical Multiaxial Inventory–III subtyping (protocol sorting, cluster analysis) was evaluated in 125 recently detoxified opioid-dependent outpatients in a 12-week randomized clinical trial. Participants received naltrexone and relapse prevention group counseling and were assigned to 1 of 3 intervention conditions: (a) no-incentive vouchers, (b) incentive vouchers alone, or (c) incentive vouchers plus relationship counseling. Affective disturbance was the most common Axis I protocol-sorted subtype (66%), antisocial–narcissistic was the most common Axis II subtype (46%), and cluster analysis suggested that a 2-cluster solution (high vs. low psychiatric severity) was optimal. Predictive validity analyses indicated less symptom improvement for the higher problem subtypes, and patient treatment matching analyses indicated that some subtypes had better outcomes in the no-incentive voucher conditions. PMID:15301655

Formation of Conceptual Provisions for the Development of the Energy Efficient Housing Construction in Russia

NASA Astrophysics Data System (ADS)

Vasilyeva, Elena

2017-10-01

Current problems and the prospects of energy saving in Russia as well as the importance of creation of complete legislative and legal base and the mechanisms of economic incentives of energy saving is are considered in article. The analysis of the existing criteria of the energy efficiency of buildings is carried out. The introduction of so-called “road map” of the development of energy saving in housing-and-communal services is expedient. According to the author, that will allow to provide owners of buildings and the servicing companies with the information for acceptance of organizational and technical project, construction and operational decisions, reasonable decisions on maintenance, reconstruction or dismantling of the buildings, directed to lowering of energetic expenses and also to the proper organization of life cycle of buildings in general.

The Texas space flight liability act and efficient regulation for the private commercial space flight era

NASA Astrophysics Data System (ADS)

Johnson, Christopher D.

2013-12-01

In the spring of 2011, the American state of Texas passed into law an act limiting the liability of commercial space flight entities. Under it, those companies would not be liable for space flight participant injuries, except in cases of intentional injury or injury proximately caused by the company's gross negligence. An analysis within the framework of international and national space law, but especially informed by the academic discipline of law and economics, discusses the incentives of all relevant parties and attempts to understand whether the law is economically "efficient" (allocating resources so as to yield maximum utility), and suited to further the development of the fledgling commercial suborbital tourism industry. Insights into the Texas law are applicable to other states hoping to foster commercial space tourism and considering space tourism related legislation.

The utility of decision support, clinical guidelines, and financial incentives as tools to achieve improved clinical performance.

PubMed

Goldfarb, S

1999-03-01

Whether one seeks to reduce inappropriate utilization of resources, improve diagnostic accuracy, increase utilization of effective therapies, or reduce the incidence of complications, the key to change is physician involvement in change. Unfortunately, a simple approach to the problem of inducing change in physician behavior is not available. There is a generally accepted view that expert, best-practice guidelines will improve clinical performance. However, there may be a bias to report positive results and a lack of careful analysis of guideline usage in routine practice in a "postmarketing" study akin to that seen in the pharmaceutical industry. Systems that allow the reliable assessment of quality of outcomes, efficiency of resource utilization, and accurate assessment of the risks associated with the care of given patient populations must be widely available before deciding whether an incentive-based system for providing the full range of medical care is feasible. Decision support focuses on providing information, ideally at the "point of service" and in the context of a particular clinical situation. Rules are self-imposed by physicians and are therefore much more likely to be adopted. As health care becomes corporatized, with increasing numbers of physicians employed by large organizations with the capacity to provide detailed information on the nature and quality of clinical care, it is possible that properly constructed guidelines, appropriate financial incentives, and robust forms of decision support will lead to a physician-led, process improvement approach to more rational and affordable health care.

Indian Renewable Energy and Energy Efficiency Policy Database (Fact Sheet)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bushe, S.

2013-09-01

This fact sheet provides an overview of the Indian Renewable Energy and Energy Efficiency Policy Database (IREEED) developed in collaboration by the United States Department of Energy and India's Ministry of New and Renewable Energy. IREEED provides succinct summaries of India's central and state government policies and incentives related to renewable energy and energy efficiency. The online, public database was developed under the U.S.- India Energy Dialogue and the Clean Energy Solution Center.

Water conservation quantities vs customer opinion and satisfaction with water efficient appliances in Miami, Florida.

PubMed

Lee, Mengshan; Tansel, Berrin

2013-10-15

During 2006-2007, Miami-Dade County, Florida, USA, provided incentives for low income and senior residents in single family homes for retrofitting with high efficiency fixtures. The participating residences were retrofitted with high-efficiency toilets, showerheads, and aerators. In 2012, a telephone survey was conducted to evaluate the satisfaction of the participants and the associated effects on water conservation practices. This study evaluates the attitudes and opinions of the participants relative to water use efficiency measures and the actual reduction in water consumption characteristics of the participating households. The participant characteristics were analyzed to identify correlations between the socio-demographic factors, program satisfaction and actual water savings. Approximately 65.5% of the survey respondents reported changes in their water use habits and 76.6% reported noticeable reduction in their water bills. The analyses showed that the satisfaction levels of the participants were closely correlated with the actual water savings. The results also showed that satisfaction level along with water saving potential (i.e., implementation of water efficiency devices) or change of water use habits has provided positive synergistic effect on actual water savings. The majority of the participants surveyed (81.3-89.1%) reported positive attitudes for water conservation incentive program and the benefits of the high efficiency fixtures. Copyright © 2013 Elsevier Ltd. All rights reserved.

Scheduling and Pricing for Expected Ramp Capability in Real-Time Power Markets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ela, Erik; O'Malley, Mark

2016-05-01

Higher variable renewable generation penetrations are occurring throughout the world on different power systems. These resources increase the variability and uncertainty on the system which must be accommodated by an increase in the flexibility of the system resources in order to maintain reliability. Many scheduling strategies have been discussed and introduced to ensure that this flexibility is available at multiple timescales. To meet variability, that is, the expected changes in system conditions, two recent strategies have been introduced: time-coupled multi-period market clearing models and the incorporation of ramp capability constraints. To appropriately evaluate these methods, it is important to assessmore » both efficiency and reliability. But it is also important to assess the incentive structure to ensure that resources asked to perform in different ways have the proper incentives to follow these directions, which is a step often ignored in simulation studies. We find that there are advantages and disadvantages to both approaches. We also find that look-ahead horizon length in multi-period market models can impact incentives. This paper proposes scheduling and pricing methods that ensure expected ramps are met reliably, efficiently, and with associated prices based on true marginal costs that incentivize resources to do as directed by the market. Case studies show improvements of the new method.« less

Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial.

PubMed

Gupta, Samir; Miller, Stacie; Koch, Mark; Berry, Emily; Anderson, Paula; Pruitt, Sandi L; Borton, Eric; Hughes, Amy E; Carter, Elizabeth; Hernandez, Sylvia; Pozos, Helen; Halm, Ethan A; Gneezy, Ayelet; Lieberman, Alicea J; Sugg Skinner, Celette; Argenbright, Keith; Balasubramanian, Bijal

2016-11-01

Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population. We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis. FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups. Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.

The 2011 mileage-based user fee symposium.

DOT National Transportation Integrated Search

2011-09-01

"The fuel tax is rapidly losing its ability to support system needs. Federal environmental : regulations and the escalating price of fossil fuels have created a strong incentive to develop and : utilize more fuel-efficient vehicles, which will drive ...

Financing & Incentives | Efficient Windows Collaborative

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Alternative Fuels Data Center: Hydrogen Basics

Science.gov Websites

; Incentives Hydrogen Basics Hydrogen (H2) is an alternative fuel that can be produced from diverse domestic for domestic production, its fast filling time, and the fuel cell's high efficiency. In fact, a fuel

Managing the NHS market.

PubMed Central

Ham, C.; Maynard, A.

1994-01-01

The purpose of the present NHS reforms is to introduce a managed market; developing some of the incentives for greater efficiency that are often found in markets while still being able to regulate proceedings to prevent market failures. If government intervenes too much there will be no incentive to improve efficiency and streamline operations: too little intervention may result in some areas having inadequate health service cover or monopoly powers abusing their position. Effective management of the NHS market requires eight core elements: openness of information, control of labour and capital markets, regulation of mergers and takeovers, arbitrating in disputes, protection of unprofitable functions such as research and development, overseeing national provision of health services, protection of basic principles of the NHS, and handling of closures and redundancy. Management of the market would best be performed by the NHS management executive and health authority purchasers acting within a framework set by politicians. Images p846-a p847-a PMID:8167496

Incentive compatibility in kidney exchange problems.

PubMed

Villa, Silvia; Patrone, Fioravante

2009-12-01

The problem of kidney exchanges shares common features with the classical problem of exchange of indivisible goods studied in the mechanism design literature, while presenting additional constraints on the size of feasible exchanges. The solution of a kidney exchange problem can be summarized in a mapping from the relevant underlying characteristics of the players (patients and their donors) to the set of matchings. The goal is to select only matchings maximizing a chosen welfare function. Since the final outcome heavily depends on the private information in possess of the players, a basic requirement in order to reach efficiency is the truthful revelation of this information. We show that for the kidney exchange problem, a class of (in principle) efficient mechanisms does not enjoy the incentive compatibility property and therefore is subject to possible manipulations made by the players in order to profit of the misrepresentation of their private information.

Quantifying individual variation in the propensity to attribute incentive salience to reward cues.

PubMed

Meyer, Paul J; Lovic, Vedran; Saunders, Benjamin T; Yager, Lindsay M; Flagel, Shelly B; Morrow, Jonathan D; Robinson, Terry E

2012-01-01

If reward-associated cues acquire the properties of incentive stimuli they can come to powerfully control behavior, and potentially promote maladaptive behavior. Pavlovian incentive stimuli are defined as stimuli that have three fundamental properties: they are attractive, they are themselves desired, and they can spur instrumental actions. We have found, however, that there is considerable individual variation in the extent to which animals attribute Pavlovian incentive motivational properties ("incentive salience") to reward cues. The purpose of this paper was to develop criteria for identifying and classifying individuals based on their propensity to attribute incentive salience to reward cues. To do this, we conducted a meta-analysis of a large sample of rats (N = 1,878) subjected to a classic Pavlovian conditioning procedure. We then used the propensity of animals to approach a cue predictive of reward (one index of the extent to which the cue was attributed with incentive salience), to characterize two behavioral phenotypes in this population: animals that approached the cue ("sign-trackers") vs. others that approached the location of reward delivery ("goal-trackers"). This variation in Pavlovian approach behavior predicted other behavioral indices of the propensity to attribute incentive salience to reward cues. Thus, the procedures reported here should be useful for making comparisons across studies and for assessing individual variation in incentive salience attribution in small samples of the population, or even for classifying single animals.

Incentives for mobility : using market mechanisms to rebuild America's transportation infrastructure

DOT National Transportation Integrated Search

1989-08-01

America's transportation infrastructure is inadequate, but the solution is not simply to spend more public money. A market-oriented analysis reveals that the problem is institutional. The incentives which operate in the public sector under current po...

The carbon price: a toothless tool for material efficiency?

PubMed Central

2017-01-01

This article explores whether a carbon price will effectively encourage the more efficient use of greenhouse gas intensive materials such as steel. The article identifies a range of distortions that arise when some of the restrictive assumptions of neoclassical economics are relaxed. Distortions occur due to the sequential nature of decision-making along supply chains, due to imperfect competition and due to government intervention to reduce the risk of carbon leakage. If upstream sectors do not pass on carbon costs, downstream sectors do not have the opportunity to react. Of the distortions identified, compensation mechanisms that reduce the risk of carbon leakage are likely to act as the greatest hinderance to appropriate incentives for the more efficient use of steel in the UK: as things currently stand, unless upstream companies are encouraged to make windfall profits, incentives downstream are weakened. The article concludes by exploring policy options to address the distortions identified, including efforts to reinstate the carbon price downstream and efforts to remove other distortive taxes. This article is part of the themed issue ‘Material demand reduction’. PMID:28461438

The carbon price: a toothless tool for material efficiency?

PubMed

Skelton, Alexandra C H; Allwood, Julian M

2017-06-13

This article explores whether a carbon price will effectively encourage the more efficient use of greenhouse gas intensive materials such as steel. The article identifies a range of distortions that arise when some of the restrictive assumptions of neoclassical economics are relaxed. Distortions occur due to the sequential nature of decision-making along supply chains, due to imperfect competition and due to government intervention to reduce the risk of carbon leakage. If upstream sectors do not pass on carbon costs, downstream sectors do not have the opportunity to react. Of the distortions identified, compensation mechanisms that reduce the risk of carbon leakage are likely to act as the greatest hinderance to appropriate incentives for the more efficient use of steel in the UK: as things currently stand, unless upstream companies are encouraged to make windfall profits, incentives downstream are weakened. The article concludes by exploring policy options to address the distortions identified, including efforts to reinstate the carbon price downstream and efforts to remove other distortive taxes.This article is part of the themed issue 'Material demand reduction'. © 2017 The Authors.

Toward a more stable blood supply: charitable incentives, donation rates, and the experience of September 11.

PubMed

Sass, Reuben G

2013-01-01

Although excess blood collection has characterized U.S. national disasters, most dramatically in the case of September 11, periodic shortages of blood have recurred for decades. In response, I propose a new model of medical philanthropy, one that specifically uses charitable contributions to health care as blood donation incentives. I explain how the surge in blood donations following 9/11 was both transient and disaster-specific, failing to foster a greater continuing commitment to donate blood. This underscores the importance of considering blood donation incentives. I defend charitable incentives as an alternative to financial incentives, which I contend would further extend neoliberal market values into health care. I explain my model's potential appeal to private foundations or public-private partnerships as a means for expanding both the pool of blood donors and the prosocial benefit of each act of blood donation. Finally I link my analysis to the empirical literature on blood donation incentives.

Adding home health care to the discussion on health information technology policy.

PubMed

Ruggiano, Nicole; Brown, Ellen L; Hristidis, Vagelis; Page, Timothy F

2013-01-01

The potential for health information technology to improve the efficiency and effectiveness of health care has resulted in several U.S. policy initiatives aimed at integrating health information technology into health care systems. However, home health care agencies have been excluded from incentive programs established through policies, raising concerns on the extent to which health information technology may be used to improve the quality of care for older adults with chronic illness and disabilities. This analysis examines the potential issues stemming from this exclusion and explores potential opportunities of integrating home health care into larger initiatives aimed at establishing health information technology systems for meaningful use.

A Comparative Analysis of the Financial Incentives of Two Distinct Experience-Rating Programs.

PubMed

Tompa, Emile; McLeod, Chris; Mustard, Cam

2016-07-01

The aim of this study was to compare the association between insurance premium incentives and claim outcomes in two different workers' compensation programs. Regression models were run for claim outcomes using data from two Canadian jurisdictions with different experience-rating programs-one with prospective (British Columbia) and another with retrospective (Ontario) adjustment of premiums. Key explanatory variables were past premium adjustments. For both programs, past premium adjustments were significantly associated with claim outcomes, suggesting adjustments provided incentives for claims reduction. The magnitudes of effects in the prospective program were smaller than the retrospective one, though relative persistence of effects over time was larger. Having large and immediate employer responses to incentives may appear desirable, but insurers should consider the time required for employers to improve and sustain good practices, and create incentives that parallel such time lines.

Empirical studies of regulatory restructuring and incentives

NASA Astrophysics Data System (ADS)

Knittel, Christopher Roland

This dissertation examines the actions of firms when faced with regulatory restructuring. Chapter I examines the equilibrium pricing behavior of local exchange telephone companies under a variety of market structures. In particular, the pricing behavior of three services are analyzed: residential local service, business local service, and intraLATA toll service. Beginning in 1984, a variety of market structure changes have taken place in the local telecommunications industry. I analyze differences in the method of price-setting regulation and the restrictions on entry. Specifically, the relative pricing behavior under rate of return and price cap regulation is analyzed, as well as the impact of entry in the local exchange and intraLATA toll service markets. In doing so, I estimate an empirical model that accounts for the stickiness of rates in regulated industries that is based on firm and regulator decision processes in the presence of adjustment costs. I find that, faced with competitive pressures that reduce rates in one service, incumbent firm rates increase in other services, thereby reducing the benefits from competition. In addition, the findings suggest that price cap regulation leads to higher rates relative to rate-of-return regulation. Chapter 2 analyzes the pricing and investment behavior of electricity firms. Electricity and natural gas markets have traditionally been serviced by one of two market structures. In some markets, electricity and natural gas are sold by a dual-product regulated monopolist, while in other markets, electricity and natural gas are sold by separate single-product regulated monopolies. This paper analyzes the relative pricing and investment decisions of electricity firms operating in the two market structures. The unique relationship between these two products imply that the relative incentives of single and dual-product firms are likely to differ. Namely electricity and natural gas are substitutes in consumption while natural gas is also an input into the generation of electricity. However because these firms are regulated, these differing incentives would only be acted upon if regulation is imperfect in some way. Chapter 2 analyzes these issues. In particular, I estimate equilibrium pricing and investment equations that capture the relative incentives of single and dual-product electricity firms. The results imply that both electricity prices and reliance on natural gas generation are higher in a dual-product setting, both suggesting that regulators respond to the relative incentives of electricity and natural gas firms. Chapter 3 analyzes electricity firm production incentives when regulated via performance based regulation. Although many electricity markets are currently considering adopting a competitive market for electricity generation, and still others have already done so, the vast majority of electricity markets remain tightly regulated. Within this traditional regulatory environment, the use of incentive regulation schemes in US electricity markets has grown during the past two decades. While every state has some program that it refers to as an incentive regulation program, these programs differ in both their goals and how they attempt to meet these goals. In this chapter, I discuss the wide array of programs that have been utilized to alter the incentives of US investor-owned utilities (IOUs). In addition, using stochastic frontier methods, I provide empirical analysis of the impact that a number of incentive regulation programs have on the efficiency of a large set of coal and natural gas generator units.

Michigan's Physician Group Incentive Program offers a regional model for incremental 'fee for value' payment reform.

PubMed

Share, David A; Mason, Margaret H

2012-09-01

Blue Cross Blue Shield of Michigan partnered with providers across the state to create an innovative, "fee for value" physician incentive program that would deliver high-quality, efficient care. The Physician Group Incentive Program rewards physician organizations-formal groups of physicians and practices that can accept incentive payments on behalf of their members-based on the number of quality and utilization measures they adopt, such as generic drug dispensing rates, and on their performance on these measures across their patient populations. Physicians also receive payments for implementing a range of patient-centered medical home capabilities, such as patient registries, and they receive higher fees for office visits for incorporating these capabilities into routine practice while also improving performance. Taken together, the incentive dollars, fee increases, and care management payments amount to a potential increase in reimbursement of 40 percent or more from Blue Cross Blue Shield of Michigan for practices designated as high-performing patient-centered medical homes. At the same time, we estimate that implementing the patient-centered medical home capabilities was associated with $155 million in lower medical costs in program year 2011 for Blue Cross Blue Shield of Michigan members. We intend to devote a higher percentage of reimbursement over time to communities of caregivers that offer high-value, system-based care, and a lower percentage of reimbursement to individual physicians on a service-specific basis.

Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market.

PubMed

Van Barneveld, E M; Lamers, L M; van Vliet, R C; van de Ven, W P

1998-07-01

Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in many countries. RACPs based on demographic variables only are insufficient, because they leave ample room for cream skimming. However, the implementation of improved RACPs does not appear to be straightforward. A solution might be to supplement imperfect RACPs with a form of mandatory pooling that reduces the incentives for cream skimming. In a previous paper it was concluded that high-risk pooling (HRP), is a promising supplement to RACPs. The purpose of this paper is to compare HRP with two other main variants of mandatory pooling. These variants are called excess-of-loss (EOL) and proportional pooling (PP). Each variant includes ex post compensations to insurers for some members which depend to various degrees on actually incurred costs. Therefore, these pooling variants reduce the incentives for cream skimming which are inherent in imperfect RACPs, but they also reduce the incentives for efficiency and cost containment. As a rough measure of the latter incentives we use the percentage of total costs for which an insurer is at risk. This paper analyzes which of the three main pooling variants yields the greatest reduction of incentives for cream skimming given such a percentage. The results show that HRP is the most effective of the three pooling variants.

Incentives for Blood Donation: A Discrete Choice Experiment to Analyze Extrinsic Motivation.

PubMed

Sadler, Andrew; Shi, Ling; Bethge, Susanne; Mühlbacher, Axel

2018-04-01

Background: Demographic trends affect size and age structure of populations. One of the consequences will be an increasing need for blood products to treat age-related diseases. Donation services rely on voluntariness and charitable motivation. It might be questioned whether there will be sufficient blood supply with voluntary donation. The present study focused on elicitation of preferences for incentives and aimed to contribute to the discussion on how to increase donation rates. Methods: A self-administered discrete choice experiment (DCE) was applied. Respondents were repeatedly asked to choose between hypothetical blood donation centers. In case of reluctance to receiving incentives a none-option was included. Random parameter logit (RPL) and latent class models (LCM) were used for analysis. Results: The study sample included 416 college students from the US and Germany. Choice decisions were significantly influenced by the characteristics of the donation center in the DCE. Incentives most preferred were monetary compensation, paid leave, and blood screening test. LCM identified subgroups with preference heterogeneity. Small subgroups indicated moderate to strong aversion to incentives. Conclusion: The majority of the sample positively responded to incentives and indicated a willingness to accept incentives. In face of future challenges, the judicious use and appropriate utilization of incentives might be an option to motivate potential donors and should be open to discussion.

Using Economic Experiments to Test the Effect of Reliability Pricing and Self-Sizing on the Private Provision of a Public Good Results: The Case of Constructing Water Conveyance Infrastructure to Mitigate Water Quantity and Quality Concerns in the Sacramento-San Joaquin Delta

NASA Astrophysics Data System (ADS)

Kaplan, J.; Howitt, R. E.; Kroll, S.

2016-12-01

Public financing of public projects is becoming more difficult with growing political and financial pressure to reduce the size and scope of government action. Private provision is possible but is often doomed by under-provision. If however, market-like mechanisms could be incorporated into the solicitation of funds to finance the provision of the good, because, for example, the good is supplied stochastically and is divisible, then we would expect fewer incentives to free ride and greater efficiency in providing the public good. In a controlled computer-based economic experiment, we evaluate two market-like conditions (reliability pricing allocation and self-sizing of the good) that are designed to reduce under-provision. The results suggest that financing an infrastructure project when the delivery is allocated based on reliability pricing rather than historical allocation results in significantly greater price formation efficiency and less free riding whether the project is of a fixed size determined by external policy makers or determined endogenously by the sum of private contributions. When reliability pricing and self-sizing (endogenous) mechanism are used in combination free-riding is reduced the greatest among the tested treatments. Furthermore, and as expected, self-sizing when combined with historical allocations results in the worst level of free-riding. This setting for this treatment creates an incentive to undervalue willingness to pay since very low contributions still return positive earnings as long as enough contributions are raised for a single unit. If everyone perceives everyone else is undervaluing their contribution the incentive grows stronger and we see the greatest degree of free riding among the treatments. Lastly, the results from the analysis suggested that the rebate rule may have encouraged those with willingness to pay values less than the cost of the project to feel confident when contributing more than their willingness to pay and to do so when they faced the endogenously-sized, reliability pricing solicitation since a rebate would likely return them positive earnings. In subsequent research we would like to explore the role of the rebate rule in the effectiveness of reliability pricing and self-sizing in increasing price-formation efficiency and reduce free riding.

Energy Efficiency Tax Incentives Act

THOMAS, 113th Congress

Sen. Cardin, Benjamin L. [D-MD

2014-04-01

Senate - 05/07/2014 Committee on Banking, Housing, and Urban Affairs Subcommittee on Economic Policy. Hearings held. With printed Hearing: S.Hrg. 113-466. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

75 FR 42745 - Production Incentives for Cellulosic Biofuels: Notice of Program Intent

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-22

... gives notice that the Office of Biomass Program, in the Office of Energy Efficiency and Renewable Energy...: Questions may be directed to: Mr. Neil Rossmeissl, Office of the Biomass Program, U.S. Department of Energy...

Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives  in Diabetic Eye Assessment  by Screening (IDEAS) trial.

PubMed

Judah, Gaby; Darzi, Ara; Vlaev, Ivo; Gunn, Laura; King, Derek; King, Dominic; Valabhji, Jonathan; Bicknell, Colin

2018-05-23

Conflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders. A three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons. 34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group. Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials.

PubMed

Barnato, Amber E; Moore, Robert; Moore, Charity G; Kohatsu, Neal D; Sudore, Rebecca L

2017-07-01

Medicaid populations have low rates of advance care planning (ACP). Potential policy interventions include financial incentives. To test the effectiveness of patient plus provider financial incentive compared with provider financial incentive alone for increasing ACP discussions among Medicaid patients. Between April 2014 and July 2015, we conducted two sequential assessor-blinded pragmatic randomized trials in a health plan that pays primary care providers (PCPs) $100 to discuss ACP: 1) a parallel cluster trial (provider-delivered patient incentive) and 2) an individual-level trial (mail-delivered patient incentive). Control and intervention arms included encouragement to complete ACP, instructions for using an online ACP tool, and (in the intervention arm) $50 for completing the online ACP tool and a small probability of $1000 (i.e., lottery) for discussing ACP with their PCP. The primary outcome was provider-reported ACP discussion within three months. In the provider-delivered patient incentive study, 38 PCPs were randomized to the intervention (n = 18) or control (n = 20) and given 10 patient packets each to distribute. Using an intention-to-treat analysis, there were 27 of 180 ACP discussions (15%) in the intervention group and 5 of 200 (2.5%) in the control group (P = .0391). In the mail-delivered patient incentive study, there were 5 of 187 ACP discussions (2.7%) in the intervention group and 5 of 189 (2.6%) in the control group (P = .99). ACP rates were low despite an existing provider financial incentive. Adding a provider-delivered patient financial incentive, but not a mail-delivered patient incentive, modestly increased ACP discussions. PCP encouragement combined with a patient incentive may be more powerful than either encouragement or incentive alone. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth

PubMed Central

Thomson, Gill; Morgan, Heather; Crossland, Nicola; Bauld, Linda; Dykes, Fiona; Hoddinott, Pat

2014-01-01

Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation. PMID:25357121

Unintended consequences of incentive provision for behaviour change and maintenance around childbirth.

PubMed

Thomson, Gill; Morgan, Heather; Crossland, Nicola; Bauld, Linda; Dykes, Fiona; Hoddinott, Pat; Dombrowski, Stephan; MacLennan, Graeme; Rothnie, Kieran; Stewart, Fiona; Farrar, Shelley; Yi, Deokhee; Hislop, Jenni; Ludbrook, Anne; Campbell, Marion; Moran, Victoria Hall; Sniehotta, Falko; Tappin, David

2014-01-01

Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation.

Payment schemes and cost efficiency: evidence from Swiss public hospitals.

PubMed

Meyer, Stefan

2015-03-01

This paper aims at analysing the impact of prospective payment schemes on cost efficiency of acute care hospitals in Switzerland. We study a panel of 121 public hospitals subject to one of four payment schemes. While several hospitals are still reimbursed on a per diem basis for the treatment of patients, most face flat per-case rates-or mixed schemes, which combine both elements of reimbursement. Thus, unlike previous studies, we are able to simultaneously analyse and isolate the cost-efficiency effects of different payment schemes. By means of stochastic frontier analysis, we first estimate a hospital cost frontier. Using the two-stage approach proposed by Battese and Coelli (Empir Econ 20:325-332, 1995), we then analyse the impact of these payment schemes on the cost efficiency of hospitals. Controlling for hospital characteristics, local market conditions in the 26 Swiss states (cantons), and a time trend, we show that, compared to per diem, hospitals which are reimbursed by flat payment schemes perform better in terms of cost efficiency. Our results suggest that mixed schemes create incentives for cost containment as well, although to a lesser extent. In addition, our findings indicate that cost-efficient hospitals are primarily located in cantons with competitive markets, as measured by the Herfindahl-Hirschman index in inpatient care. Furthermore, our econometric model shows that we obtain biased estimates from frontier analysis if we do not account for heteroscedasticity in the inefficiency term.

Enabling Energy Efficiency in South Africa's Commercial Buildings

DOE Office of Scientific and Technical Information (OSTI.GOV)

2016-04-01

South Africa is leading a number of efforts to support a thriving economy while also reducing energy use. Increasing energy demand coupled with a highly energy intensive economy and energy inefficient industries provide the backdrop for strong government action underway in South Africa. This brochure details how the Clean Energy Solutions Center supported development of the Regulations on Allowance for the Energy Efficiency Savings legislation designed to provide a framework for effective energy efficiency regulation, incentives and energy reduction targets for South Africa's commercial buildings sector.

Opportunities for Energy Efficiency and Automated Demand Response in Industrial Refrigerated Warehouses in California

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lekov, Alex; Thompson, Lisa; McKane, Aimee

2009-05-11

This report summarizes the Lawrence Berkeley National Laboratory's research to date in characterizing energy efficiency and open automated demand response opportunities for industrial refrigerated warehouses in California. The report describes refrigerated warehouses characteristics, energy use and demand, and control systems. It also discusses energy efficiency and open automated demand response opportunities and provides analysis results from three demand response studies. In addition, several energy efficiency, load management, and demand response case studies are provided for refrigerated warehouses. This study shows that refrigerated warehouses can be excellent candidates for open automated demand response and that facilities which have implemented energy efficiencymore » measures and have centralized control systems are well-suited to shift or shed electrical loads in response to financial incentives, utility bill savings, and/or opportunities to enhance reliability of service. Control technologies installed for energy efficiency and load management purposes can often be adapted for open automated demand response (OpenADR) at little additional cost. These improved controls may prepare facilities to be more receptive to OpenADR due to both increased confidence in the opportunities for controlling energy cost/use and access to the real-time data.« less

Analyzing the Impacts of a Biogas-to-Electricity Purchase Incentive on Electric Vehicle Deployment with the MA 3T Vehicle Choice Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Podkaminer, Kara; Xie, Fei; Lin, Zhenhong

In 2014, the EPA approved a biogas-to-electricity pathway under the Renewable Fuel Standard (RFS). However, no specific applications for this pathway have been approved to date. This analysis helps understand the impact of the pathway by representing the biogas-to-electricity pathway as a point of purchase incentive and tests the impact of this incentive on EV deployment using a vehicle consumer choice model.

Combined heat and power systems: economic and policy barriers to growth

PubMed Central

2012-01-01

Background Combined Heat and Power (CHP) systems can provide a range of benefits to users with regards to efficiency, reliability, costs and environmental impact. Furthermore, increasing the amount of electricity generated by CHP systems in the United States has been identified as having significant potential for impressive economic and environmental outcomes on a national scale. Given the benefits from increasing the adoption of CHP technologies, there is value in improving our understanding of how desired increases in CHP adoption can be best achieved. These obstacles are currently understood to stem from regulatory as well as economic and technological barriers. In our research, we answer the following questions: Given the current policy and economic environment facing the CHP industry, what changes need to take place in this space in order for CHP systems to be competitive in the energy market? Methods We focus our analysis primarily on Combined Heat and Power Systems that use natural gas turbines. Our analysis takes a two-pronged approach. We first conduct a statistical analysis of the impact of state policies on increases in electricity generated from CHP system. Second, we conduct a Cost-Benefit analysis to determine in which circumstances funding incentives are necessary to make CHP technologies cost-competitive. Results Our policy analysis shows that regulatory improvements do not explain the growth in adoption of CHP technologies but hold the potential to encourage increases in electricity generated from CHP system in small-scale applications. Our Cost-Benefit analysis shows that CHP systems are only cost competitive in large-scale applications and that funding incentives would be necessary to make CHP technology cost-competitive in small-scale applications. Conclusion From the synthesis of these analyses we conclude that because large-scale applications of natural gas turbines are already cost-competitive, policy initiatives aimed at a CHP market dominated primarily by large-scale (and therefore already cost-competitive) systems have not been effectively directed. Our recommendation is that for CHP technologies using natural gas turbines, policy focuses should be on increasing CHP growth in small-scale systems. This result can be best achieved through redirection of state and federal incentives, research and development, adoption of smart grid technology, and outreach and education. PMID:22540988

Are financial incentives cost-effective to support smoking cessation during pregnancy?

PubMed

Boyd, Kathleen A; Briggs, Andrew H; Bauld, Linda; Sinclair, Lesley; Tappin, David

2016-02-01

To investigate the cost-effectiveness of up to £400 worth of financial incentives for smoking cessation in pregnancy as an adjunct to routine health care. Cost-effectiveness analysis based on a Phase II randomized controlled trial (RCT) and a cost-utility analysis using a life-time Markov model. The RCT was undertaken in Glasgow, Scotland. The economic analysis was undertaken from the UK National Health Service (NHS) perspective. A total of 612 pregnant women randomized to receive usual cessation support plus or minus financial incentives of up to £400 vouchers (US $609), contingent upon smoking cessation. Comparison of usual support and incentive interventions in terms of cotinine-validated quitters, quality-adjusted life years (QALYs) and direct costs to the NHS. The incremental cost per quitter at 34-38 weeks pregnant was £1127 ($1716).This is similar to the standard look-up value derived from Stapleton & West's published ICER tables, £1390 per quitter, by looking up the Cessation in Pregnancy Incentives Trial (CIPT) incremental cost (£157) and incremental 6-month quit outcome (0.14). The life-time model resulted in an incremental cost of £17 [95% confidence interval (CI) = -£93, £107] and a gain of 0.04 QALYs (95% CI = -0.058, 0.145), giving an ICER of £482/QALY ($734/QALY). Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse after birth. The expected value of perfect information was £30 million (at a willingness to pay of £30 000/QALY), so given current uncertainty, additional research is potentially worthwhile. Financial incentives for smoking cessation in pregnancy are highly cost-effective, with an incremental cost per quality-adjusted life years of £482, which is well below recommended decision thresholds. © 2015 Society for the Study of Addiction.

Cost-effectiveness analysis of malaria rapid diagnostic test incentive schemes for informal private healthcare providers in Myanmar.

PubMed

Chen, Ingrid T; Aung, Tin; Thant, Hnin Nwe Nwe; Sudhinaraset, May; Kahn, James G

2015-02-05

The emergence of artemisinin-resistant Plasmodium falciparum parasites in Southeast Asia threatens global malaria control efforts. One strategy to counter this problem is a subsidy of malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) within the informal private sector, where the majority of malaria care in Myanmar is provided. A study in Myanmar evaluated the effectiveness of financial incentives vs information, education and counselling (IEC) in driving the proper use of subsidized malaria RDTs among informal private providers. This cost-effectiveness analysis compares intervention options. A decision tree was constructed in a spreadsheet to estimate the incremental cost-effectiveness ratios (ICERs) among four strategies: no intervention, simple subsidy, subsidy with financial incentives, and subsidy with IEC. Model inputs included programmatic costs (in dollars), malaria epidemiology and observed study outcomes. Data sources included expenditure records, study data and scientific literature. Model outcomes included the proportion of properly and improperly treated individuals with and without P. falciparum malaria, and associated disability-adjusted life years (DALYs). Results are reported as ICERs in US dollars per DALY averted. One-way sensitivity analysis assessed how outcomes depend on uncertainty in inputs. ICERs from the least to most expensive intervention are: $1,169/DALY averted for simple subsidy vs no intervention, $185/DALY averted for subsidy with financial incentives vs simple subsidy, and $200/DALY averted for a subsidy with IEC vs subsidy with financial incentives. Due to decreasing ICERs, each strategy was also compared to no intervention. The subsidy with IEC was the most favourable, costing $639/DALY averted compared with no intervention. One-way sensitivity analysis shows that ICERs are most affected by programme costs, RDT uptake, treatment-seeking behaviour, and the prevalence and virulence of non-malarial fevers. In conclusion, private provider subsidies with IEC or a combination of IEC and financial incentives may be a good investment for malaria control.

"All the money in the world …" patient perspectives regarding the influence of financial incentives.

PubMed

Reisinger, Heather Schacht; Brackett, Rachel Horner; Buzza, Colin D; Páez, Monica B Williams; Gourley, Ryan; Weg, Mark W Vander; Christensen, Alan J; Kaboli, Peter J

2011-12-01

To analyze patient perspectives of the use of financial incentives in a hypertension intervention. Study Setting. Twelve Veterans Affairs primary care clinics over a 9-month period. Qualitative semistructured interviews conducted with 54 hypertensive veterans participating in an intervention to promote guideline-consistent therapy. Intervention components included an intervention letter requesting patients talk with their providers, an offer of U.S.$20 to bring in the letter to their provider, and a health educator phone call. Semistructured interviews were conducted. Transcripts were coded for thematic content. The financial incentive theme was then subcoded for more detailed analysis. Most participants (n=48; 88.9 percent) stated the incentive had (or would have) no effect on their decision to initiate a discussion with their provider. Some participants articulated reservations about the effectiveness and/or appropriateness of financial incentives in health care decisions; however, a few expressed the opinion that there may be some potential benefits to the use of financial incentives if they encourage patients to be active in their health care. The findings of this study raise questions about the appropriateness and unintended consequences of employing patient-directed financial incentives in health care settings. © Health Research and Educational Trust.

Understanding congestion in China's medical market: an incentive structure perspective.

PubMed

Sun, Zesheng; Wang, Shuhong; Barnes, Stephen R

2016-04-01

Congestion has become one of the most important factors leading to patient dissatisfaction and doctor-patient conflicts in the medical market of China. In this study, we explore the causes and effects of structural congestion in the Chinese medical market from an incentive structure perspective. Our analysis reveals that prior medical system reforms with price regulation in China have induced hospitals to establish incentives for capital-intensive investments, while ignoring human capital, and have driven medical staff and patients to higher-level hospitals, reinforcing an incentive structure in which congestion in higher-level hospitals and idle resources in lower-level hospitals coexist. The existing incentive structure has led to cost increases and degradation of human capital and specific factor effects. Recent reforms to reduce congestion in the Chinese medical market were not effective. Most of them had no impact on and did not involve the existing distorted incentive structure. Future reforms should consider rebalancing expectations for medical quality, free flow of human capital and price regulation reforms to rebuild a new incentive structure. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

77 FR 66025 - Program Access Rules

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-31

... distribution market if the prohibition were lifted.'' Accordingly, we rely on ``economic theory and predictive... incentive and the ability to harm competition and diversity in the distribution of video programming by entering into exclusive contracts. We undertake the same analysis here. Below, we consider the ``incentive...

Safety belt and motorcycle helmet use in Virginia : the 1996 update.

DOT National Transportation Integrated Search

1996-01-01

This series of surveys to determine the safety belt and motorcycle helmet use rates in Virginia was initiated to qualify the Commonwealth for incentive funds in accordance with the requirements of the Intermodal Surface Transportation Efficiency Act,...

Rethinking Equity--There Are Alternatives.

ERIC Educational Resources Information Center

Picus, Lawrence O.

1998-01-01

Defines "equity" in terms of three concepts (horizontal equity, vertical equity, and fiscal neutrality), summarizes school finance litigation history, and presents alternative distribution formats to improve student achievement. Enhancing equity and efficiency requires reallocation of existing resources, incentives for improved performance, a more…

Quantifying Individual Variation in the Propensity to Attribute Incentive Salience to Reward Cues

PubMed Central

Meyer, Paul J.; Lovic, Vedran; Saunders, Benjamin T.; Yager, Lindsay M.; Flagel, Shelly B.; Morrow, Jonathan D.; Robinson, Terry E.

2012-01-01

If reward-associated cues acquire the properties of incentive stimuli they can come to powerfully control behavior, and potentially promote maladaptive behavior. Pavlovian incentive stimuli are defined as stimuli that have three fundamental properties: they are attractive, they are themselves desired, and they can spur instrumental actions. We have found, however, that there is considerable individual variation in the extent to which animals attribute Pavlovian incentive motivational properties (“incentive salience”) to reward cues. The purpose of this paper was to develop criteria for identifying and classifying individuals based on their propensity to attribute incentive salience to reward cues. To do this, we conducted a meta-analysis of a large sample of rats (N = 1,878) subjected to a classic Pavlovian conditioning procedure. We then used the propensity of animals to approach a cue predictive of reward (one index of the extent to which the cue was attributed with incentive salience), to characterize two behavioral phenotypes in this population: animals that approached the cue (“sign-trackers”) vs. others that approached the location of reward delivery (“goal-trackers”). This variation in Pavlovian approach behavior predicted other behavioral indices of the propensity to attribute incentive salience to reward cues. Thus, the procedures reported here should be useful for making comparisons across studies and for assessing individual variation in incentive salience attribution in small samples of the population, or even for classifying single animals. PMID:22761718

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

Eighteen papers arising from the conference are presented: legal requirements for economic analysis (Row, C.); The role of economics in national forest planning (Palmer, C; Row, C; Randal, R.M.); The framework for examining silvicultural options in forest planning (Ortman, T.); Integrating forest planning with regional planning and management (Merzenich, J.P.); Genetic gains realizable in rust resistance programs - what are we buying. (Manning, G.; Howe, G.); How should we consider other resources in silvicultural planning (McDivitt, J.; Hansen, C.); Interrelationships among biological, financial and silvicultural decisions in forestry (Fey, W.R.; Robinson, V.L.); Searching the response surface of stand simulators undermore » different objectives and constraints. DFSIM (Douglas fir simulator) as a case study (Sleavin, K.E.; Johnson, K.N.); What good are efficient timber prescriptions. (Fight, R.D.); Handheld programmable computers (Stanger, L.O.); Economic efficiency in the forest service planning process: a critique of the definition of economic efficiency (Medema, L.); An evaluation of federal silvicultural investments made through the 1979 forestry incentives program (Risbrudt, C.D.); Analysing bids for silvicultural contracts promotes efficient allocation of funds (Guldin, R.W.); Some economic aspects of R-8 planning (Greenhalgh, R.); A practical application of economic analysis to vegetation management treatments (Skinner, M.); Stratifying sites by productivity and treatment constrains for reforestation (Fiske, J.); Causes of variation in the direct cost of silvicultural treatments on national forest land (Mills, T.J.); and Problem solving and decision analysis in silviculture (Beuter, J.H.).« less

Effectiveness of a financial incentive to physicians for timely follow-up after hospital discharge: a population-based time series analysis.

PubMed

Lapointe-Shaw, Lauren; Mamdani, Muhammad; Luo, Jin; Austin, Peter C; Ivers, Noah M; Redelmeier, Donald A; Bell, Chaim M

2017-10-02

Timely follow-up after hospital discharge may decrease readmission to hospital. Financial incentives to improve follow-up have been introduced in the United States and Canada, but it is unknown whether they are effective. Our objective was to evaluate the impact of an incentive program on timely physician follow-up after hospital discharge. We conducted an interventional time series analysis of all medical and surgical patients who were discharged home from hospital between Apr. 1, 2002, and Jan. 30, 2015, in Ontario, Canada. The intervention was a supplemental billing code for physician follow-up within 14 days of discharge from hospital, introduced in 2006. The primary outcome was an outpatient visit within 14 days of discharge. Secondary outcomes were 7-day follow-up and a composite of emergency department visits, nonelective hospital readmission and death within 14 days. We included 8 008 934 patient discharge records. The incentive code was claimed in 31% of eligible visits by 51% of eligible physicians, and cost $17.5 million over the study period. There was no change in the average monthly rate of outcomes in the year before the incentive was introduced compared with the year following introduction: 14-day follow-up (66.5% v. 67.0%, overall p = 0.5), 7-day follow-up (44.9% v. 44.9%, overall p = 0.5) and composite outcome (16.7% v. 16.9%, overall p = 0.2). Despite uptake by physicians, a financial incentive did not alter follow-up after hospital discharge. This lack of effect may be explained by features of the incentive or by extra-physician barriers to follow-up. These barriers should be considered by policymakers before introducing similar initiatives. © 2017 Canadian Medical Association or its licensors.

An Output Approach to Incentive Reimbursement for Hospitals

PubMed Central

Ro, Kong-kyun; Auster, Richard

1969-01-01

A method of incentive reimbursement for health care institutions is described that is designed to stimulate the providers' efficiency. The two main features are: (1) reimbursement based on a weighted average of actual cost and mean cost plus or minus an appropriate number of standard deviations; (2) output defined as episodes of illness given adequate treatment instead of days of hospitalization. It is suggested that despite the operational difficulties involved in a method of payment based on an output approach, the flexibility incorporated into the determination of reimbursement by use of the properties of a normal frequency distribution would make the system workable. PMID:5349002

Innovative market-based policy instruments for waste management: A case study on shredder residues in Belgium.

PubMed

Dubois, Maarten; Hoogmartens, Rob; Van Passel, Steven; Van Acker, Karel; Vanderreydt, Ive

2015-10-01

In an increasingly complex waste market, market-based policy instruments, such as disposal taxes, can give incentives for sustainable progress while leaving flexibility for innovation. However, implementation of disposal taxes is often criticised by domestic waste handlers that fear to be outcompeted by competitors in other countries. The article discusses three innovative market-based instruments that limit the impact on international competitiveness: Tradable recycling credits, refunded disposal taxes and differentiated disposal taxes. All three instruments have already been implemented for distinct environmental policies in Europe. In order to illustrate how these instruments can be used for waste policy, the literature review is complemented with a case study on shredder residues from metal-containing waste streams in Belgium. The analysis shows that a conventional disposal tax remains the most efficient, simple and transparent instrument. However, if international competition is a significant issue or if political support is weak, refunded and differentiated disposal taxes can have an added value as second-best instruments. Tradable recycling credits are not an appropriate instrument for use in small waste markets with market power. In addition, refunded taxes create similar incentives, but induce lower transactions costs. © The Author(s) 2015.

A bioeconomic analysis of bushmeat hunting

PubMed Central

Damania, R.; Milner-Gulland, E.J.; Crookes, D.J.

2005-01-01

Unsustainable bushmeat hunting is a major threat to mammal species, particularly in West/Central Africa. We developed a multispecies dynamic simulation model of hunter behaviour, parameterized using data from the Ashanti region, Ghana. The model distinguishes between two hunting techniques, snaring and gun hunting. We analyse the impact of key economic parameters on off-takes. Economic incentives determine the effort devoted to hunting, the choice of hunting technique, and the species that are consumed domestically or traded in markets. These factors, together with the growth rates and catchabilities of hunted species, determine the ecological impact of hunting. The results suggest that increased bushmeat prices are likely to lead to a switch from snaring, which is cheaper but less efficient, to gun hunting, with a consequent impact on vulnerable species. Increases in agricultural prices have an ambiguous effect on hunter behaviour, depending on the balance between incentives to invest in agriculture and increased consumption as incomes improve. Penalties are more effective if they target bushmeat sales, rather than the act of hunting. This model represents a step forward because it explicitly considers bushmeat as a component of the household economy. This has important implications as regards the development of policies to conserve species hunted for bushmeat. PMID:15705550

Factors associated with job satisfaction among commune health workers: implications for human resource policies.

PubMed

Tran, Bach Xuan; Van Hoang, Minh; Nguyen, Hinh Duc

2013-01-30

Job satisfaction among health workers is an important indicator in assessing the performance and efficiency of health services. This study measured job satisfaction and determined associated factors among health workers in 38 commune health stations in an urban district and a rural district of Hanoi, Vietnam. A total of 252 health workers (36 medical doctors and 216 nurses and technicians; 74% female) were interviewed. A job satisfaction measure was developed using factor analysis, from which four dimensions emerged, namely 'benefits and prospects,' 'facility and equipment,' 'performance,' and 'professionals.' The results demonstrate that respondents were least satisfied with the following categories: salary and incentives (24.0%), benefit packages (25.1%), equipment (35.7%), and environment (41.8%). The average satisfaction score was moderate across four domains; it was the highest for 'performance' (66.6/100) and lowest for 'facility and equipment' (50.4/100). Tobit-censored regression models, constructed using stepwise selection, determined significant predictors of job satisfaction including age, areas of work and expertise, professional education, urban versus rural setting, and sufficient number of staff. The findings highlight the need to implement health policies that focus on incentives, working conditions, workloads, and personnel management at grassroots level.

Net costs of health worker rural incentive packages: an example from the Lao People's Democratic Republic.

PubMed

Keuffel, Eric; Jaskiewicz, Wanda; Paphassarang, Chanthakhath; Tulenko, Kate

2013-11-01

Many developing countries are examining whether to institute incentive packages that increase the share of health workers who opt to locate in rural settings; however, uncertainty exists with respect to the expected net cost (or benefit) from these packages. We utilize the findings from the discrete choice experiment surveys applied to students training to be health professionals and costing analyses in Lao People's Democratic Republic to model the anticipated effect of incentive packages on new worker location decisions and direct costs. Incorporating evidence on health worker density and health outcomes, we then estimate the expected 5-year net cost (or benefit) of each incentive packages for 3 health worker cadres--physicians, nurses/midwives, and medical assistants. Under base case assumptions, the optimal incentive package for each cadre produced a 5-year net benefit (maximum net benefit for physicians: US$ 44,000; nurses/midwives: US$ 5.6 million; medical assistants: US$ 485,000). After accounting for health effects, the expected net cost of select incentive packages would be substantially less than the original estimate of direct costs. In the case of Lao People's Democratic Republic, incentive packages that do not invest in capital-intensive components generally should produce larger net benefits. Combining discrete choice experiment surveys, costing surveys and cost-benefit analysis methods may be replicated by other developing countries to calculate whether health worker incentive packages are viable policy options.

Attitudes towards and perceptions of eco-driving and the role of feedback systems.

PubMed

Harvey, Joan; Thorpe, Neil; Fairchild, Richard

2013-01-01

This paper addresses whether eco-driving may be encouraged by providing drivers with feedback, and how eco-driving attitudes fit with other environmental attitudes. Eight focus groups, including fleet drivers, discussed how feedback and other motives might affect driving behaviour. A survey of 350 respondents investigated attitudes towards saving fuel, the role of incentives and use of eco-friendly products. The focus groups' findings show that the environment is a lower priority than comfort and convenience, that feedback might provide a stimulus to eco-driving and that saving money was less important than saving time. The attitude survey showed that price, convenience, attitudes and eco-driving are not conceptually linked together, that convenience is rated as more important than saving money from fuel efficiency and that although the environment is of concern, it is not a high enough priority to increase fuel efficiency. The findings are discussed in relation to the low level of priority given to environmental concerns and the inability of financial incentives presenting significant challenges in terms of changing the subjective norms of the majority of drivers. This paper, using focus groups and a questionnaire, aims to understand how feedback devices, attitudes and motivation can improve eco-driving behaviours. The incentive to save money by better fuel economy was found to be insufficient, and roles for feedback devices and how information is presented are identified.

Effects of incentives on psychosocial performances in simulated space-dwelling groups

NASA Astrophysics Data System (ADS)

Hienz, Robert D.; Brady, Joseph V.; Hursh, Steven R.; Gasior, Eric D.; Spence, Kevin R.; Emurian, Henry H.

Prior research with individually isolated 3-person crews in a distributed, interactive, planetary exploration simulation examined the effects of communication constraints and crew configuration changes on crew performance and psychosocial self-report measures. The present report extends these findings to a model of performance maintenance that operationalizes conditions under which disruptive affective responses by crew participants might be anticipated to emerge. Experiments evaluated the effects of changes in incentive conditions on crew performance and self-report measures in simulated space-dwelling groups. Crews participated in a simulated planetary exploration mission that required identification, collection, and analysis of geologic samples. Results showed that crew performance effectiveness was unaffected by either positive or negative incentive conditions, while self-report measures were differentially affected—negative incentive conditions produced pronounced increases in negative self-report ratings and decreases in positive self-report ratings, while positive incentive conditions produced increased positive self-report ratings only. Thus, incentive conditions associated with simulated spaceflight missions can significantly affect psychosocial adaptation without compromising task performance effectiveness in trained and experienced crews.

Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period.

PubMed

2016-11-04

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

Financial incentives for diabetes prevention in a Medicaid population: Study design and baseline characteristics.

PubMed

Desai, Jay; Taylor, Gretchen; Vazquez-Benitez, Gabriela; Vine, Sara; Anderson, Julie; Garrett, Joyce E; Gilmer, Todd; Vue-Her, Houa; Schiff, Jeff; Rinn, Sarah; Engel, Katelyn; Michael, Amy; O'Connor, Patrick J

2017-02-01

Medicaid beneficiaries at high risk for diabetes can benefit from the Diabetes Prevention Program (DPP) lifestyle intervention. The We Can Prevent Diabetes (WCPD) trial examined whether financial incentives are more effective than no financial incentives in sustaining participation in the DPP and increasing weight loss. Here we describe the study design and baseline characteristics. The WCPD was a 3-arm group-randomized controlled trial. Medicaid beneficiaries were aged 18 to 74years, had prediabetes or gestational diabetes, and were overweight or obese. Subjects enrolled from 13 primary care clinics into groups of 8 to 15 participants. Participants received the 12-month DPP delivered by the YMCA or trained clinic staff, free of costs. Participants from groups randomized into the intervention conditions were eligible to receive incentives up to $520 by attending sessions and meeting weight loss goals. The WCPD enrolled 1154 participants into 98 groups. Among the 847 attending at least one DPP session, 71.2% were women; the mean age was 48.3years; 79.3% were obese; and 87.6% entered the study with an elevated HbA1c or fasting plasma glucose. Participants' primary languages were Somali (21.0%), Hmong (3.1%), Spanish (2.2%), or English (72.4%). The WCPD trial demonstrated that a collaborative approach with primary care clinics and the YMCA can efficiently identify, enroll, and deliver the 12-month DPP to Medicaid beneficiaries. If the WCPD incentive arms increase attendance and weight loss, the use of financial incentives may be an avenue for engaging low-income, high-risk patients in lifestyle change. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Miscellaneous Papers Presented at the Telecommunications Policy Research Conference.

ERIC Educational Resources Information Center

Telecommunications Policy Research Conference, Inc., Washington, DC.

This document consists of 26 miscellaneous conference papers that consider various aspects of telecommunications policy, as follows: (1) "New Communications Systems and Services" (Baer); (2) "Regulatory Incentive Mechanisms and Political Action" (Baron); (3) "Efficiency Issues in Competitive Allocation of the Broadcast…

Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes.

PubMed

Till, Sara R; Everetts, David; Haas, David M

2015-12-15

Prenatal care is recommended during pregnancy as a method to improve neonatal and maternal outcomes. Improving the use of prenatal care is important, particularly for women at moderate to high risk of adverse outcomes. Incentives are sometimes utilized to encourage women to attend prenatal care visits. To determine whether incentives are an effective tool to increase utilization of timely prenatal care among women. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2015) and the reference lists of all retrieved studies. Randomized controlled trials (RCTs), quasi-RCTs, and cluster-RCTs that utilized direct incentives to pregnant women explicitly linked to initiation and frequency of prenatal care were included. Incentives could include cash, vouchers, coupons or products not generally offered to women as a standard of prenatal care. Comparisons were to no incentives and to incentives not linked directly to utilization of care. We also planned to compare different types of interventions, i.e. monetary versus products or services. Two review authors independently assessed studies for inclusion and methodological quality. Two review authors independently extracted data. Data were checked for accuracy. We identified 11 studies (19 reports), six of which we excluded. Five studies, involving 11,935 pregnancies were included, but only 1893 pregnancies contributed data regarding our specified outcomes. Incentives in the studies included cash, gift card, baby carrier, baby blanket or taxicab voucher and were compared with no incentives. Meta-analysis was performed for only one outcome 'Return for postpartum care' and this outcome was not pre-specified in our protocol. Other analyses were restricted to data from single studies.Trials were at a moderate risk of bias overall. Randomization and allocation were adequate and risk of selection bias was low in three studies and unclear in two studies. None of the studies were blinded to the participants. Blinding of outcome assessors was adequate in one study, but was limited or not described in the remaining four studies. Risk of attrition was deemed to be low in all studies that contributed data to the review. Two of the studies reported or analyzed data in a manner that was not consistent with the predetermined protocol and thus were deemed to be at high risk. The other three studies were low risk for reporting bias. The largest two of the five studies comprising the majority of participants took place in rural, low-income, homogenously Hispanic communities in Central America. This setting introduces a number of confounding factors that may affect generalizability of these findings to ethnically and economically diverse urban communities in developed countries.The five included studies of incentive programs did not report any of this review's primary outcomes: preterm birth, small-for-gestational age, or perinatal death.In terms of this review's secondary outcomes, pregnant women receiving incentives were no more likely to initiate prenatal care (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.78 to 1.38, one study, 104 pregnancies). Pregnant women receiving incentives were more likely to attend prenatal visits on a frequent basis (RR 1.18, 95% CI 1.01 to 1.38, one study, 606 pregnancies) and obtain adequate prenatal care defined by number of "procedures" such as testing blood sugar or blood pressure, vaccinations and counseling about breastfeeding and birth control (mean difference (MD) 5.84, 95% CI 1.88 to 9.80, one study, 892 pregnancies). In contrast, women who received incentives were more likely to deliver by cesarean section (RR 1.97, 95% CI 1.18 to 3.30, one study, 979 pregnancies) compared to those women who did not receive incentives.Women who received incentives were no more likely to return for postpartum care based on results of meta-analysis (average RR 0.75, 95% CI 0.21 to 2.64, two studies, 833 pregnancies, Tau² = 0.81, I² = 98%). However, there was substantial heterogeneity in this analysis so a subgroup analysis was performed and this identified a clear difference between subgroups based on the type of incentive being offered. In one study, women receiving non-cash incentives were more likely to return for postpartum care (RR 1.26, 95% CI 1.09 to 1.47, 240 pregnancies) than women who did not receive non-cash incentives. In another study, women receiving cash incentives were less likely to return for postpartum care (RR 0.43, 95% CI 0.30 to 0.62, 593 pregnancies) than women who did not receive cash incentives.No data were identified for the following secondary outcomes: frequency of prenatal care; pre-eclampsia; satisfaction with birth experience; maternal mortality; low birthweight (less than 2500 g); infant macrosomia (birthweight greater than 4000 g); or five-minute Apgar less than seven. The included studies did not report on this review's main outcomes: preterm birth, small-for-gestational age, or perinatal death. There is limited evidence that incentives may increase utilization and quality of prenatal care, but may also increase cesarean rate. Overall, there is insufficient evidence to fully evaluate the impact of incentives on prenatal care initiation. There are conflicting data as to the impact of incentives on return for postpartum care. Two of the five studies which accounted for the majority of women in this review were conducted in rural, low-income, overwhelmingly Hispanic communities in Central America, thus limiting the external validity of these results.There is a need for high-quality RCTs to determine whether incentive program increase prenatal care use and improve maternal and neonatal outcomes. Incentive programs, in particular cash-based programs, as suggested in this review and in several observational studies may improve the frequency and ensure adequate quality of prenatal care. No peer-reviewed data have been made publicly available for one of the largest incentive-based prenatal programs - the statewide Medicaid-based programs within the United States. These observational data represent an important starting point for future research with significant implications for policy development and allocation of healthcare resources. The disparate findings related to attending postpartum care should also be further explored as the findings were limited by the number of studies. Future large RCTs are needed to focus on the outcomes of preterm birth, small-for-gestational age and perinatal outcomes.

Does Intellectual Property Restrict Output? An Analysis of Pharmaceutical Markets*

PubMed Central

Lakdawalla, Darius; Philipson, Tomas

2013-01-01

Standard normative analysis of intellectual property focuses on the balance between incentives for research and the static welfare costs of reduced price-competition from monopoly. However, static welfare loss from patents is not universal. While patents restrict price competition, they may also provide static welfare benefits by improving incentives for marketing, which is a form of non-price competition. We show theoretically how stronger marketing incentives mitigate, and can even offset, the static costs of monopoly pricing. Empirical analysis in the pharmaceutical industry context suggests that, in the short-run, patent expirations reduce consumer welfare as a result of decreased marketing effort. In the long-run, patent expirations do benefit consumers, but by 30% less than would be implied by the reduction in price alone. The social value of monopoly marketing to consumers alone is roughly on par with its costs to firms. PMID:25221349

Does Intellectual Property Restrict Output? An Analysis of Pharmaceutical Markets.

PubMed

Lakdawalla, Darius; Philipson, Tomas

2012-02-01

Standard normative analysis of intellectual property focuses on the balance between incentives for research and the static welfare costs of reduced price-competition from monopoly. However, static welfare loss from patents is not universal. While patents restrict price competition, they may also provide static welfare benefits by improving incentives for marketing, which is a form of non -price competition. We show theoretically how stronger marketing incentives mitigate, and can even offset, the static costs of monopoly pricing. Empirical analysis in the pharmaceutical industry context suggests that, in the short-run, patent expirations reduce consumer welfare as a result of decreased marketing effort. In the long-run, patent expirations do benefit consumers, but by 30% less than would be implied by the reduction in price alone. The social value of monopoly marketing to consumers alone is roughly on par with its costs to firms.

Evaluating the effect of the new incentive system for high-risk pressure ulcer patients on wound healing and cost-effectiveness: a cohort study.

PubMed

Sanada, Hiromi; Nakagami, Gojiro; Mizokami, Yuko; Minami, Yukiko; Yamamoto, Aya; Oe, Makoto; Kaitani, Toshiko; Iizaka, Shinji

2010-03-01

To evaluate the effectiveness and cost-effectiveness of new incentive system for pressure ulcer management, which focused on skilled nurse staffing in terms of rate of healing and medical costs. A prospective cohort study included two types of groups: 39 institutions, which introduced the new incentive system, and 20 non-introduced groups (control). Sixty-seven patients suffering from severe pressure ulcers in the introduced group and 38 patients in the non-introduced group were included. Wound healing and medical costs were monitored weekly for three weeks by their skilled nurses in charge. Healing status and related medical costs. The introduced group showed significantly higher rate of healing compared with the control group at each weekly assessment. Multiple regression analysis revealed that the introduction of the new incentive system was independently associated with the faster healing rate (beta=3.44, P<.001). The budget impact analysis demonstrated that introducing this system could reduce cost of treating severe pressure ulcers by 1.776 billion yen per year. The new incentive system for the management of pressure ulcers, which focused on staffing with skilled nurses can improve healing rate with reduced medical cost. Copyright 2009 Elsevier Ltd. All rights reserved.

[Analysis of motivational orientation of young people for systematic tutoring improving sports].

PubMed

Yvashchenko, S N

2011-01-01

This article examines the results of core and additional motivation which define the content of motivational orientation of young persons in regular classes recreational physical culture and sports. To determine the nature and capacity-building incentive used experimental method of calculating the integral coefficient of incentive tension.

Teacher Mobility and Financial Incentives: A Descriptive Analysis of Denver's ProComp

ERIC Educational Resources Information Center

Fulbeck, Eleanor S.

2014-01-01

Extensive teacher mobility can undermine policy efforts to develop a high-quality workforce. In response, policymakers have increasingly championed financial incentives to retain teachers. In 2006, the Denver Public Schools adopted an alternative teacher compensation reform, the Professional Compensation System for Teachers ("ProComp").…

Krakow conference on low emissions sources: Proceedings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pierce, B.L.; Butcher, T.A.

1995-12-31

The Krakow Conference on Low Emission Sources presented the information produced and analytical tools developed in the first phase of the Krakow Clean Fossil Fuels and Energy Efficiency Program. This phase included: field testing to provide quantitative data on missions and efficiencies as well as on opportunities for building energy conservation; engineering analysis to determine the costs of implementing pollution control; and incentives analysis to identify actions required to create a market for equipment, fuels, and services needed to reduce pollution. Collectively, these Proceedings contain reports that summarize the above phase one information, present the status of energy system managementmore » in Krakow, provide information on financing pollution control projects in Krakow and elsewhere, and highlight the capabilities and technologies of Polish and American companies that are working to reduce pollution from low emission sources. It is intended that the US reader will find in these Proceedings useful results and plans for control of pollution from low emission sources that are representative of heating systems in central and Eastern Europe. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database.« less

Alternative Fuel Vehicle Adoption Increases Fleet Gasoline Consumption and Greenhouse Gas Emissions under United States Corporate Average Fuel Economy Policy and Greenhouse Gas Emissions Standards.

PubMed

Jenn, Alan; Azevedo, Inês M L; Michalek, Jeremy J

2016-03-01

The United States Corporate Average Fuel Economy (CAFE) standards and Greenhouse Gas (GHG) Emission standards are designed to reduce petroleum consumption and GHG emissions from light-duty passenger vehicles. They do so by requiring automakers to meet aggregate criteria for fleet fuel efficiency and carbon dioxide (CO2) emission rates. Several incentives for manufacturers to sell alternative fuel vehicles (AFVs) have been introduced in recent updates of CAFE/GHG policy for vehicles sold from 2012 through 2025 to help encourage a fleet technology transition. These incentives allow automakers that sell AFVs to meet less-stringent fleet efficiency targets, resulting in increased fleet-wide gasoline consumption and emissions. We derive a closed-form expression to quantify these effects. We find that each time an AFV is sold in place of a conventional vehicle, fleet emissions increase by 0 to 60 t of CO2 and gasoline consumption increases by 0 to 7000 gallons (26,000 L), depending on the AFV and year of sale. Using projections for vehicles sold from 2012 to 2025 from the Energy Information Administration, we estimate that the CAFE/GHG AFV incentives lead to a cumulative increase of 30 to 70 million metric tons of CO2 and 3 to 8 billion gallons (11 to 30 billion liters) of gasoline consumed over the vehicles' lifetimes - the largest share of which is due to legacy GHG flex-fuel vehicle credits that expire in 2016. These effects may be 30-40% larger in practice than we estimate here due to optimistic laboratory vehicle efficiency tests used in policy compliance calculations.

Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange-based tuberculin skin testing.

PubMed

Perlman, David C; Friedmann, Patricia; Horn, Leslie; Nugent, Anne; Schoeb, Veronika; Carey, Jeanne; Salomon, Nadim; Des Jarlais, Don C

2003-09-01

Syringe-exchange programs (SEPs) have proven to be valuable sites to conduct tuberculin skin testing among active injection drug users. Chest x-rays (CXRs) are needed to exclude active tuberculosis prior to initiating treatment for latent tuberculosis infection. Adherence of drug users to referral for off-site chest x-rays has been incomplete. Previous cost modeling demonstrated that a monetary incentive to promote adherence could be justified on the cost basis if it had even a modest effect on adherence. We compared adherence to referral for chest x-rays among injection drug users undergoing syringe exchange-based tuberculosis screening in New York City before and after the implementation of monetary incentives. From 1995 to 1998, there were 119 IDUs referred for CXRs based on tuberculin skin testing at the SEP. From 1999 to 2001, there were 58 IDUs referred for CXRs with a $25 incentive based on adherence. Adherence to CXR referral within 7 days was 46/58 (79%) among individuals who received the monetary incentive versus 17/119 (14%) prior to the implementation of the monetary incentive (P<.0001; odds ratio [OR]=23; 95% confidence interval [CI]=9.5-57). The median time to obtaining a CXR was significantly shorter among those given the incentive than among those referred without the incentive (2 vs. 11 days, P<.0001). In multivariate logistic regression analysis, use of the incentive was highly independently associated with increased adherence (OR=22.9; 95% CI=10-52). Monetary incentives are highly effective in increasing adherence to referral for screening CXRs to exclude active tuberculosis after syringe exchange-based tuberculin skin testing. Prior cost modeling demonstrated that monetary incentives could be justified on the cost basis if they had even a modest effect on adherence. The current data demonstrated that monetary incentives are highly effective at increasing adherence in this setting and therefore are justifiable on a cost basis. When health care interventions for drug users require referral off site, monetary incentives may be particularly valuable in promoting adherence.

The role of imperfect surrogate endpoint information in drug approval and reimbursement decisions.

PubMed

Bognar, Katalin; Romley, John A; Bae, Jay P; Murray, James; Chou, Jacquelyn W; Lakdawalla, Darius N

2017-01-01

Approval of new drugs is increasingly reliant on "surrogate endpoints," which correlate with but imperfectly predict clinical benefits. Proponents argue surrogate endpoints allow for faster approval, but critics charge they provide inadequate evidence. We develop an economic framework that addresses the value of improvement in the predictive power, or "quality," of surrogate endpoints, and clarifies how quality can influence decisions by regulators, payers, and manufacturers. For example, the framework shows how lower-quality surrogates lead to greater misalignment of incentives between payers and regulators, resulting in more drugs that are approved for use but not covered by payers. Efficient price-negotiation in the marketplace can help align payer incentives for granting access based on surrogates. Higher-quality surrogates increase manufacturer profits and social surplus from early access to new drugs. Since the return on better quality is shared between manufacturers and payers, private incentives to invest in higher-quality surrogates are inefficiently low. Copyright © 2016 The Author(s). Published by Elsevier B.V. All rights reserved.

Universal health insurance through incentives reform.

PubMed

Enthoven, A C; Kronick, R

1991-05-15

Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

BIM Methodology Approach to Infrastructure Design: Case Study of Paniga Tunnel

NASA Astrophysics Data System (ADS)

Osello, Anna; Rapetti, Niccolò; Semeraro, Francesco

2017-10-01

Nowadays, the implementation of Building Information Modelling (BIM) in civil design represent a new challenge for the AECO (Architecture, Engineering, Construction, Owner and Operator) world, which will involve the interest of many researchers in the next years. It is due to the incentives of Public Administration and European Directives that aim to improve the efficiency and to enhance a better management of the complexity of infrastructure projects. For these reasons, the goal of this research is to propose a methodology for the use of BIM in a tunnel project, analysing the definition of a correct level of detail (LOD) and the possibility to share information via interoperability for FEM analysis.

10 CFR 451.9 - Procedures for processing applications.

Code of Federal Regulations, 2012 CFR

2012-01-01

....9 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.9...-hours claimed to have been generated and sold by the qualified renewable energy facility and for which... Energy Efficiency and Renewable Energy shall determine the extent to which appropriated funds are...

10 CFR 451.9 - Procedures for processing applications.

Code of Federal Regulations, 2011 CFR

2011-01-01

....9 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.9...-hours claimed to have been generated and sold by the qualified renewable energy facility and for which... Energy Efficiency and Renewable Energy shall determine the extent to which appropriated funds are...

10 CFR 451.9 - Procedures for processing applications.

Code of Federal Regulations, 2013 CFR

2013-01-01

....9 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.9...-hours claimed to have been generated and sold by the qualified renewable energy facility and for which... Energy Efficiency and Renewable Energy shall determine the extent to which appropriated funds are...

10 CFR 451.9 - Procedures for processing applications.

Code of Federal Regulations, 2014 CFR

2014-01-01

....9 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.9...-hours claimed to have been generated and sold by the qualified renewable energy facility and for which... Energy Efficiency and Renewable Energy shall determine the extent to which appropriated funds are...

Safety belt and motorcycle helmet use in Virginia : results of the 1992 through 1995 surveys.

DOT National Transportation Integrated Search

1995-01-01

This series of surveys to determine the safety belt and motorcycle helmet use rates in Virginia was initiated to qualify the Commonwealth for incentive funds in accordance with the requirements of the Intermodal Surface Transportation Efficiency Act,...

Women’s preferences for alternative financial incentive schemes for breastfeeding: A discrete choice experiment

PubMed Central

Anokye, Nana; de Bekker-Grob, Esther W.; Higgins, Ailish; Relton, Clare; Strong, Mark; Fox-Rushby, Julia

2018-01-01

Background Increasing breastfeeding rates have been associated with reductions in disease in babies and mothers as well as in related costs. ‘Nourishing Start for Health (NoSH)’, a financial incentive scheme has been proposed as a potentially effective way to increase both the number of mothers breastfeeding and duration of breastfeeding. Aims To establish women’s relative preferences for different aspects of a financial incentive scheme for breastfeeding and to identify importance of scheme characteristics on probability on participation in an incentive scheme. Methods A discrete choice experiment (DCE) obtained information on alternative specifications of the NoSH scheme designed to promote continued breastfeeding duration until at least 6 weeks after birth. Four attributes framed alternative scheme designs: value of the incentive; minimum breastfeeding duration required to receive incentive; method of verifying breastfeeding; type of incentive. Three versions of the DCE questionnaire, each containing 8 different choice sets, provided 24 choice sets for analysis. The questionnaire was mailed to 2,531 women in the South Yorkshire Cohort (SYC) aged 16–45 years in IMD quintiles 3–5. The analytic approach considered conditional and mixed effects logistic models to account for preference heterogeneity that may be associated with a variation in effects mediated by respondents’ characteristics. Results 564 women completed the questionnaire and a response rate of 22% was achieved. Most of the included attributes were found to affect utility and therefore the probability to participate in the incentive scheme. Higher rewards were preferred, although the type of incentive significantly affected women’s preferences on average. We found evidence for preference heterogeneity based on individual characteristics that mediated preferences for an incentive scheme.Conclusions Although participants’ opinion in our sample was mixed, financial incentives for breastfeeding may be an acceptable and effective instrument to change behaviour. However, individual characteristics could mediate the effect and should therefore be considered when developing and targeting future interventions. PMID:29649245

Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public

PubMed Central

Hoddinott, Pat; Morgan, Heather; MacLennan, Graeme; Sewel, Kate; Thomson, Gill; Bauld, Linda; Yi, Deokhee; Ludbrook, Anne; Campbell, Marion K

2014-01-01

Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design. Design Cross-sectional survey. Setting and participants British general public. Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models. Results Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%). Conclusions Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions. Trial registration number CRD42012001980. PMID:25037645

Performance Incentives: Their Growing Impact on American K-12 Education

ERIC Educational Resources Information Center

Springer, Matthew G., Ed.

2009-01-01

The concept of "pay for performance" for public school teachers is once again growing in popularity and use. U.S. education is now at a critical juncture that requires thoughtful and informed consideration of this policy innovation. "Performance Incentives" offers the most up-to-date and complete analysis yet of the…

Implementation of the Career Education Incentive Act. First Interim Report on the Evaluability Assessment.

ERIC Educational Resources Information Center

Jung, Steven M.; And Others

Survey activities are reported which were designed to provide the foundation for a national evaluation of the effectiveness of programs assisted under the Career Education Incentive Act of 1977 (PL 95-207). The methodology described, called "program evaluability assessment," focuses on detailed analysis of program assumptions in order to…

Marketing Schools: Consumer Goods and Competitive Incentives for Consumer Information

ERIC Educational Resources Information Center

Lubienski, Christopher

2007-01-01

Effective school-choice plans depend on the quality of information available to families. Examining the promotional materials provided by different schools in a highly competitive and diverse urban area tells us not only about the quality of that information but also how schools respond to competitive incentives. This analysis outlines an economic…

77 FR 10492 - Order Reaffirming Commission Policy and Terminating Proceeding; Analysis of Horizontal Market...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-22

... acquisition will reduce the financial incentive to compete because losses from one owned firm are offset by... the Commission to consider intervenor theories of competitive harm, regardless of whether [[Page 10495... look beyond HHI, focus on whether a merger will change incentives such that there will be an increase...

Use of incentive spirometry in portable chest radiography.

PubMed

McEntee, Mark F; Houssein, Nariman; Al-azawi, Dhafir

2014-01-01

The degree of lung inflation seen on a chest radiograph is dependent on the point during the patient's respiratory cycle at which the radiographer exposes the image receptor. Exposing the image receptor at the exact peak of inflation can be difficult because of the limited time available in which to capture the inspiratory pause. An incentive spirometer can indicate the moment of peak inhalation. This study tested whether images taken with and without an incentive spirometer display different levels of image quality. This is a paired, prospective, single-blinded study of 30 patients undergoing portable chest radiography. The radiographs were acquired with and without the use of an incentive spirometer. Visual grading analysis was performed using the 1996 European Guidelines on Quality Criteria for Diagnostic Radiographic Images. The mean patient age was 53 years. Sixty images were acquired, 30 with the use of incentive spirometry and 30 without. The most common indication for portable chest radiography was "postlung lobectomy." Scoring on the radiologist's ability to see the sixth rib, spine, trachea, and cardiac border was not affected significantly by the use of incentive spirometry. Use of an incentive spirometer was associated with significant improvement in ability to see the 10th rib (P ≤ .004), vascular pattern (P ≤ .001), retrocardiac lung (P ≤ .013), and the costophrenic angles (P ≤ .005). This study introduces a technique to improve the quality of portable chest radiographs. The use of incentive spirometry improved inspiratory depth and image quality for portable chest radiographs.

Incentive-Based Primary Care: Cost and Utilization Analysis.

PubMed

Hollander, Marcus J; Kadlec, Helena

2015-01-01

In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. The study used Ministry of Health administrative data for Fiscal Year 2010-2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). After controlling for patients' age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization.

Incentives to promote breastfeeding: a systematic review.

PubMed

Moran, Victoria Hall; Morgan, Heather; Rothnie, Kieran; MacLennan, Graeme; Stewart, Fiona; Thomson, Gillian; Crossland, Nicola; Tappin, David; Campbell, Marion; Hoddinott, Pat

2015-03-01

Few women in industrialized countries achieve the World Health Organization's recommendation to breastfeed exclusively for 6 months. Governments are increasingly seeking new interventions to address this problem, including the use of incentives. The goal of this study was to assess the evidence regarding the effectiveness of incentive interventions, delivered within or outside of health care settings, to individuals and/or their families seeking to increase and sustain breastfeeding in the first 6 months after birth. Searches of electronic databases, reference lists, and grey literature were conducted to identify relevant reports of published, unpublished, and ongoing studies. All study designs published in English, which met our definition of incentives and that were from a developed country, were eligible for inclusion. Abstract and full-text article review with sequential data extraction were conducted by 2 independent authors. Sixteen full reports were included in the review. The majority evaluated multicomponent interventions of varying frequency, intensity, and duration. Incentives involved providing access to breast pumps, gifts, vouchers, money, food packages, and help with household tasks, but little consensus in findings was revealed. The lack of high-quality, randomized controlled trials identified by this review and the multicomponent nature of the interventions prohibited meta-analysis. This review found that the overall effect of providing incentives for breastfeeding compared with no incentives is unclear due to study heterogeneity and the variation in study quality. Further evidence on breastfeeding incentives offered to women is required to understand the possible effects of these interventions. Copyright © 2015 by the American Academy of Pediatrics.

First carrot, then stick: how the adaptive hybridization of incentives promotes cooperation

PubMed Central

Chen, Xiaojie; Sasaki, Tatsuya; Brännström, Åke; Dieckmann, Ulf

2015-01-01

Social institutions often use rewards and penalties to promote cooperation. Providing incentives tends to be costly, so it is important to find effective and efficient policies for the combined use of rewards and penalties. Most studies of cooperation, however, have addressed rewarding and punishing in isolation and have focused on peer-to-peer sanctioning as opposed to institutional sanctioning. Here, we demonstrate that an institutional sanctioning policy we call ‘first carrot, then stick’ is unexpectedly successful in promoting cooperation. The policy switches the incentive from rewarding to punishing when the frequency of cooperators exceeds a threshold. We find that this policy establishes and recovers full cooperation at lower cost and under a wider range of conditions than either rewards or penalties alone, in both well-mixed and spatial populations. In particular, the spatial dynamics of cooperation make it evident how punishment acts as a ‘booster stage’ that capitalizes on and amplifies the pro-social effects of rewarding. Together, our results show that the adaptive hybridization of incentives offers the ‘best of both worlds’ by combining the effectiveness of rewarding in establishing cooperation with the effectiveness of punishing in recovering it, thereby providing a surprisingly inexpensive and widely applicable method of promoting cooperation. PMID:25551138

Changing physician incentives for affordable, quality cancer care: results of an episode payment model.

PubMed

Newcomer, Lee N; Gould, Bruce; Page, Ray D; Donelan, Sheila A; Perkins, Monica

2014-09-01

This study tested the combination of an episode payment coupled with actionable use and quality data as an incentive to improve quality and reduce costs. Medical oncologists were paid a single fee, in lieu of any drug margin, to treat their patients. Chemotherapy medications were reimbursed at the average sales price, a proxy for actual cost. Five volunteer medical groups were compared with a large national payer registry of fee-for-service patients with cancer to examine the difference in cost before and after the initiation of the payment change. Between October 2009 and December 2012, the five groups treated 810 patients with breast, colon, and lung cancer using the episode payments. The registry-predicted fee-for-service cost of the episodes cohort was $98,121,388, but the actual cost was $64,760,116. The predicted cost of chemotherapy drugs was $7,519,504, but the actual cost was $20,979,417. There was no difference between the groups on multiple quality measures. Modifying the current fee-for-service payment system for cancer therapy with feedback data and financial incentives that reward outcomes and cost efficiency resulted in a significant total cost reduction. Eliminating existing financial chemotherapy drug incentives paradoxically increased the use of chemotherapy. Copyright © 2014 by American Society of Clinical Oncology.

Higher incentives can impair performance: neural evidence on reinforcement and rationality

PubMed Central

Achtziger, Anja; Hügelschäfer, Sabine; Steinhauser, Marco

2015-01-01

Standard economic thinking postulates that increased monetary incentives should increase performance. Human decision makers, however, frequently focus on past performance, a form of reinforcement learning occasionally at odds with rational decision making. We used an incentivized belief-updating task from economics to investigate this conflict through measurements of neural correlates of reward processing. We found that higher incentives fail to improve performance when immediate feedback on decision outcomes is provided. Subsequent analysis of the feedback-related negativity, an early event-related potential following feedback, revealed the mechanism behind this paradoxical effect. As incentives increase, the win/lose feedback becomes more prominent, leading to an increased reliance on reinforcement and more errors. This mechanism is relevant for economic decision making and the debate on performance-based payment. PMID:25816816

Extraversion and reward-related processing: probing incentive motivation in affective priming tasks.

PubMed

Robinson, Michael D; Moeller, Sara K; Ode, Scott

2010-10-01

Based on an incentive motivation theory of extraversion (Depue & Collins, 1999), it was hypothesized that extraverts (relative to introverts) would exhibit stronger positive priming effects in affective priming tasks, whether involving words or pictures. This hypothesis was systematically supported in four studies involving 229 undergraduates. In each of the four studies, and in a subsequent combined analysis, extraversion was positively predictive of positive affective priming effects, but was not predictive of negative affective priming effects. The results bridge an important gap in the literature between biological and trait models of incentive motivation and do so in a way that should be informative to subsequent efforts to understand the processing basis of extraversion as well as incentive motivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

[Analysis of contractual incentives for kidney transplants in Brazil using the principal-agent model].

PubMed

Costa, Cassia Kely Favoretto; Balbinotto, Giácomo; Sampaio, Luciano Menezes Bezerra

2016-09-12

The aim of this article was to analyze contractual incentives for kidney transplants in Brazil based on the principal-agent model. The approach assumes that the Brazilian Ministry of Health is the principal and the public hospitals accredited by the National Transplant System are the agent. The Ministry of Health's welfare depends on measures taken by hospitals in kidney uptake. Hospitals allocate administrative, financial, and management efforts to conduct measures in kidney donation, removal, uptake, and transplantation. Hospitals may choose the levels of effort that are consistent with the payments and incentives received in relation to transplantation costs. The solution to this type of problem lies in structuring an optimal incentives contract, which requires aligning the interests of both parties involved in the transplantation system.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spencer, D.F.

This analysis evaluates the incentives necessary to introduce commercial scale Advanced Clean Coal Technologies, specifically Integrated Coal Gasification Combined Cycle (ICGCC) and Pressurized Fluidized Bed Combustion (PFBC) powerplants. The incentives required to support the initial introduction of these systems are based on competitive busbar electricity costs with natural gas fired combined cycle powerplants, in baseload service. A federal government price guarantee program for up to 10 Advanced Clean Coal Technology powerplants, 5 each ICGCC and PFBC systems is recommended in order to establish the commercial viability of these systems by 2010. By utilizing a decreasing incentives approach as the technologiesmore » mature (plants 1--5 of each type), and considering the additional federal government benefits of these plants versus natural gas fired combined cycle powerplants, federal government net financial exposure is minimized. Annual net incentive outlays of approximately 150 million annually over a 20 year period could be necessary. Based on increased demand for Advanced Clean Coal Technologies beyond 2010, the federal government would be revenue neutral within 10 years of the incentives program completion.« less

Cost containment: challenging fidelity and justice.

PubMed

Haavi Morreim, E

1988-12-01

Cost containment heralds a general tightening of health care funds, which subjects every health care intervention to scrutiny for its economic as well as its medical wisdom and imposes upon physicians a variety of controls and incentives. Fiduciary fidelity is challenged by the conflict between clinical authority and patient loyalty, by financial and professional incentives that pit the physician's own interests against those of his or her patients, by the stratification of resources which results in greater scarcity of funds for indigent care, and by standardization of care through the implementation of "efficiency protocols." Questions of clinical justice are analyzed in the areas of distribution of medical services and of contractual relations among patient, payer, physician, and institution.

Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review.

PubMed

Tambor, Marzena; Pavlova, Milena; Golinowska, Stanisława; Arsenijevic, Jelena; Groot, Wim

2016-09-05

To motivate people to lead a healthier life and to engage in disease prevention, explicit financial incentives, such as monetary rewards for attaining health-related targets (e.g. smoking cessation, weight loss or increased physical activity) or disincentives for reverting to unhealthy habits, are applied. A review focused on financial incentives for health promotion among older people is lacking. Attention to this group is necessary because older people may respond differently to financial incentives, e.g. because of differences in opportunity costs and health perceptions. To outline how explicit financial incentives for healthy lifestyle and disease prevention work among older persons, this study reviews the recent evidence on this topic. We applied the method of systematic literature review and we searched in PUBMED, ECONLIT and COCHRANE LIBRARY for studies focused on explicit financial incentives targeted at older adults to promote health and stimulate primary prevention as well as screening. The publications selected as relevant were analyzed based on directed (relational) content analysis. The results are presented in a narrative manner complemented with an appendix table that describes the study details. We assessed the design of the studies reported in the publications in a qualitative manner. We also checked the quality of our review using the PRISMA 2009 checklist. We identified 15 studies on the role of explicit financial incentives in changing health-related behavior of older people. They include both, quantitative studies on the effectiveness of financial rewards as well as qualitative studies on the acceptability of financial incentives. The quantitative studies are characterized by a great diversity of designs and provide mixed results on the effects of explicit financial incentives. The results of the qualitative studies indicate limited trust of older people in the use of explicit financial incentives for health promotion and prevention. More research is needed on the effects of explicit financial incentives for prevention and promotion among older people before their broader use can be recommended. Overall, the design of the financial incentive system may be a crucial element in their acceptability.

The Mixed Nature of Incentives for Community Health Workers: Lessons from a Qualitative Study in Two Districts in India.

PubMed

Sarin, Enisha; Lunsford, Sarah Smith; Sooden, Ankur; Rai, Sanjay; Livesley, Nigel

2016-01-01

Incentives play an important role in motivating community health workers (CHWs). In India, accredited social health activists (ASHAs) are female CHWs who provide a range of services, including those specific to reproductive, maternal, neonatal, child, and adolescent health. Qualitative interviews were conducted with 49 ASHAs and one of their family members (husband, mother-in-law, sister-in-law, or son) from Gurdaspur and Mewat districts to explore the role of family, community, and health system in supporting ASHAs in their work. Thematic analysis revealed that incentives were both empowering and a source of distress for ASHAs and their families. Earning income and contributing to the household's financial wellbeing inspired a sense of financial independence and self-confidence for ASHAs, especially with respect to relations with their husbands and parents-in-law. In spite of the empowering effects of the incentives, they were a cause of distress. Low incentive rates relative to the level of effort required to complete ASHA responsibilities, compounded by irregular and incomplete payment, put pressure on families. ASHAs dedicated much of their time and own resources to perform their duties, drawing them away from their household responsibilities. Communication around incentives from supervisors may have led ASHAs to prioritize and promote those services that yielded higher incentives, as opposed to focusing on the most appropriate services for the client. ASHAs and their families maintained hope that their positions would eventually bring in a regular salary, which contributed to retention of ASHAs. Incentives, therefore, are both motivating and inspiring as well as a cause dissatisfaction among ASHAs and their families. Recommendations include revising the incentive scheme to be responsive to the time and effort required to complete tasks and the out-of-pocket costs incurred while working as an ASHA; improve communication to ASHAs on incentives and responsibilities; and ensure timely and complete payment of incentives to ASHAs. The findings from this study contribute to the existing literature on incentivized CHW programs and help throw added light on the role incentives play in family dynamics which affects performance of CHW.

Venture Capital Throws Dough That Could Fix Health Care Woe.

PubMed

Kelley, Timothy

2017-11-01

Some experts say that investors funding innovative startup companies can disrupt American health care, making it smarter and more efficient. Others warn that incentives must change if VC money is to make a real difference. It's a trend no one in health care can ignore.

Incentives and intrinsic motivation in healthcare.

PubMed

Berdud, Mikel; Cabasés, Juan M; Nieto, Jorge

It has been established in the literature that workers within public organisations are intrinsically motivated. This paper is an empirical study of the healthcare sector using methods of qualitative analysis research, which aims to answer the following hypotheses: 1) doctors are intrinsically motivated; 2) economic incentives and control policies may undermine doctors' intrinsic motivation; and 3) well-designed incentives may encourage doctors' intrinsic motivation. We conducted semi-structured interviews à-la-Bewley with 16 doctors from Navarre's Healthcare Service (Servicio Navarro de Salud-Osasunbidea), Spain. The questions were based on current theories of intrinsic motivation and incentives to test the hypotheses. Interviewees were allowed to respond openly without time constraints. Relevant information was selected, quantified and analysed by using the qualitative concepts of saturation and codification. The results seem to confirm the hypotheses. Evidence supporting hypotheses 1 and 2 was gathered from all interviewees, as well as indications of the validity of hypothesis 3 based on interviewees' proposals of incentives. The conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis.

PubMed

Driessen, Julia; Olson, Zachary D; Jamison, Dean T; Verguet, Stéphane

2015-08-01

Vaccination coverage rates often mask wide variation in access, uptake, and cost of providing vaccination. Financial incentives have been effective at creating demand for social services in a variety of settings. Using methods of extended cost-effectiveness analysis, we compare the health and economic implications of three different vaccine delivery strategies for measles vaccination in Ethiopia: i) routine immunization, ii) routine immunization with financial incentives, and iii) mass campaigns, known as supplemental immunization activities (SIAs). We examine annual birth cohorts of almost 3,000,000 births over a ten year period, exploring variation in these outcomes based on economic status to understand how various options may improve equity. SIAs naturally achieve higher levels of vaccine coverage, but at higher costs. Routine immunization combined with financial incentives bolsters demand among more economically vulnerable households. The relative appeal of routine immunization with financial incentives and SIAs will depend on the policy environment, including short-term financial limitations, time horizons, and the types of outcomes that are desired. While the impact of financial incentives has been more thoroughly studied in other policy arenas, such as education, consideration of this approach alongside standard vaccination models such as SIAs is timely given the dialog around measles eradication. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Medicaid expenditures for the disabled under a work incentive program

PubMed Central

Andrews, Roxanne M.; Ruther, Martin; Baugh, David K.; Pine, Penelope L.; Rymer, Marilyn P.

1988-01-01

Congress enacted Section 1619 of the Social Security Act to enable the disabled receiving Supplemental Security Income (SSI) to obtain jobs and still retain Medicaid health benefits. Congress intended this work incentive to remove the fear of the severely disabled that by obtaining employment they would lose Medicaid benefits. Based on data from 11 States, our analysis found that Medicaid expenditures for Section 1619 enrollees were relatively small and only one-half the average Medicaid expenditure for the disabled. Retaining Medicaid appears to provide a significant work incentive because Medicaid expenditures represent 13 percent of Section 1619 enrollees' earnings. PMID:10318077

Cost analysis and the practicing radiologist/manager: an introduction to managerial accounting.

PubMed

Forman, H P; Yin, D

1996-06-01

Cost analysis is inherently one of the most tedious tasks falling on the shoulders of any manager. In today's world, whether in a service business such as radiology or medicine or in a product line such as car manufacturing, accurate cost analysis is critical to all aspects of management: marketing, competitive strategy, quality control, human resource management, accounting (financial), and operations management, to name but a few. This is a topic that we will explore with the intention of giving the radiologist/manager the understanding and the basic skills to use cost analysis efficiently, making sure that major financial decisions are being made with adequate cost information, and showing that cost accounting is really managerial accounting in that it pays little attention to the bottom line of financial statements but places much more emphasis on equipping managers with the information to determine budgets, prices, salaries, and incentives and influences capital budgeting decisions through an understanding of product profitability rather than firm profitability.

Acceptability of financial incentives for breastfeeding: thematic analysis of readers' comments to UK online news reports.

PubMed

Giles, Emma L; Holmes, Matthew; McColl, Elaine; Sniehotta, Falko F; Adams, Jean M

2015-05-16

Whilst it is recommended that babies are breastfed exclusively for the first six months, many mothers do not maintain breastfeeding for this length of time. Previous research confirms that women and midwives value financial incentives for breastfeeding, but limited research has explored the wider acceptability of these interventions to the general public. This paper examines opinion towards financial incentives for breastfeeding using reader responses to UK on-line media coverage of a study undertaken in this area. This study used netnography to undertake a thematic analysis of 3,373 reader comments posted in response to thirteen articles, published in November 2013, which reported findings from a feasibility study of financial incentives for breastfeeding. All articles were published on one of six UK news websites that achieved a monthly audience of at least five million viewers across laptop and desktop computers and mobile devices during April-May 2013. Nine analytical themes were identified, with a majority view that financial incentives for breastfeeding are unacceptable. These themes cover a range of opinions: from negligent parents unable to take responsibility for their own actions; through to psychologically vulnerable members of society who should be protected from coercion and manipulation; to capable and responsible women who can, and should be allowed to, make their own decisions. Many views focused on the immediate costs of the intervention, concluding that this was something that was currently unaffordable to fund (e.g. by the NHS). Others contrasted the value of the incentive against other 'costs' of breastfeeding. There was some consideration of the issue of cost-effectiveness and cost-saving, where the potential future benefit from initial investment was identified. Many commenters identified that financial incentives do not address the many structural and cultural barriers to breastfeeding. Overall, those commenting on the on-line UK news articles viewed financial incentives for breastfeeding as unacceptable and that alternative, structural, interventions were likely to be more effective. Further consideration of how best to conduct internet-based qualitative research to elicit opinion towards public health issues is required.

Financial incentive policies at workplace cafeterias for preventing obesity--a systematic review and meta-analysis (Protocol).

PubMed

Sawada, Kimi; Ota, Erika; Shahrook, Sadequa; Mori, Rintaro

2014-10-28

Various studies are currently investigating ways to prevent lifestyle-related diseases and obesity among workers through interventions using incentive strategies, including price discounts for low-fat snacks and sugar-free beverages at workplace cafeterias or vending machines, and the provision of a free salad bar in cafeterias. Rather than assessing individual or group interventions, we will focus on the effectiveness of nutrition education programs at the population level, which primarily incorporate financial incentive strategies to prevent obesity. This paper describes the protocol of a systematic review that will examine the effectiveness of financial incentive programs at company cafeterias in improving dietary habits, nutrient intake, and obesity prevention. We will conduct searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO. Interventions will be assessed using data from randomized control trials (RCTs) and cluster RCTs. However, if few such trials exist, we will include quasi-RCTs. We will exclude controlled before-and-after studies and crossover RCTs. We will assess food-based interventions that include financial incentive strategies (discount strategies or social marketing) for workplace cafeterias, vending machines, and kiosks. Two authors will independently review studies for inclusion and will resolve differences by discussion and, if required, through consultation with a third author. We will assess the risk of bias of included studies according to the Cochrane Collaboration's "risk of bias" tool. The purpose of this paper is to outline the study protocol for a systematic review and meta-analysis that will investigate the effectiveness of population-level, incentive-focused interventions at the workplace cafeteria that aim to promote and prevent obesity. This review will give an important overview of the available evidence about the effectiveness of incentive-based environmental interventions to improve obesity prevention in the workplace and will guide future research in nutrition education and health promotion globally. PROSPERO CRD42014010561.

Implementing Welfare-Employment Programs: An Institutional Analysis of the Work Incentive (WIN) Program.

ERIC Educational Resources Information Center

Mitchell, John J.; And Others

Factors that influence the effectiveness of state and local units of the federal Work Incentive (WIN) program were examined to suggest ways to improve the program, which is designed to move recipients of Aid to Families with Dependent Children (AFDC) into productive jobs. Factors studied were organizational, managerial, and service delivery…

State property tax incentives for promoting ecosystem goods and services from private forest land in the United States: a review and analysis

Treesearch

Michael A. Kilgore; Paul B. Ellefson; Travis J. Funk; Gregory E. Frey

2017-01-01

Financial incentives provided by State property tax programs are a means of promoting ecosystem services from private forest land. Identified by this 50-State 2015 review, categories of ecosystem services frequently promoted by such programs are open space and scenic resources, conservation of...

An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas

ERIC Educational Resources Information Center

Chan, Leighton; Hart, L. Gary; Ricketts III, Thomas C.; Beaver, Shelli K.

2004-01-01

Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians. Purpose: To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's…

The Determinants of School District Salary Incentives: An Empirical Analysis of, Where and Why

ERIC Educational Resources Information Center

Martin, Stephanie M.

2010-01-01

Most public school districts in the United States use a salary schedule to determine compensation for teachers within the district. However, some school districts have implemented incentive pay schemes that allow flexibility at the school or even individual teacher level. These compensation schemes in some ways may more closely approximate a…

Policy support, economic incentives and the adoption of irrigation technology in China

NASA Astrophysics Data System (ADS)

Cremades, R.; Wang, J.; Morris, J.

2014-11-01

The challenges China faces in terms of water availability in the agricultural sector are exacerbated by the sector's low irrigation efficiency. To increase irrigation efficiency, promoting irrigation technology has been emphasized by policy makers in China. The overall goal of this paper is to understand the effect of policy support and economic incentives on the adoption of irrigation technology in China. Based on a unique dataset collected at household and village levels from seven provinces in China, results indicated that household-based irrigation technology has become noticeable in almost every Chinese village. In contrast, only about half of Chinese villages have adopted community-based irrigation technology. Despite the relatively high adoption level of household-based irrigation technology at the village level, its actual adoption on crop-sown areas was not high, and it was even lower for community-based irrigation technology. The econometric analyses results revealed that policy supports via subsidies and extension services have played an important role in promoting the adoption of irrigation technology. Strikingly, the present irrigation pricing policy has played significant but contradictory roles in promoting the adoption of different types of irrigation technology. Irrigation pricing showed a positive impact on household-based irrigation technology, and a negative impact on community-based irrigation technology, possibly related to their substitution relationship, because having higher adoption of household-based irrigation technology reduce the incentives to invest in community-based irrigation technology. The paper finally concludes and discusses some policy implications.

Characterization and effectiveness of pay-for-performance in ophthalmology: a systematic review.

PubMed

Herbst, Tim; Emmert, Martin

2017-06-05

To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology. A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the "Model for Implementing and Monitoring Incentives for Quality" (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists. Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing. Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches.

[Leaders as intermediates between economic incentive models and professional motivation].

PubMed

Korlén, Sara; Essén, Anna; Lindgren, Peter; Amer-Wåhlin, Isis; von Thiele Schwarz, Ulrica

2018-05-24

The application of economic incentives to providers in health care governance is debated. Advocates argue that it drives efficiency and improvement, opponents claim that it leads to unintended consequences for patients and professionals. Research shows that incentives can increase well-defined activities and targets, but there is a lack of substantial evidence that applications in health care lead to desired outcomes. The motivational literature acknowledges internal sources of motivation as important determinants of behavior, and the literature about professions suggests that professional values of serving patient needs is a key motivator. The management literature identifies the important role of leaders in aligning external demands and rewards to staff preferences, using their own management and leadership skills. Findings in health services research confirm the vital role of leaders for successful implementation and improvement work. In sum, internal motivators and the role of leaders are important to acknowledge also when understanding how economic governance models are put into practice.Our recently published qualitative case study provides empirical examples of how clinical leaders function as intermediaries between a local care choice model, including financial incentives, and the motivation of staff. The strategies deployed by the leaders aimed to align the economic logics of the model to the professional focus on increasing patient value. The main conclusion from these empirical examples, as well as previous research, is that health care managers play a key role in aligning economic incentive models with professional values and in translating such models in to feasible tasks related to the provision of high quality care.

43 CFR 418.26 - Charges for water use.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Charges for water use. 418.26 Section 418... and Management § 418.26 Charges for water use. The District must maintain a financing and accounting... provides reasonable financial incentives for the economical and efficient use of water. ...

43 CFR 418.26 - Charges for water use.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Charges for water use. 418.26 Section 418... and Management § 418.26 Charges for water use. The District must maintain a financing and accounting... provides reasonable financial incentives for the economical and efficient use of water. ...

42 CFR § 512.725 - Data sharing for FFS-CR participants.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants Provisions for Ffs-Cr Participants § 512... quality. (3) Enhance efficiencies in the delivery of care. (4) Otherwise achieve the goals of the model...

76 FR 36908 - Draft Competition Rules for a Global Appliance Efficiency Award for Televisions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-23

... solicitation of comments. SUMMARY: The U.S. Department of Energy (DOE) is working with partner governments... program can be directed to: Mr. Arne Jacobson, Senior Advisor, DOE Office of Policy and International... working groups, covering standards and test procedures, awards, procurement, incentives, and cross-cutting...

76 FR 11410 - Defense Federal Acquisition Regulation Supplement; Increase the Use of Fixed-Price Incentive...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-02

.... SUPPLEMENTARY INFORMATION: I. Background This DFARS case was initiated to incentivize productivity and... military departments and directors of defense agencies on obtaining greater efficiency and productivity in... order to incentivize productivity and innovation in industry. However, DoD has prepared an initial...

Virtual sea border

NASA Astrophysics Data System (ADS)

Ferriere, D.; Rucinski, A.; Jankowski, T.

2007-04-01

Establishing a Virtual Sea Border by performing a real-time, satellite-accessible Internet-based bio-metric supported threat assessment of arriving foreign-flagged cargo ships, their management and ownership, their arrival terminal operator and owner, and rewarding proven legitimate operators with an economic incentive for their transparency will simultaneously improve port security and maritime transportation efficiencies.

43 CFR 418.26 - Charges for water use.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Charges for water use. 418.26 Section 418... and Management § 418.26 Charges for water use. The District must maintain a financing and accounting... provides reasonable financial incentives for the economical and efficient use of water. ...

43 CFR 418.26 - Charges for water use.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Charges for water use. 418.26 Section 418... and Management § 418.26 Charges for water use. The District must maintain a financing and accounting... provides reasonable financial incentives for the economical and efficient use of water. ...

Go Figure: Computer Database Adds the Personal Touch.

ERIC Educational Resources Information Center

Gaffney, Jean; Crawford, Pat

1992-01-01

A database for recordkeeping for a summer reading club was developed for a public library system using an IBM PC and Microsoft Works. Use of the database resulted in more efficient program management, giving librarians more time to spend with patrons and enabling timely awarding of incentives. (LAE)

Safety belt and motorcycle helmet use in Virginia : results of the 1994 survey : technical assistance report.

DOT National Transportation Integrated Search

1994-01-01

This series of surveys was initiated to qualify the state for Intermodal Surface Transportation Efficiency Act 153 incentive funds. To qualify for funds in each of the 3 years the program was in operation, states had to meet specific standards with r...

Patterns and predictors of local health department accreditation in Missouri

PubMed Central

Mayer, Jeffrey; Elliott, Michael; Brownson, Ross C.; Abdulloeva, Safina; Wojciehowski, Kathleen

2016-01-01

Context Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments face many challenges including lower levels of staffing and funding than LHDs serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities. Objective To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the rural local health department (RHLD) perspective. Design Qualitative analysis of semi-structured key informant interviews with Missouri LHDs serving rural communities. Participants Eleven administrators of RLHDs, seven from accredited and four from unaccredited departments were interviewed. Population size served ranged from 6,400 to 52,000 for accredited RLHDs and 7,200 to 73,000 for unaccredited RLHDs. Results Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed significantly more incentives then their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation. Conclusions There is a need for better documentation of measurable benefits in order for a RLHD to pursue voluntary accreditation. Those who pursue are likely to see benefits after the fact, but those who do not, do not see the immediate and direct benefits of voluntary accreditation. The findings from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation. PMID:24722052

Modelling Per Capita Water Demand Change to Support System Planning

NASA Astrophysics Data System (ADS)

Garcia, M. E.; Islam, S.

2016-12-01

Water utilities have a number of levers to influence customer water usage. These include levers to proactively slow demand growth over time such as building and landscape codes as well as levers to decrease demands quickly in response to water stress including price increases, education campaigns, water restrictions, and incentive programs. Even actions aimed at short term reductions can result in long term water usage declines when substantial changes are made in water efficiency, as in incentives for fixture replacement or turf removal, or usage patterns such as permanent lawn watering restrictions. Demand change is therefore linked to hydrological conditions and to the effects of past management decisions - both typically included in water supply planning models. Yet, demand is typically incorporated exogenously using scenarios or endogenously using only price, though utilities also use rules and incentives issued in response to water stress and codes specifying standards for new construction to influence water usage. Explicitly including these policy levers in planning models enables concurrent testing of infrastructure and policy strategies and illuminates interactions between the two. The City of Las Vegas is used as a case study to develop and demonstrate this modeling approach. First, a statistical analysis of system data was employed to rule out alternate hypotheses of per capita demand decrease such as changes in population density and economic structure. Next, four demand sub-models were developed including one baseline model in which demand is a function of only price. The sub-models were then calibrated and tested using monthly data from 1997 to 2012. Finally, the best performing sub-model was integrated with a full supply and demand model. The results highlight the importance of both modeling water demand dynamics endogenously and taking a broader view of the variables influencing demand change.

The effect of external non-driving factors, payment type and waiting and queuing on fatigue in long distance trucking.

PubMed

Williamson, Ann; Friswell, Rena

2013-09-01

The aim of this study was to explore the effects of external influences on long distance trucking, in particular, incentive-based remuneration systems and the need to wait or queue to load or unload on driver experiences of fatigue. Long distance truck drivers (n=475) were recruited at truck rest stops on the major transport corridors within New South Wales, Australia and asked to complete a survey by self-administration or interview. The survey covered demographics, usual working arrangements, details of the last trip and safety outcomes including fatigue experiences. On average drivers' last trip was over 2000 km and took 21.5 h to complete with an additional 6h of non-driving work. Incentive payments were associated with longer working hours, greater distances driven and higher fatigue for more drivers. Drivers required to wait in queues did significantly more non-driving work and experienced fatigue more often than those who did not. Drivers who were not paid to wait did the longest trips with average weekly hours above the legal working hours limits, had the highest levels of fatigue and the highest levels of interference by work with family life. In contrast, drivers who were paid to wait did significantly less work with shorter usual hours and shorter last trips. Multivariate analysis showed that incentive-based payment and unpaid waiting in queues were significant predictors of driver fatigue. The findings suggest that mandating payment of drivers for non-driving work including waiting would reduce the amount of non-driving work required for drivers and reduce weekly hours of work. In turn this would reduce driver fatigue and safety risk as well as enhancing the efficiency of the long distance road transport industry. Copyright © 2013 Elsevier Ltd. All rights reserved.

“It Makes You Feel Like Someone Cares” acceptability of a financial incentive intervention for HIV viral suppression in the HPTN 065 (TLC-Plus) study

PubMed Central

Greene, Elizabeth; Pack, Allison; Stanton, Jill; Shelus, Victoria; Tolley, Elizabeth E.; Taylor, Jamilah; El Sadr, Wafaa M.; Branson, Bernard M.; Leider, Jason; Rakhmanina, Natella; Gamble, Theresa

2017-01-01

Background HPTN 065 (TLC-Plus) evaluated the feasibility and effectiveness of providing quarterly $70 gift card financial incentives to HIV-infected patients on antiretroviral therapy (ART) to encourage ART adherence and viral suppression, and represents the largest study to-date of a financial incentive intervention for HIV viral suppression. A post-trial qualitative substudy was undertaken to examine acceptability of the financial incentives among those receiving and implementing the intervention. Methods Between July and October 2013, semi-structured interviews were conducted with 72 patients and 12 investigators from 14 sites; three focus groups were conducted with 12 staff from 10 sites. Qualitative data collection elicited experiences with and attitudes about the intervention, including philosophical viewpoints and implementation experiences. Transcripts were analyzed in NVivo 10. Memos and matrices were developed to explore themes from different participant group perspectives. Results Patients, investigators, and staff found the intervention highly acceptable, primarily due to the emotional benefits gained through giving or receiving the incentive. Feeling rewarded or cared for was a main value perceived by patients; this was closely tied to the financial benefit for some. Other factors influencing acceptability for all included perceived effectiveness and health-related benefits, philosophical concerns about the use of incentives for health behavior change, and implementation issues. The termination of the incentive at the end of the study was disappointing to participants and unexpected by some, but generally accepted. Conclusion Positive experiences with the financial incentive intervention and strategies used to facilitate implementation led to high acceptability of the intervention, despite some reluctance in principle to the use of incentives. The findings of this analysis provide encouraging evidence in support of the acceptability of a large-scale financial incentive intervention for HIV viral suppression in a clinical setting, and offer valuable lessons for future applications of similar interventions. PMID:28182706

Reports of unintended consequences of financial incentives to improve management of hypertension.

PubMed

Hysong, Sylvia J; SoRelle, Richard; Broussard Smitham, Kristen; Petersen, Laura A

2017-01-01

Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives. We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis. Sixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site. Emergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems) rather than financial incentives. Many unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended consequences. Clinicaltrials.gov Identifier: NCT00302718.

Incentive-Based Primary Care: Cost and Utilization Analysis

PubMed Central

Hollander, Marcus J; Kadlec, Helena

2015-01-01

Context: In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. Objective: To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. Design: The study used Ministry of Health administrative data for Fiscal Year 2010–2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Main Outcome Measures: Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). Results: After controlling for patients’ age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Conclusion: Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization. PMID:26263389

Development of immunity following financial incentives for hepatitis B vaccination among people who inject drugs: A randomized controlled trial.

PubMed

Day, Carolyn A; Shanahan, Marian; Wand, Handan; Topp, Libby; Haber, Paul S; Rodgers, Craig; Deacon, Rachel; Walsh, Nick; Kaldor, John; van Beek, Ingrid; Maher, Lisa

2016-01-01

People who inject drugs (PWID) are at risk of hepatitis B virus (HBV) but have low rates of vaccination completion. The provision of modest financial incentives increases vaccination schedule completion, but their association with serological protection has yet to be determined. To investigate factors associated with vaccine-induced immunity among a sample of PWID randomly allocated to receive AUD$30 cash following receipt of doses two and three ('incentive condition') or standard care ('control condition') using an accelerated 3-dose (0,7,21 days) HBV vaccination schedule. A randomised controlled trial among PWID attending two inner-city health services and a field site in Sydney, Australia, assessing vaccine-induced immunity measured by hepatitis B surface antibodies (HBsAb ≥ 10 mIU/ml) at 12 weeks. The cost of the financial incentives and the provision of the vaccine program are also reported. Just over three-quarters of participants - 107/139 (77%)--completed the vaccination schedule and 79/139 (57%) were HBsAb ≥ 10 mIU/ml at 12 weeks. Vaccine series completion was the only variable significantly associated with vaccine-induced immunity in univariate analysis (62% vs 41%, p<0.035) but was not significant in multivariate analysis. There was no statistically discernible association between group allocation and series completion (62% vs 53%). The mean costs were AUD$150.5, (95% confidence interval [CI]: 142.7-158.3) and AUD$76.9 (95% CI: 72.6-81.3) for the intervention and control groups respectively. Despite increasing HBV vaccination completion, provision of financial incentives was not associated with enhanced serological protection. Further research into factors which affect response rates and the optimal vaccination regimen and incentive schemes for this population are needed. Copyright © 2015 Elsevier B.V. All rights reserved.

Incentive regulation and performance measurement of the Portuguese solid waste management services.

PubMed

Marques, Rui Cunha; Simões, Pedro

2009-03-01

Measuring the performance of solid waste management services usually uncovers very high potential for gains in efficiency and productivity. This circumstance occurs, naturally, due to the fact that these services are outside the market and because they are subjected to various market failures in their organizational framework. The aim of this study was to examine the Portuguese regulatory model and to measure the performance of the Portuguese solid waste management services in order to identify the major reforms carried out and their outcomes. As a first objective, the sunshine regulatory approach adopted in Portugal, in which performance comparison and its public discussion are the main tools, was investigated. The second objective was to compute the efficiency of the Portuguese solid waste management services by means of the non-parametric technique of data envelopment analysis (DEA), evaluating the Portuguese regulatory model and the existing market structure, as well as the influence of the operational environment on efficiency. The benchmarking frontier technique of DEA is particularly useful in the efficiency measurement of public utilities, in which knowledge of the production function is relatively scarce. Several DEA models were used and they all depicted significant inefficiency. The study also proved that efficiency did not depend on ownership (public or private) and that there was no difference in efficiency between the players, irrespective of whether they were regulated or not.

Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery.

PubMed

Guimarães, Michele Mf; El Dib, Regina; Smith, Andrew F; Matos, Delcio

2009-07-08

Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry (IS) compared to no therapy, or physiotherapy including coughing and deep breathing, on all-cause postoperative pulmonary complications and mortality in adult patients admitted for upper abdominal surgery. To assess the effects of incentive spirometry compared to no such therapy (or other therapy) on all-cause postoperative pulmonary complications (atelectasis, acute respiratory inadequacy) and mortality in adult patients admitted for upper abdominal surgery. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 3), MEDLINE, EMBASE, and LILACS (from inception to July 2006). There were no language restrictions. We included randomized controlled trials of incentive spirometry in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures. Two authors independently assessed trial quality and extracted data. We included 11 studies with a total of 1754 participants. Many trials were of only moderate methodological quality and did not report on compliance with the prescribed therapy. Data from only 1160 patients could be included in the meta-analysis. Three trials (120 patients) compared the effects of incentive spirometry with no respiratory treatment. Two trials (194 patients) compared incentive spirometry with deep breathing exercises. Two trials (946 patients) compared incentive spirometry with other chest physiotherapy. All showed no evidence of a statistically significant effect of incentive spirometry. There was no evidence that incentive spirometry is effective in the prevention of pulmonary complications. We found no evidence regarding the effectiveness of the use of incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large randomized trials of high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public.

PubMed

Hoddinott, Pat; Morgan, Heather; MacLennan, Graeme; Sewel, Kate; Thomson, Gill; Bauld, Linda; Yi, Deokhee; Ludbrook, Anne; Campbell, Marion K

2014-07-18

To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design. Cross-sectional survey. British general public. Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models. Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%). Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions. CRD42012001980. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The effectiveness of recruitment strategies on general practitioner’s survey response rates – a systematic review

PubMed Central

2014-01-01

Background Low survey response rates in general practice are common and lead to loss of power, selection bias, unexpected budgetary constraints and time delays in research projects. Methods Objective: To assess the effectiveness of recruitment strategies aimed at increasing survey response rates among GPs. Design: Systematic review. Search methods: MEDLINE (OVIDSP, 1948-2012), EMBASE (OVIDSP, 1980-2012), Evidence Based Medicine Reviews (OVIDSP, 2012) and references of included papers were searched. Major search terms included GPs, recruitment strategies, response rates, and randomised controlled trials (RCT). Selection criteria: Cluster RCTs, RCTs and factorial trial designs that evaluate recruitment strategies aimed at increasing GP survey response rates. Data collection and analysis: Abstracts identified by the search strategy were reviewed and relevant articles were retrieved. Each full-text publication was examined to determine whether it met the predetermined inclusion criteria. Data extraction and study quality was assessed by using predetermined checklists. Results Monetary and nonmonetary incentives were more effective than no incentive with monetary incentives having a slightly bigger effect than nonmonetary incentives. Large incentives were more effective than small incentives, as were upfront monetary incentives compared to promised monetary incentives. Postal surveys were more effective than telephone or email surveys. One study demonstrated that sequentially mixed mode (online survey followed by a paper survey with a reminder) was more effective than an online survey or the combination of an online and paper survey sent similtaneously in the first mail out. Pre-contact with a phonecall from a peer, personalised packages, sending mail on Friday, and using registered mail also increased response rates in single studies. Pre-contact by letter or postcard almost reached statistical signficance. Conclusions GP survey response rates may improve by using the following strategies: monetary and nonmonetary incentives, larger incentives, upfront monetary incentives, postal surveys, pre-contact with a phonecall from a peer, personalised packages, sending mail on Friday, and using registered mail. Mail pre-contact may also improve response rates and have low costs. Improved reporting and further trials, including sequential mixed mode trials and social media, are required to determine the effectiveness of recruitment strategies on GPs' response rates to surveys. PMID:24906492

Commercial Building Energy Asset Rating Program -- Market Research

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCabe, Molly J.; Wang, Na

2012-04-19

Under contract to Pacific Northwest National Laboratory, HaydenTanner, LLC conducted an in-depth analysis of the potential market value of a commercial building energy asset rating program for the U.S. Department of Energy (DOE) Office of Energy Efficiency and Renewable Energy. The market research objectives were to: (1) Evaluate market interest and need for a program and tool to offer asset rating and rapidly identify potential energy efficiency measures for the commercial building sector. (2) Identify key input variables and asset rating outputs that would facilitate increased investment in energy efficiency. (3) Assess best practices and lessons learned from existing nationalmore » and international energy rating programs. (4) Identify core messaging to motivate owners, investors, financiers, and others in the real estate sector to adopt a voluntary asset rating program and, as a consequence, deploy high-performance strategies and technologies across new and existing buildings. (5) Identify leverage factors and incentives that facilitate increased investment in these buildings. To meet these objectives, work consisted of a review of the relevant literature, examination of existing and emergent asset and operational rating systems, interviews with industry stakeholders, and an evaluation of the value implication of an asset label on asset valuation. This report documents the analysis methodology and findings, conclusion, and recommendations. Its intent is to support and inform the DOE Office of Energy Efficiency and Renewable Energy on the market need and potential value impacts of an asset labeling and diagnostic tool to encourage high-performance new buildings and building efficiency retrofit projects.« less

Reforms from the ground up: a review of community-based forest management in tropical developing countries.

PubMed

Tole, Lise

2010-06-01

After an initial burst of enthusiasm in the 1990 s, community-based forest management (CBFM) is increasingly being viewed with a critical eye. Evidence suggests that many programs have failed to promote their stated objectives of sustainability, efficiency, equity, democratic participation and poverty reduction. A large volume of academic literature now exists on CBFM, examining both the success and failure of such initiatives in a wide variety of countries. Through analysis of key themes, concepts and issues in CBFM, this article provides a review of CBFM initiatives in tropical developing countries for policymakers, practitioners and planners wishing to gain an understanding of this wide-ranging, interdisciplinary academic literature. The article identifies key institutions and incentives that appear to significantly affect the success or failure of CBFM initiatives. In particular, it reports that consideration of institutional and socioeconomic factors along with personal characteristics of key stakeholders such as beliefs, attitudes, financial resources and skills are important determinants of CBFM outcomes. However, local incentive structures also appear to be important. There is increasing recognition in the literature of the need to consider the conditions under which local politicians entrusted with carrying out CBFM initiatives will deem it worthwhile to invest their scarce time and resources on environmental governance.

Reforms from the Ground Up: A Review of Community-Based Forest Management in Tropical Developing Countries

NASA Astrophysics Data System (ADS)

Tole, Lise

2010-06-01

After an initial burst of enthusiasm in the 1990s, community-based forest management (CBFM) is increasingly being viewed with a critical eye. Evidence suggests that many programs have failed to promote their stated objectives of sustainability, efficiency, equity, democratic participation and poverty reduction. A large volume of academic literature now exists on CBFM, examining both the success and failure of such initiatives in a wide variety of countries. Through analysis of key themes, concepts and issues in CBFM, this article provides a review of CBFM initiatives in tropical developing countries for policymakers, practitioners and planners wishing to gain an understanding of this wide-ranging, interdisciplinary academic literature. The article identifies key institutions and incentives that appear to significantly affect the success or failure of CBFM initiatives. In particular, it reports that consideration of institutional and socioeconomic factors along with personal characteristics of key stakeholders such as beliefs, attitudes, financial resources and skills are important determinants of CBFM outcomes. However, local incentive structures also appear to be important. There is increasing recognition in the literature of the need to consider the conditions under which local politicians entrusted with carrying out CBFM initiatives will deem it worthwhile to invest their scarce time and resources on environmental governance.

Maine PACE Program Final Technical Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fischer, Dana; Adamson, Joy M

The ARRA EECBG BetterBuilding helped augment the existing Home Energy Savings Programs (HESP) and incentives with financing through a subordinate lien PACE and HUD PowerSaver programs. The program was designed to document innovative techniques to dramatically increase the number of homes participating in weatherization programs in participating towns. Maine will support new energy efficiency retrofit pilots throughout the state, designed to motivate a large number of homeowners to invest in comprehensive home energy efficiency upgrades to bring real solutions to market.

An Analysis of the Costs, Benefits, and Implications of Different Approaches to Capturing the Value of Renewable Energy Tax Incentives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bolinger, Mark

This report compares the relative costs, benefits, and implications of capturing the value of renewable energy tax benefits in these three different ways – applying them against outside income , carrying them forward in time until they can be fully absorbed internally, or monetizing them through third-party tax equity investors – to see which method is most competitive under various scenarios. It finds that under current law and late-2013 market conditions, monetization makes sense for all but the most tax-efficient project sponsors. In other words, for most project sponsors, bringing in third-party tax equity currently provides net benefits to amore » project.« less

An Analysis of a Contingency Program on Designated Drivers at a College Bar

ERIC Educational Resources Information Center

Kazbour, Richard R.; Bailey, Jon S.

2010-01-01

The present study evaluated the effects of prompts and incentives on designated drivers in a bar. We defined the dependent variable as the percentage of customers either functioning as or riding with a designated driver. We used an ABCA design to evaluate the effectiveness of prompts and incentives on the dependent variable. Results indicated that…

Teacher Pension Incentives, Retirement Behavior, and Potential for Reform in Arkansas. Conference Paper 2009-10

ERIC Educational Resources Information Center

Costrell, Robert M.; McGee, Josh B.

2009-01-01

In this paper, we present an analysis of the Arkansas Teacher Retirement System (ATRS) pension plan and an empirical investigation of the behavioral response to that plan, as well as to a possible reform plan. We begin by describing the plan parameters and discussing the incentives these parameters create. We then estimate the effect of pension…

Heap pumps marketing problems and the role played by the financial incentives provided by the law 308/82

NASA Astrophysics Data System (ADS)

Dallavalle, E.; Piantoni, E.

The principle techno-economic factors which influence the utilization of heat pumps are examined. Through the analysis of current technology and the economic incentives expected from articles 6-7, 8-9, and 12 of law 308/82, some results are derived which give some indication of the future of the market.

Breaking Ground: Analysis of the Assessment System and Impact of Mexico's Teacher Incentive Program "Carrera Magisterial." Technical Report

ERIC Educational Resources Information Center

Santibanez, Lucrecia; Martinez, Jose Felipe; Datar, Ashlesha; McEwan, Patrick J.; Setodji, Claude Messan; Basurto-Davila, Ricardo

2007-01-01

Mexico's Carrera Magisterial (CM) is one of the pioneer teacher incentive programs in the world. It was instituted in 1992 and designed jointly by the federal education authorities, state authorities, and the teachers' union as a horizontal promotion system that rewards teachers with salary bonuses on the basis of their performance. Teacher…

Key Trends in Institutional Changes Under Sustainable Development

NASA Astrophysics Data System (ADS)

Karpova, Olga; Pevneva, Inna; Dymova, Irina; Kostina, Tatiana; Li, Sergey

2017-11-01

The article is devoted to the consideration of the essential problems of accounting institution formation under the sustainable development of the country and the region. The research is based on the key research the field of the intuition economics and considers the trends of institutional changes including incremental, evolutionary and revolutionary. Approaches to the analysis of institutions are presented as well. The first approach states that economic efficiency is guaranteed by newly emerging institutions. The second approach involves certain internal and external incentives for changing institutions. Whereas the third approach insists on considering institutional changes to be the relation of individual economic entities to institutional innovations in terms of the net benefit from their implementation. The conclusion draws the leading role of the state in the process of the emergence and further development of newly created institutions focusing on the fact that not every change leads to greater efficiency. Thus it is crucial to consider the previous background of institutions development at implementing changes in accounting and control.

Data centers as dispatchable loads to harness stranded power

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Kibaek; Yang, Fan; Zavala, Victor M.

Here, we analyze how traditional data center placement and optimal placement of dispatchable data centers affect power grid efficiency. We use detailed network models, stochastic optimization formulations, and diverse renewable generation scenarios to perform our analysis. Our results reveal that significant spillage and stranded power will persist in power grids as wind power levels are increased. A counter-intuitive finding is that collocating data centers with inflexible loads next to wind farms has limited impacts on renewable portfolio standard (RPS) goals because it provides limited system-level flexibility. Such an approach can, in fact, increase stranded power and fossil-fueled generation. In contrast,more » optimally placing data centers that are dispatchable provides system-wide flexibility, reduces stranded power, and improves efficiency. In short, optimally placed dispatchable computing loads can enable better scaling to high RPS. In our case study, we find that these dispatchable computing loads are powered to 60-80% of their requested capacity, indicating that there are significant economic incentives provided by stranded power.« less

Data centers as dispatchable loads to harness stranded power

DOE PAGES

Kim, Kibaek; Yang, Fan; Zavala, Victor M.; ...

2016-07-20

Here, we analyze how traditional data center placement and optimal placement of dispatchable data centers affect power grid efficiency. We use detailed network models, stochastic optimization formulations, and diverse renewable generation scenarios to perform our analysis. Our results reveal that significant spillage and stranded power will persist in power grids as wind power levels are increased. A counter-intuitive finding is that collocating data centers with inflexible loads next to wind farms has limited impacts on renewable portfolio standard (RPS) goals because it provides limited system-level flexibility. Such an approach can, in fact, increase stranded power and fossil-fueled generation. In contrast,more » optimally placing data centers that are dispatchable provides system-wide flexibility, reduces stranded power, and improves efficiency. In short, optimally placed dispatchable computing loads can enable better scaling to high RPS. In our case study, we find that these dispatchable computing loads are powered to 60-80% of their requested capacity, indicating that there are significant economic incentives provided by stranded power.« less

Essays on Industry Response to Energy and Environmental Policy

NASA Astrophysics Data System (ADS)

Sweeney, Richard Leonard

This dissertation consists of three essays on the relationship between firm incentives and energy and environmental policy outcomes. Chapters 1 and 2 study the impact of the 1990 Clean Air Act Amendments on the United States oil refining industry. This legislation imposed extensive restrictions on refined petroleum product markets, requiring select end users to purchase new cleaner versions of gasoline and diesel. In Chapter 2, I estimate the static impact of this intervention on refining costs, product prices and consumer welfare. Isolating these effects is complicated by several challenges likely to appear in other regulatory settings, including overlap between regulated and non-regulated markets and deviations from perfect competition. Using a rich database of refinery operations, I estimate a structural model that incorporates each of these dimensions, and then use this cost structure to simulate policy counterfactuals. I find that the policies increased gasoline production costs by 7 cents per gallon and diesel costs by 3 cents per gallon on average, although these costs varied considerably across refineries. As a result of these restrictions, consumers in regulated markets experienced welfare losses on the order of 3.7 billion per year, but this welfare loss was partially offset by gains of 1.5 billion dollars per year among consumers in markets not subject to regulation. The results highlight the importance of accounting for imperfect competition and market spillovers when assessing the cost of environmental regulation. Chapter 2 estimates the sunk costs incurred by United States oil refineries as a result of the low sulfur diesel program. The complex, regionally integrated nature of the industry poses many challenges for estimating these costs. I overcome them by placing the decision to invest in sulfur removal technology within the framework of a two period model and estimate the model using moment inequalities. I find that the regulation induced between 2.8 and 3.3 billion worth of investment in order to produce this new fuel. The results highlight the importance of accounting for sunk costs when evaluating environmental regulation, and suggest that the estimation approach used here might provide a viable way to estimate the sunk costs of other environmental policies. Chapter 3, coauthored with Hunt Allcott, turns the to retail market for water heaters to study the topic of energy efficiency. We run a natural field experiment at a large nationwide retailer to measure the effects of energy use information disclosure, customer rebates, and sales agent incentives on demand for energy efficient durable goods. We find that while a combination of large rebates plus sales incentives substantially increases market share, information and sales incentives alone each have zero statistical effect and explain at most a small fraction of the low baseline market share. Sales agents strategically comply only partially with the experiment, targeting information at more interested consumers but not discussing energy efficiency with the disinterested majority. These results suggest that at current prices in this context, seller-provided information is not a major barrier to energy efficiency investments. We theoretically and empirically explore the novel policy option of combining customer subsidies with government-provided sales incentives.

Re-examining Potential for Geothermal Energy in United States

NASA Astrophysics Data System (ADS)

Showstack, Randy

New technological initiatives, along with potential policy and economic incentives, could help to bring about a resurgence in geothermal energy development in the United States, said several experts at a 22 May forum in Washington, D.C. The forum was sponsored by the House and Senate Renewable Energy and Energy Efficiency Caucuses, the Sustainable Energy Coalition, and the Environmental and Energy Study Institute. Among these initiatives is an ambitious program of the U.S. Department of Energy to expand existing geothermal energy fields and potentially create new fields through ``enhanced geothermal systems.'' In addition, a program of the Bush administration encourages geothermal development on some public lands, and current legislation would provide tax credits and other incentives for geothermal development.

Perceived Self-Efficacy and Financial Incentives: Factors Affecting Health Behaviors and Weight Loss in a Workplace Weight Loss Intervention.

PubMed

Faghri, Pouran D; Simon, Julia; Huedo-Medina, Tania; Gorin, Amy

2017-05-01

To evaluate if self-efficacy (SE) and financial incentives (FI) mediate the effect of health behavior on weight loss in a group of overweight and obese nursing-home employees participating in a 16-week weight-loss intervention with 12-week follow-up. Ninety nine overweight/obese (body mass index [BMI] > 25) employees from four nursing-homes participated, with a mean age of 46.98 years and BMI of 35.33. Nursing-homes were randomized to receiving an incentive-based intervention (n = 51) and no incentive (n = 48). Participants' health behaviors and eating and exercise self-efficacy (Ex-SE) were assessed at week 1, 16, and 28 using a self-reported questionnaire. Mediation and moderated mediation analysis assessed relationships among these variables. Eating self-efficacy (Eat-SE) and Ex-SE were significant mediators between health behaviors and weight loss (P < 0.05). Incentives significantly moderated the effects of self-efficacy (P = 0.00) on weight loss. Self-efficacy and FI may affect weight loss and play a role in weight-loss interventions.

Text-message reminders plus incentives increase adherence to antidiabetic medication in adults with type 2 diabetes.

PubMed

Raiff, Bethany R; Jarvis, Brantley P; Dallery, Jesse

2016-12-01

Some adults with Type 2 diabetes mellitus have difficulty adhering to their oral medication regimens. The current study used a multiple baseline design with 3 adults with Type 2 diabetes. Medication taking was monitored remotely in real time via an electronic pill bottle. During the intervention, monetary incentives were delivered contingent on evidence of adherence to taking medication at specified times. Text-message reminders were also sent if medication was not taken. Adherence increased for all participants. Future studies should separate the relative contributions of text-message and incentive components of the intervention. © 2016 Society for the Experimental Analysis of Behavior.

AEP Ohio gridSMART Demonstration Project Real-Time Pricing Demonstration Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Widergren, Steven E.; Subbarao, Krishnappa; Fuller, Jason C.

2014-02-01

This report contributes initial findings from an analysis of significant aspects of the gridSMART® Real-Time Pricing (RTP) – Double Auction demonstration project. Over the course of four years, Pacific Northwest National Laboratory (PNNL) worked with American Electric Power (AEP), Ohio and Battelle Memorial Institute to design, build, and operate an innovative system to engage residential consumers and their end-use resources in a participatory approach to electric system operations, an incentive-based approach that has the promise of providing greater efficiency under normal operating conditions and greater flexibility to react under situations of system stress. The material contained in this report supplementsmore » the findings documented by AEP Ohio in the main body of the gridSMART report. It delves into three main areas: impacts on system operations, impacts on households, and observations about the sensitivity of load to price changes.« less

Potential Avenues for Significant Biofuels Penetration in the U.S. Aviation Market

DOE Office of Scientific and Technical Information (OSTI.GOV)

Newes, Emily; Han, Jeongwoo; Peterson, Steve

Industry associations have set goals to reduce greenhouse gas (GHG) emissions and increase fuel efficiency. One focal area for reducing GHG emissions is in the use of aviation biofuel. This study examines assumptions under which the United States could see large production in aviation biofuel. Our results suggest that a high penetration (6 billion gallons) of aviation biofuels by 2030 could be possible, but factors around policy design (in the absence of high oil prices) contribute to the timing and magnitude of aviation biofuels production: 1) Incentives targeted towards jet fuel production such as financial incentives (e.g., producer tax credit,more » carbon tax) can be sufficient; 2) Investment in pre-commercial cellulosic technologies is needed to reduce the cost of production through learning-by-doing; 3) Reduction of investment risk through loan guarantees may allow production to ramp up more quickly through accelerating industry learning. In cases with high levels of incentives and investment in aviation biofuels, there could be a 25 percent reduction in overall GHG emissions from the aviation sector.« less

International Microgrid Assessment. Governance, INcentives, and Experience (IMAGINE)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marnay, Chris; Zhou, Nan; Qu, Min

Microgrids can provide an avenue for increasing the amount of distributed generation and delivery of electricity, where control is more dispersed and quality of service is locally tailored to end-use requirements. Much of this functionality is very different from the predominant utility model to date of centralized power production which is then transmitted and distributed across long distances with a uniform quality of service. This different functionality holds much promise for positive change, in terms of increasing reliability, energy efficiency, and renewable energy while decreasing and carbon emissions. All of these functions should provide direct cost savings for customers andmore » utilities as well as positive externalities for society. As we have seen from the international experience, allowing microgrids to function in parallel with the grid requires some changes in electricity governance and incentives to capture cost savings and actively price in positive externalities. If China can manage to implement these governance changes and create those incentive policies, it will go beyond the establishment of a successful microgrid demonstration program and become an international leader in microgrid deployment.« less

Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers systematic reviews of provider assessment and feedback and provider incentives.

PubMed

Sabatino, Susan A; Habarta, Nancy; Baron, Roy C; Coates, Ralph J; Rimer, Barbara K; Kerner, Jon; Coughlin, Steven S; Kalra, Geetika P; Chattopadhyay, Sajal

2008-07-01

Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of two provider-directed intervention approaches to increase screening for breast, cervical, and colorectal cancers. These approaches, provider assessment and feedback, and provider incentives encourage providers to deliver screening services at appropriate intervals. Evidence in these reviews indicates that provider assessment and feedback interventions can effectively increase screening by mammography, Pap test, and fecal occult blood test. Health plans, healthcare systems, and cancer control coalitions should consider such evidence-based findings when implementing interventions to increase screening use. Evidence was insufficient to determine the effectiveness of provider incentives in increasing use of any of these tests. Specific areas for further research are suggested in this report, including the need for additional research to determine whether provider incentives are effective in increasing use of any of these screening tests, and whether assessment and feedback interventions are effective in increasing other tests for colorectal cancer (i.e., flexible sigmoidoscopy, colonoscopy, or double-contrast barium enema).

Financial incentives to encourage healthy behaviour: an analysis of U.K. media coverage.

PubMed

Parke, Hannah; Ashcroft, Richard; Brown, Rebecca; Marteau, Theresa M; Seale, Clive

2013-09-01

Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion. To describe U.K. mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups. Thematic content analysis. National and local news coverage in newspapers, news media targeted at health-care providers and popular websites between January 2005 and February 2010. U.K. mass media. The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health-care provider interests dominated favourable coverage; opposition came from rival politicians, taxpayers' representatives, certain charities and from some journalists themselves. Those promoting incentive schemes for people who might be regarded as 'undeserving' should plan a media strategy that anticipates their public reception. © 2011 John Wiley & Sons Ltd.

Financial incentives to encourage healthy behaviour: an analysis of UK media coverage

PubMed Central

Parke, Hannah; Ashcroft, Richard; Brown, Rebecca; Marteau, Theresa M; Seale, Clive

2011-01-01

Abstract Background  Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion. Objective  To describe UK mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups. Design  Thematic content analysis. Subjects  National and local news coverage in newspapers, news media targeted at health‐care providers and popular websites between January 2005 and February 2010. Setting  UK mass media. Results  The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health‐care provider interests dominated favourable coverage; opposition came from rival politicians, taxpayers’ representatives, certain charities and from some journalists themselves. Conclusions  Those promoting incentive schemes for people who might be regarded as ‘undeserving’ should plan a media strategy that anticipates their public reception. PMID:21771227

Financial incentives to improve organ donation: what is the opinion of the Vaud French-speaking population?

PubMed

Bosisio, Francesca; Santiago, Marie; Benaroyo, Lazare

2011-12-09

With the increase of the organ shortage, several authors assume that financial incentives would improve organ donation rates and fill the unbalance between the demand and the organs available for transplant medicine. This line of argument has been criticised with people arguing that an exchange of money for organs would violate the legal and the ethical principle of gratuity, decrease voluntarism and increase the body parts commodification phenomena. Switzerland is often highlighted as having under-average organ donation rates compared to other European countries. In this paper we investigate the opinions of the Vaud French-speaking population concerning direct, indirect and non financial incentives in order to assess their opinions and anticipate the further debate. As part of a broad survey about the organ donation decision-making process, questions about incentives for both living and deceased organ donation were addressed to Vaud inhabitants and physicians. The data collected showed that respondents were opposed to rewarding both living and deceased organ donation. The analysis of positive answers showed that indirect and non financial incentives were the most likely choice to acknowledge the donor's act. People in critical financial situations preferred direct financial incentives. These results showed that altruism and gratuity were key-values in the organ donation and transplantation social perceptions of the respondents. Thus, we assume that introducing financial incentives could tarnish the image of transplant medicine. Nevertheless, further studies are needed to evaluate if their introduction would improve the organ donation rates or decrease voluntarism.

Higher incentives can impair performance: neural evidence on reinforcement and rationality.

PubMed

Achtziger, Anja; Alós-Ferrer, Carlos; Hügelschäfer, Sabine; Steinhauser, Marco

2015-11-01

Standard economic thinking postulates that increased monetary incentives should increase performance. Human decision makers, however, frequently focus on past performance, a form of reinforcement learning occasionally at odds with rational decision making. We used an incentivized belief-updating task from economics to investigate this conflict through measurements of neural correlates of reward processing. We found that higher incentives fail to improve performance when immediate feedback on decision outcomes is provided. Subsequent analysis of the feedback-related negativity, an early event-related potential following feedback, revealed the mechanism behind this paradoxical effect. As incentives increase, the win/lose feedback becomes more prominent, leading to an increased reliance on reinforcement and more errors. This mechanism is relevant for economic decision making and the debate on performance-based payment. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

A Qualitative Study on Incentives and Disincentives for Care of Common Mental Disorders in Ontario Family Health Teams

PubMed Central

Silveira, Jose; Mckenzie, Kwame

2016-01-01

Background: An opportunity to address the needs of patients with common mental disorders (CMDs) resides in primary care. Barriers are restricting availability of treatment for CMDs in primary care. By understanding the incentives that promote and the disincentives that deter treatment for CMDs in a collaborative primary care context, this study aims to help contribute to goals of greater access to mental healthcare. Method: A qualitative pilot study using semi-structured interviews with thematic analysis. Results: Participants identified 10 themes of incentives and disincentives influencing quality treatment of CMDs in a collaborative primary care setting: high service demands, clinical presentation, patient-centred care, patient attributes, education, physician attributes, organizational, access to mental health resources, psychiatry and physician payment model. Conclusion: An understanding of the incentives and disincentives influencing care is essential to achieve greater integration and capacity for care for the treatment of CMDs in primary care. PMID:27585029

Reward Motivation Enhances Task Coding in Frontoparietal Cortex

PubMed Central

Etzel, Joset A.; Cole, Michael W.; Zacks, Jeffrey M.; Kay, Kendrick N.; Braver, Todd S.

2016-01-01

Reward motivation often enhances task performance, but the neural mechanisms underlying such cognitive enhancement remain unclear. Here, we used a multivariate pattern analysis (MVPA) approach to test the hypothesis that motivation-related enhancement of cognitive control results from improved encoding and representation of task set information. Participants underwent two fMRI sessions of cued task switching, the first under baseline conditions, and the second with randomly intermixed reward incentive and no-incentive trials. Information about the upcoming task could be successfully decoded from cue-related activation patterns in a set of frontoparietal regions typically associated with task control. More critically, MVPA classifiers trained on the baseline session had significantly higher decoding accuracy on incentive than non-incentive trials, with decoding improvement mediating reward-related enhancement of behavioral performance. These results strongly support the hypothesis that reward motivation enhances cognitive control, by improving the discriminability of task-relevant information coded and maintained in frontoparietal brain regions. PMID:25601237

International Review of Frameworks for Impact Evaluation of Appliance Standards, Labeling, and Incentives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, Nan; Romankiewicz, John; Vine, Edward

2012-12-15

In recent years, the number of energy efficiency policies implemented has grown very rapidly as energy security and climate change have become top policy issues for many governments around the world. Within the sphere of energy efficiency policy, governments (federal and local), electric utilities, and other types of businesses and institutions are implementing a wide variety of programs to spread energy efficiency practices in industry, buildings, transport, and electricity. As programs proliferate, there is an administrative and business imperative to evaluate the savings and processes of these programs to ensure that program funds spent are indeed leading to a moremore » energy-efficient economy.« less

Auctions with Dynamic Populations: Efficiency and Revenue Maximization

NASA Astrophysics Data System (ADS)

Said, Maher

We study a stochastic sequential allocation problem with a dynamic population of privately-informed buyers. We characterize the set of efficient allocation rules and show that a dynamic VCG mechanism is both efficient and periodic ex post incentive compatible; we also show that the revenue-maximizing direct mechanism is a pivot mechanism with a reserve price. We then consider sequential ascending auctions in this setting, both with and without a reserve price. We construct equilibrium bidding strategies in this indirect mechanism where bidders reveal their private information in every period, yielding the same outcomes as the direct mechanisms. Thus, the sequential ascending auction is a natural institution for achieving either efficient or optimal outcomes.

A novel and cost-effective monitoring approach for outcomes in an Australian biodiversity conservation incentive program.

PubMed

Lindenmayer, David B; Zammit, Charles; Attwood, Simon J; Burns, Emma; Shepherd, Claire L; Kay, Geoff; Wood, Jeff

2012-01-01

We report on the design and implementation of ecological monitoring for an Australian biodiversity conservation incentive scheme - the Environmental Stewardship Program. The Program uses competitive auctions to contract individual land managers for up to 15 years to conserve matters of National Environmental Significance (with an initial priority on nationally threatened ecological communities). The ecological monitoring was explicitly aligned with the Program's policy objective and desired outcomes and was applied to the Program's initial Project which targeted the critically endangered White Box-Yellow Box-Blakely's Red Gum Grassy Woodland and Derived Native Grassland ecological community in south eastern Australia. These woodlands have been reduced to <3% of their original extent and persist mostly as small remnants of variable condition on private farmland. We established monitoring sites on 153 farms located over 172,232 sq km. On each farm we established a monitoring site within the woodland patch funded for management and, wherever possible, a matched control site. The monitoring has entailed gathering data on vegetation condition, reptiles and birds. We also gathered data on the costs of experimental design, site establishment, field survey, and data analysis. The costs of monitoring are approximately 8.5% of the Program's investment in the first four years and hence are in broad accord with the general rule of thumb that 5-10% of a program's funding should be invested in monitoring. Once initial monitoring and site benchmarking are completed we propose to implement a novel rotating sampling approach that will maintain scientific integrity while achieving an annual cost-efficiency of up to 23%. We discuss useful lessons relevant to other monitoring programs where there is a need to provide managers with reliable early evidence of program effectiveness and to demonstrate opportunities for cost-efficiencies.

The economic and environmental consequences of implementing nitrogen-efficient technologies and management practices in agriculture.

PubMed

Zhang, Xin; Mauzerall, Denise L; Davidson, Eric A; Kanter, David R; Cai, Ruohong

2015-03-01

Technologies and management practices (TMPs) that reduce the application of nitrogen (N) fertilizer while maintaining crop yields can improve N use efficiency (NUE) and are important tools for meeting the dual challenges of increasing food production and reducing N pollution. However, because farmers operate to maximize their profits, incentives to implement TMPs are limited, and TMP implementation will not always reduce N pollution. Therefore, we have developed the NUE Economic and Environmental impact analytical framework (NUE) to examine the economic and environmental consequences of implementing TMPs in agriculture, with a specific focus on farmer profits, N fertilizer consumption, N losses, and cropland demand. Our analytical analyses show that impact of TMPs on farmers' economic decision-making and the environment is affected by how TMPs change the yield ceiling and the N fertilization rate at the ceiling and by how the prices of TMPs, fertilizer, and crops vary. Technologies and management practices that increase the yield ceiling appear to create a greater economic incentive for farmers than TMPs that do not but may result in higher N application rates and excess N losses. Nevertheless, the negative environmental impacts of certain TMPs could be avoided if their price stays within a range determined by TMP yield response, fertilizer price, and crop price. We use a case study on corn production in the midwestern United States to demonstrate how NUE can be applied to farmers' economic decision-making and policy analysis. Our NUE framework provides an important tool for policymakers to understand how combinations of fertilizer, crop, and TMP prices affect the possibility of achieving win-win outcomes for farmers and the environment. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care.

PubMed

Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E

2011-01-01

Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost-containment expenses be reported by category of cost; compile information on the types of medical services that are subject to UR denials and expedited hearings; and expand ongoing monitoring of system performance. Finally, to increase administrative efficiency, California should use an external medical review organization to review medical-necessity determinations, and it should explore best practices of other WC programs and health programs in carrying out medical cost-containment activities.

Conservation cropping systems: Increasing water use efficiency and lowering production costs

USDA-ARS?s Scientific Manuscript database

As of the 2007 Census of Agriculture, irrigated acres were only found on 4.4% of agricultural operations in Alabama. To increase irrigated acres, the Alabama Legislature passed the Irrigation Incentives Bill in 2012 to provide a state income tax credit of 20 percent of the costs of the purchase and ...

Evaluation of an Intervention Program to Increase Immunization Compliance among School Children

ERIC Educational Resources Information Center

Luthy, Karlen E.; Thorpe, Aubrey; Dymock, Leah Clark; Connely, Samantha

2011-01-01

State immunization laws necessitate compliance for students enrolling in a public or private school system. In support of state laws, school nurses expend hours to achieve immunization compliance with school-age children. For the purpose of creating a more efficient system, researchers implemented an educational and incentive program in local…

Space Situational Awareness using Market Based Agents

NASA Astrophysics Data System (ADS)

Sullivan, C.; Pier, E.; Gregory, S.; Bush, M.

2012-09-01

Space surveillance for the DoD is not limited to the Space Surveillance Network (SSN). Other DoD-owned assets have some existing capabilities for tasking but have no systematic way to work collaboratively with the SSN. These are run by diverse organizations including the Services, other defense and intelligence agencies and national laboratories. Beyond these organizations, academic and commercial entities have systems that possess SSA capability. Most all of these assets have some level of connectivity, security, and potential autonomy. Exploiting them in a mutually beneficial structure could provide a more comprehensive, efficient and cost effective solution for SSA. The collection of all potential assets, providers and consumers of SSA data comprises a market which is functionally illiquid. The development of a dynamic marketplace for SSA data could enable would-be providers the opportunity to sell data to SSA consumers for monetary or incentive based compensation. A well-conceived market architecture could drive down SSA data costs through increased supply and improve efficiency through increased competition. Oceanit will investigate market and market agent architectures, protocols, standards, and incentives toward producing high-volume/low-cost SSA.

A Simulation Modeling Framework to Optimize Programs Using Financial Incentives to Motivate Health Behavior Change.

PubMed

Basu, Sanjay; Kiernan, Michaela

2016-01-01

While increasingly popular among mid- to large-size employers, using financial incentives to induce health behavior change among employees has been controversial, in part due to poor quality and generalizability of studies to date. Thus, fundamental questions have been left unanswered: To generate positive economic returns on investment, what level of incentive should be offered for any given type of incentive program and among which employees? We constructed a novel modeling framework that systematically identifies how to optimize marginal return on investment from programs incentivizing behavior change by integrating commonly collected data on health behaviors and associated costs. We integrated "demand curves" capturing individual differences in response to any given incentive with employee demographic and risk factor data. We also estimated the degree of self-selection that could be tolerated: that is, the maximum percentage of already-healthy employees who could enroll in a wellness program while still maintaining positive absolute return on investment. In a demonstration analysis, the modeling framework was applied to data from 3000 worksite physical activity programs across the nation. For physical activity programs, the incentive levels that would optimize marginal return on investment ($367/employee/year) were higher than average incentive levels currently offered ($143/employee/year). Yet a high degree of self-selection could undermine the economic benefits of the program; if more than 17% of participants came from the top 10% of the physical activity distribution, the cost of the program would be expected to always be greater than its benefits. Our generalizable framework integrates individual differences in behavior and risk to systematically estimate the incentive level that optimizes marginal return on investment. © The Author(s) 2015.

Carrot or stick? Modelling how landowner behavioural responses can cause incentive-based forest governance to backfire.

PubMed

Henderson, Kirsten A; Anand, Madhur; Bauch, Chris T

2013-01-01

Mitigating the negative impacts of declining worldwide forest cover remains a significant socio-ecological challenge, due to the dominant role of human decision-making. Here we use a Markov chain model of land-use dynamics to examine the impact of governance on forest cover in a region. Each land parcel can be either forested or barren (deforested), and landowners decide whether to deforest their parcel according to perceived value (utility). We focus on three governance strategies: yearly incentive for conservation, one-time penalty for deforestation and one-time incentive for reforestation. The incentive and penalty are incorporated into the expected utility of forested land, which decreases the net gain of deforestation. By analyzing the equilibrium and stability of the landscape dynamics, we observe four possible outcomes: a stationary-forested landscape, a stationary-deforested landscape, an unstable landscape fluctuating near the equilibrium, and a cyclic-forested landscape induced by synchronized deforestation. We find that the two incentive-based strategies often result in highly fluctuating forest cover over decadal time scales or longer, and in a few cases, reforestation incentives actually decrease the average forest cover. In contrast, a penalty for deforestation results in the stable persistence of forest cover (generally >30%). The idea that larger conservation incentives will always yield higher and more stable forest cover is not supported in our findings. The decision to deforest is influenced by more than a simple, "rational" cost-benefit analysis: social learning and myopic, stochastic decision-making also have important effects. We conclude that design of incentive programs may need to account for potential counter-productive long-term effects due to behavioural feedbacks.

A simulation modeling framework to optimize programs using financial incentives to motivate health behavior change

PubMed Central

Basu, Sanjay; Kiernan, Michaela

2015-01-01

Introduction While increasingly popular among mid- to large-size employers, using financial incentives to induce health behavior change among employees has been controversial, in part due to poor quality and generalizability of studies to date. Thus, fundamental questions have been left unanswered: to generate positive economic returns on investment, what level of incentive should be offered for any given type of incentive program and among which employees? Methods We constructed a novel modeling framework that systematically identifies how to optimize marginal return on investment from programs incentivizing behavior change by integrating commonly-collected data on health behaviors and associated costs. We integrated “demand curves” capturing individual differences in response to any given incentive with employee demographic and risk factor data. We also estimated the degree of self-selection that could be tolerated, i.e., the maximum percentage of already-healthy employees who could enroll in a wellness program while still maintaining positive absolute return on investment. In a demonstration analysis, the modeling framework was applied to data from 3,000 worksite physical activity programs across the nation. Results For physical activity programs, the incentive levels that would optimize marginal return on investment ($367/employee/year) were higher than average incentive levels currently offered ($143/employee/year). Yet a high degree of self-selection could undermine the economic benefits of the program; if more than 17% of participants came from the top 10% of the physical activity distribution, the cost of the program would be expected to always be greater than its benefits. Discussion Our generalizable framework integrates individual differences in behavior and risk to systematically estimate the incentive level that optimizes marginal return on investment. PMID:25977362

Carrot or Stick? Modelling How Landowner Behavioural Responses Can Cause Incentive-Based Forest Governance to Backfire

PubMed Central

Henderson, Kirsten A.; Anand, Madhur; Bauch, Chris T.

2013-01-01

Mitigating the negative impacts of declining worldwide forest cover remains a significant socio-ecological challenge, due to the dominant role of human decision-making. Here we use a Markov chain model of land-use dynamics to examine the impact of governance on forest cover in a region. Each land parcel can be either forested or barren (deforested), and landowners decide whether to deforest their parcel according to perceived value (utility). We focus on three governance strategies: yearly incentive for conservation, one-time penalty for deforestation and one-time incentive for reforestation. The incentive and penalty are incorporated into the expected utility of forested land, which decreases the net gain of deforestation. By analyzing the equilibrium and stability of the landscape dynamics, we observe four possible outcomes: a stationary-forested landscape, a stationary-deforested landscape, an unstable landscape fluctuating near the equilibrium, and a cyclic-forested landscape induced by synchronized deforestation. We find that the two incentive-based strategies often result in highly fluctuating forest cover over decadal time scales or longer, and in a few cases, reforestation incentives actually decrease the average forest cover. In contrast, a penalty for deforestation results in the stable persistence of forest cover (generally >30%). The idea that larger conservation incentives will always yield higher and more stable forest cover is not supported in our findings. The decision to deforest is influenced by more than a simple, “rational” cost-benefit analysis: social learning and myopic, stochastic decision-making also have important effects. We conclude that design of incentive programs may need to account for potential counter-productive long-term effects due to behavioural feedbacks. PMID:24204942

An empirical investigation of the efficiency effects of integrated care models in Switzerland

PubMed Central

Reich, Oliver; Rapold, Roland; Flatscher-Thöni, Magdalena

2012-01-01

Introduction This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006–2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5%, respectively, of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy-makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care. PMID:22371691

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

PubMed Central

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-01-01

Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. PMID:25231492

Steering Patients to Safer Hospitals? The Effect of a Tiered Hospital Network on Hospital Admissions

PubMed Central

Scanlon, Dennis P; Lindrooth, Richard C; Christianson, Jon B

2008-01-01

Objective To determine if a tiered hospital benefit and safety incentive shifted the distribution of admissions toward safer hospitals. Data Sources/Study Setting A large manufacturing company instituted the hospital safety incentive (HSI) for union employees. The HSI gave union patients a financial incentive to choose hospitals that met the Leapfrog Group's three patient safety “leaps.” The analysis merges data from four sources: claims and enrollment data from the company, the American Hospital Association, the AHRQ HCUP-SID, and a state Office of the Insurance Commissioner. Study Design Changes in hospital admissions’ patterns for union and nonunion employees using a difference-in-difference design. We estimate the probability of choosing a specific hospital from a set of available alternatives using conditional logistic regression. Principal Findings Patients affiliated with the engineers’ union and admitted for a medical diagnosis were 2.92 times more likely to select a hospital designated as safer in the postperiod than in the preperiod, while salaried nonunion (SNU) patients (not subject to the financial incentive) were 0.64 times as likely to choose a compliant hospital in the post- versus preperiod. The difference-in-difference estimate, which is based on the predictions of the conditional logit model, is 0.20. However, the machinists’ union was also exposed to the incentive and they were no more likely to choose a safer hospital than the SNU patients. The incentive did not have an effect on patients admitted for a surgical diagnosis, regardless of union status. All patients were averse to travel time, but those union patients selecting an incentive hospital were less averse to travel time. Conclusions Patient price incentives and quality/safety information may influence hospital selection decisions, particularly for medical admissions, though the optimal incentive level for financial return to the plan sponsor is not clear. PMID:18761676

Organizing and managing care in a changing health system.

PubMed

Kohn, L T

2000-04-01

To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. Site visits conducted in 12 randomly selected communities in 1996/ 1997. Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change.

Supporting the academic mission in an era of constrained resources: approaches at the University of Arizona College of Medicine.

PubMed

Joiner, Keith A; Libecap, Ann; Cress, Anne E; Wormsley, Steve; St Germain, Patricia; Berg, Robert; Malan, Philip

2008-09-01

The authors describe initiatives at the University of Arizona College of Medicine to markedly expand faculty, build research along programmatic lines, and promote a new, highly integrated medical school curriculum. Accomplishing these goals in this era of declining resources is challenging. The authors describe their approaches and outcomes to date, derived from a solid theoretical framework in the management literature, to (1) support research faculty recruitment, emphasizing return on investment, by using net present value to guide formulation of recruitment packages, (2) stimulate efficiency and growth through incentive plans, by using utility theory to optimize incentive plan design, (3) distribute resources to support programmatic growth, by allocating research space and recruitment dollars to maximize joint hires between units with shared interests, and (4) distribute resources from central administration to encourage medical student teaching, by aligning state dollars to support a new integrated organ-system based-curriculum. Detailed measurement is followed by application of management principles, including mathematical modeling, to make projections based on the data collected. Although each of the initiatives was developed separately, they are linked functionally and financially, and they are predicated on explicitly identifying opportunity costs for all major decisions, to achieve efficiencies while supporting growth. The overall intent is to align institutional goals in education, research, and clinical care with incentives for unit heads and individual faculty to achieve those goals, and to create a clear line of sight between expectations and rewards. Implementation is occurring in a hypothesis-driven fashion, permitting testing and refinement of the strategies.

Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis

PubMed Central

2012-01-01

Background The General Medical Services primary care contract for the United Kingdom financially rewards performance in 19 clinical areas, through the Quality and Outcomes Framework. Little is known about how best to determine the size of financial incentives in pay for performance schemes. Our aim was to test the hypothesis that performance indicators with larger population health benefits receive larger financial incentives. Methods We performed cross sectional analyses to quantify associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the Quality and Outcomes Framework. We used non-parametric two-sided Spearman rank correlation tests. Health gain was measured in expected lives saved in one year and in quality adjusted life years. For each quality indicator in an average sized general practice we tested for associations first, between the marginal increase in payment and the health gain resulting from a one percent point improvement in performance and second, between total payment and the health gain at the performance threshold for maximum payment. Results Evidence for lives saved or quality adjusted life years gained was found for 28 indicators accounting for 41% of the total incentive payments. No statistically significant associations were found between the expected health gain and incentive gained from a marginal 1% increase in performance in either the 2004 or 2006 version of the Quality and Outcomes Framework. In addition no associations were found between the size of financial payment for achievement of an indicator and the expected health gain at the performance threshold for maximum payment measured in lives saved or quality adjusted life years. Conclusions In this subgroup of indicators the financial incentives were not aligned to maximise health gain. This disconnection between incentive and expected health gain risks supporting clinical activities that are only marginally effective, at the expense of more effective activities receiving lower incentives. When designing pay for performance programmes decisions about the size of the financial incentive attached to an indicator should be informed by information on the health gain to be expected from that indicator. PMID:22507660

Horizontal-axis clothes washer market poised for expansion

DOE Office of Scientific and Technical Information (OSTI.GOV)

George, K.L.

1994-12-31

The availability of energy- and water-efficient horizontal-axis washing machines in the North American market is growing, as US and European manufacturers position for an expected long-term market shift toward horizontal-axis (H-axis) technology. Four of the five major producers of washing machines in the US are developing or considering new H-axis models. New entrants, including US-based Staber Industries and several European manufacturers, are also expected to compete in this market. The intensified interest in H-axis technology is partly driven by speculation that new US energy efficiency standards, to be proposed in 1996 and implemented in 1999, will effectively mandate H-axis machines.more » H-axis washers typically use one-third to two-thirds less energy, water, and detergent than vertical-axis machines. Some models also reduce the energy needed to dry the laundry, since their higher spin speeds extract more water than is typical with vertical-axis designs. H-axis washing machines are the focus of two broadly-based efforts to support coordinated research and incentive programs by electric, gas, and water utilities: The High-Efficiency Laundry Metering/Marketing Analysis (THELMA), and the Consortium for Energy Efficiency (CEE) High-Efficiency Clothes Washer Initiative. These efforts may help to pave the way for new types of marketing partnerships among utilities and other parties that could help to speed adoption of H-axis washers.« less

Efficient dynamic scarcity pricing in urban water supply

NASA Astrophysics Data System (ADS)

Lopez-Nicolas, Antonio; Pulido-Velazquez, Manuel; Rougé, Charles; Harou, Julien J.; Escriva-Bou, Alvar

2017-04-01

Water pricing is a key instrument for water demand management. Despite the variety of existing strategies for urban water pricing, urban water rates are often far from reflecting the real value of the resource, which increases with water scarcity. Current water rates do not bring any incentive to reduce water use in water scarcity periods, since they do not send any signal to the users of water scarcity. In California, the recent drought has spurred the implementation of drought surcharges and penalties to reduce residential water use, although it is not a common practice yet. In Europe, the EU Water Framework Directive calls for the implementation of new pricing policies that assure the contribution of water users to the recovery of the cost of water services (financial instrument) while providing adequate incentives for an efficient use of water (economic instrument). Not only financial costs should be recovered but also environmental and resource (opportunity) costs. A dynamic pricing policy is efficient if the prices charged correspond to the marginal economic value of water, which increases with water scarcity and is determined by the value of water for all alternative uses in the basin. Therefore, in the absence of efficient water markets, measuring the opportunity costs of scarce water can only be achieved through an integrated basin-wide hydroeconomic simulation approach. The objective of this work is to design a dynamic water rate for urban water supply accounting for the seasonal marginal value of water in the basin, related to water scarcity. The dynamic pricing policy would send to the users a signal of the economic value of the resource when water is scarce, therefore promoting more efficient water use. The water rate is also designed to simultaneously meet the expected basic requirements for water tariffs: revenue sufficiency (cost recovery) and neutrality, equity and affordability, simplicity and efficiency. A dynamic increasing block rate (IBR) tariff is designed, including a variable charge related to the scarcity value of water in the basin. The new tariff would encourage water conservation, providing more incentives with great water scarcity. The approach is applied to the supply to the city of Valencia with water resources from the Jucar river basin, a drought-prone Mediterranean basin in Eastern Spain that constitutes a good case for testing this policy. Our results demonstrate the potential of integrating the marginal value of water in the urban water tariffs, with water savings reaching up to 30% during scarcity conditions with respect to the baseline urban water tariffs.

A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace

PubMed Central

2013-01-01

Background Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer’s perspective. Methods Employees used a 'loyalty card’ to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates. Results The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds. Conclusions The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer’s perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable “business model” which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges. PMID:24112295

A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace.

PubMed

Dallat, Mary Anne T; Hunter, Ruth F; Tully, Mark A; Cairns, Karen J; Kee, Frank

2013-10-10

Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer's perspective. Employees used a 'loyalty card' to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates. The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds. The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer's perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable "business model" which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges.

A multi-objective model for closed-loop supply chain optimization and efficient supplier selection in a competitive environment considering quantity discount policy

NASA Astrophysics Data System (ADS)

Jahangoshai Rezaee, Mustafa; Yousefi, Samuel; Hayati, Jamileh

2017-06-01

Supplier selection and allocation of optimal order quantity are two of the most important processes in closed-loop supply chain (CLSC) and reverse logistic (RL). So that providing high quality raw material is considered as a basic requirement for a manufacturer to produce popular products, as well as achieve more market shares. On the other hand, considering the existence of competitive environment, suppliers have to offer customers incentives like discounts and enhance the quality of their products in a competition with other manufacturers. Therefore, in this study, a model is presented for CLSC optimization, efficient supplier selection, as well as orders allocation considering quantity discount policy. It is modeled using multi-objective programming based on the integrated simultaneous data envelopment analysis-Nash bargaining game. In this study, maximizing profit and efficiency and minimizing defective and functions of delivery delay rate are taken into accounts. Beside supplier selection, the suggested model selects refurbishing sites, as well as determining the number of products and parts in each network's sector. The suggested model's solution is carried out using global criteria method. Furthermore, based on related studies, a numerical example is examined to validate it.

Perceptions of financial incentives for smoking cessation: a survey of smokers in a country with an endgame goal.

PubMed

Robertson, Lindsay; Gendall, Philip; Hoek, Janet; Marsh, Louise; McGee, Rob

2017-12-15

Financial incentives can support smoking cessation, yet low acceptability may limit the wider implementation of such schemes. Few studies have examined how smokers view financial-incentive interventions aimed at reducing smoking prevalence. We recruited a sample of 623 smokers from an internet panel to a survey assessing support for, and perceived effectiveness of, financial incentives for smoking cessation. We used descriptive statistics, plus logistic regression, to test associations between demographics and smoking, and support. We used qualitative content analysis to analyse open-ended responses to a question that invited respondents to comment on financial incentives. 38.4% of smokers supported financial incentives; 42.2% did not (19.4% had no opinion). Support was higher among heavy (OR 3.96, CI 2.39 - 6.58) and moderate smokers (OR 1.68, CI 1.13 - 2.49), and those with a recent quit attempt (OR 1.47, 1.04 - 2.07). Support was strongly associated with perceived effectiveness. A Government-funded reward-only scheme was seen as the most acceptable option (preferred by 26.6% of participants), followed by a Government-funded deposit-based scheme (20.6%); few respondents supported employer-funded schemes. Open-ended responses (n=301) indicated three overarching themes expressing opposition to financial incentives: smokers' individual responsibility for quitting, concerns about abuse of an incentive scheme, and concerns about unfairness. Even amongst those who would benefit from schemes designed to reward smokers for quitting, support for such schemes is muted, despite evidence of their effectiveness. Media advocacy and health education could be used to increase understanding of, and support for, financial incentives for smoking cessation. Given the absolute effectiveness and cost-effectiveness of financial-incentive schemes for smoking cessation amongst pregnant smokers and in workplaces, implementing such schemes at a national-level could help reduce overall smoking prevalence and contribute to endgame goals. Our study found that similar proportions of smokers supported and opposed financial-incentive schemes, and suggests much of the opposition was underpinned by information gaps, which could be addressed using education and media advocacy. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Analysis of federal and state policies and environmental issues for bioethanol production facilities.

PubMed

McGee, Chandra; Chan Hilton, Amy B

2011-03-01

The purpose of this work was to investigate incentives and barriers to fuel ethanol production from biomass in the U.S. during the past decade (2000-2010). In particular, we examine the results of policies and economic conditions during this period by way of cellulosic ethanol activity in four selected states with the potential to produce different types of feedstocks (i.e., sugar, starch, and cellulosic crops) for ethanol production (Florida, California, Hawaii, and Iowa). Two of the four states, Iowa and California, currently have commercial ethanol production facilities in operation using corn feedstocks. While several companies have proposed commercial scale facilities in Florida and Hawaii, none are operating to date. Federal and state policies and incentives, potential for feedstock production and conversion to ethanol and associated potential environmental impacts, and environmental regulatory conditions among the states were investigated. Additionally, an analysis of proposed and operational ethanol production facilities provided evidence that a combination of these policies and incentives along with the ability to address environmental issues and regulatory environment and positive economic conditions all impact ethanol production. The 2000-2010 decade saw the rise of the promise of cellulosic ethanol. Federal and state policies were enacted to increase ethanol production. Since the initial push for development, expansion of cellulosic ethanol production has not happened as quickly as predicted. Government and private funding supported the development of ethanol production facilities, which peaked and then declined by the end of the decade. Although there are technical issues that remain to be solved to more efficiently convert cellulosic material to ethanol while reducing environmental impacts, the largest barriers to increasing ethanol production appear to be related to government policies, economics, and logistical issues. The numerous federal and state policies do not effectively give investors confidence to commit to the construction and long-term operation of facilities under current economic conditions. Additional changes in policy and breakthroughs in technology and logistics will be required to address these hurdles to increases in ethanol production in the U.S. in the next decade.

Modulation of working memory function by motivation through loss-aversion

PubMed Central

Krawczyk, Daniel C.; D’Esposito, Mark

2012-01-01

Cognitive performance is affected by motivation. Few studies, however, have investigated the neural mechanisms of the influence of motivation through potential monetary punishment on working memory. We employed functional MRI during a delayed recognition task that manipulated top-down control demands with added monetary incentives to some trials in the form of potential losses of bonus money. Behavioral performance on the task was influenced by loss-threatening incentives in the form of faster and more accurate performance. As shown previously, we found enhancement of activity for relevant stimuli occurs throughout all task periods (e.g. stimulus encoding, maintenance, and response) in both prefrontal and visual association cortex. Further, these activation patterns were enhanced for trials with possible monetary loss relative to non-incentive trials. During the incentive cue, the amygdala and striatum showed significantly greater activation when money was at a possible loss on the trial. We also evaluated patterns of functional connectivity between regions responsive to monetary consequences and prefrontal areas responsive to the task. This analysis revealed greater delay period connectivity between and the left insula and prefrontal cortex with possible monetary loss relative to non-incentive trials. Overall, these results reveal that incentive motivation can modulate performance on working memory tasks through top-down signals via amplification of activity within prefrontal and visual association regions selective to processing the perceptual inputs of the stimuli to be remembered. PMID:22113962

The impact of alternative incentive schemes on completion of health risk assessments.

PubMed

Haisley, Emily; Volpp, Kevin G; Pellathy, Thomas; Loewenstein, George

2012-01-01

The biggest challenge for corporate wellness initiatives is low rates of employee participation. We test whether a behavioral economic approach to incentive design (i.e., a lottery) is more effective than a direct economic payment of equivalent monetary value (i.e., a grocery gift certificate) in encouraging employees to complete health risk assessments (HRAs). Employees were assigned to one of three arms. Assignment to a treatment arm versus the nontreatment arm was determined by management. Assignment to an arm among those eligible for treatment was randomized by office. A large health care management and information technology consulting company. A total of 1299 employees across 14 offices participated. All employees were eligible to receive $25 for completing the HRA. Those in the lottery condition were assigned to teams of four to eight people and, conditional on HRA completion, were entered into a lottery with a prize of $100 (expected value, $25) and a bonus value of an additional $25 if 80% of team members participated. Those in the grocery gift certificate condition who completed an HRA received a $25 grocery gift certificate. Those in the comparison condition received no additional incentive. HRA completion rates. Logistic regression analysis. HRA completion rates were significantly higher among participations in the lottery incentive condition (64%) than in both the grocery gift certificate condition (44%) and the comparison condition (40%). Effects were larger for lower-income employees, as indicated by a significant interaction between income and the lottery incentive. Lottery incentives that incorporate regret aversion and social pressure can provide higher impact for the same amount of money as simple economic incentives.

Measuring the costs and benefits of conservation programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Einhorn, M.A.

1985-07-25

A step-by-step analysis of the effects of utility-sponsored conservation promoting programs begins by identifying several factors which will reduce a program's effectiveness. The framework for measuring cost savings and designing a conservation program needs to consider the size of appliance subsidies, what form incentives should take, and how will customer behavior change as a result of incentives. Continual reevaluation is necessary to determine whether to change the size of rebates or whether to continue the program. Analytical tools for making these determinations are improving as conceptual breakthroughs in econometrics permit more rigorous analysis. 5 figures.

Thinking outside the medicine cabinet: a comparative content analysis of direct-to-consumer advertisements for prescription drug treatments.

PubMed

McKeever, Robert

2014-01-01

This study content analyzed online direct-to-consumer advertisements (DTCA) for prescription drug treatments to explore whether ads for prescription treatments for psychiatric conditions, which are commonly untreated, differ from other drug advertisements. Coded variables included the presence of interactive technological components, use of promotional incentives, and the social contexts portrayed in images shown on each site. Statistical analysis revealed ads for psychiatric medications contained fewer interactive website features, financial incentives, and calls to action than other types of prescription drug advertisements. Implications for health communication researchers are discussed.

Interventions to improve adherence to tuberculosis treatment: systematic review and meta-analysis.

PubMed

Müller, A M; Osório, C S; Silva, D R; Sbruzzi, G; de Tarso, P; Dalcin, Roth

2018-07-01

One of the most serious problems in tuberculosis (TB) control is non-adherence to treatment. Several strategies have been developed to improve adherence and increase the cure rate. To systematically review interventions to improve adherence to anti-tuberculosis treatment. We performed a systematic review and meta-analysis of 22 randomised clinical trials (RCTs) to ascertain whether providing directly observed treatment, short-course (DOTS), financial incentives, food incentives and/or patient education/counselling improved adherence to anti-tuberculosis treatment. The primary outcome was cure rate; secondary outcomes were default and mortality rates. Sources used were Medline (accessed via PubMed), Cochrane Central, LILACS (Literatura Latino Americana em Ciências da Saúde, Latin American and Caribbean Health Sciences Literature) and Embase from inception to October 2015. A significant increase in cure rates, by 18% with DOTS and by 16% with patient education and counselling, was observed. In addition, the default rate decreased by 49% with DOTS, by 26% with financial incentives and by 13% with patient education and counselling. There was no statistically significant reduction in mortality rates with these interventions. Use of DOTS and patient education/counselling significantly improved cure rates; DOTS, patient education/counselling and financial incentives led to a reduction in the default rate.

[System-immanent incentives in the remuneration for psychiatry and psychosomatics : Analysis exemplified by treatment of alcohol-related disorders].

PubMed

Horter, H; Zapp, W; Driessen, M

2016-07-01

The German fixed rate remuneration system in psychiatry and psychosomatics (PEPP) has been criticized by many specialty associations because negative effects on mental healthcare are expected through economic incentives. Through analysis of performance data in the treatment of alcohol dependency at the Evangelical Hospital Bielefeld (Evangelisches Krankenhaus Bielefeld, EvKB) from 2014 and various simulations, the incentives of the PEPP (version 2015) were analyzed and its potential impact on patient care was evaluated. Groups of cases were created based on the clinical data. Various parameters were evaluated, such as duration of treatment, PEPP coding, loss of income by merging cases and case remuneration. Additionally, changes in the duration of treatment, the intensity of treatment and the intensity of care were simulated. In the simulations a reduction in the duration of treatment by 16.1 % led to additional revenues of 1.9 % per treatment day. The calculated additional costs of 1:1 care and intensive nursing care were not completely covered by the additional revenues, whereas psychotherapeutic inpatient treatment programs showed positive profit contributions. Complicated cases with increased merging of cases showed lower revenues but with above average expenditure of efforts. The current version of the PEPP leads to misdirected incentives in patient care. This is caused, for example, by the fact that higher profit contributions can be realized in some patient groups and intensive nursing care of patients is insufficiently represented. It is not clear whether these incentives will persist or can be compensated in subsequent versions of the system.

To Cut Costs, Ought Colleges Look to For-Profit Models?

ERIC Educational Resources Information Center

Blumenstyk, Goldie

2008-01-01

It's not just the climbing walls and the salaries for star professors driving up the cost of college. In some cases, costs go up because the culture and management of traditional institutions are simply not structured to promote efficiency and savings. At for-profit colleges, it's a different story. There, the "incentives to save money are…

Chapter 6: Residential Lighting Evaluation Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kurnik, Charles W; Dimetrosky, Scott; Parkinson, Katie

Given new regulations, increased complexity in the market, and the general shift from CFLs to LEDs, this evaluation protocol was updated in 2017 to shift the focus of the protocols toward LEDs and away from CFLs and to resolve evaluation uncertainties affecting residential lighting incentive programs.

Green Pays Its Way--Performance-Based Fees.

ERIC Educational Resources Information Center

Burns, Cameron M.; Eubank, Huston

2002-01-01

Reports that giving building and design professionals a financial incentive to create high-efficiency schools has proven to be a winning strategy for both the firms that design and build schools and the students who learn in them. Discusses a group of educators who had heard about the effects of natural lighting and ventilation on student and…

Cooperation as a Strategy for Rural Economic Development. Rural Research Report. Volume 19, Issue 2, Spring 2008

ERIC Educational Resources Information Center

Kuhn, Bill

2008-01-01

Cooperative behaviors among private investors, local entities and a county can create significant efficiencies and resources to achieve a countywide vision. A county willing to take on this leadership role can provide technology and creates incentives for cooperation, supports opportunistic action, and regulates a balance between private sector…

USES OF MARKETING TECHNIQUES THE U. S. GEOLOGICAL SURVEY.

USGS Publications Warehouse

McDermott, Michael P.

1983-01-01

The use of marketing techniques by government agencies to provide more efficient and effective dissemination of their information is a fairly recent development. A recessive economy, and increased scrutiny of operations have become a powerful incentive to maximize revenues and minimize expenses wherever possible as long as the primary mission of public service is satisfactorily met.

Lessons from international experience in controlling pharmaceutical expenditure. III: Regulating industry.

PubMed Central

Bloor, K.; Maynard, A.; Freemantle, N.

1996-01-01

This is the third of three papers that review international policies to control spending on drugs and to improve the efficiency of drug use. This paper reviews policies regulating the supply of drugs, particularly licensing and reimbursement controls, price and profit regulation. Price and profit controls contain few incentives for improving cost effective use of drugs, and focus on cost containment and profitability of domestic industry. Carefully monitored economic evaluation could lead to improvements in efficiency and benefits to patients and the health care system. PMID:8664771

Should mandatory energy reporting be eliminated

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kendall, R.

1981-08-01

Energy users report problems with the Industrial Reporting Program (IRP), a joint voluntary energy-efficiency program which began in 1975. Since energy-intensive industries were already organizing voluntary reporting, the new program required unnecessary expenditures. The Reagan administration's plan to eliminate the program by not funding it is opposed by many energy managers who want the data collected to help them with their management programs. Their interest is primarily in a data base because energy costs provide adequate incentives to conserve. They also want interaction (preferably voluntary) between industry and goverment on efficiency-improvement opportunities. (DCK)

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study.

PubMed

Saronga, Happiness P; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell A; Savadogo, Germain; Tonchev, Pencho; Dong, Hengjin; Sauerborn, Rainer; Loukanova, Svetla

2014-02-28

Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described. The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency. Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives.

Factors affecting the labor efficiency of hospital-based blood bank laboratories.

PubMed

Lam, H C; Kominski, G F; Petz, L D; Sofaer, S

1994-09-01

A variety of financing mechanisms and managerial innovations have been developed in the past decade to control hospital costs. Some evidence suggests that those changes have not produced substantial improvements in labor efficiency among employees in the hospital's technical level, such as in the blood bank laboratories. This study measured labor efficiency in 40 hospital-based blood bank laboratories in Southern California during the year from July 1989 to June 1990 and explored the impact of financial, managerial, and operational factors on labor efficiency. With standardized output measures used in all blood bank laboratories, a wide variation of labor efficiency was found. Multivariate analyses indicate that the labor efficiency of blood bank employees was not influenced by organizational financial incentives, but was affected by the managerial styles of blood bank managers. Interpretation of the findings suggests that labor efficiency is affected by operational designs intended to improve responses to variable workloads and reduce slack time.

The take-it-or-leave-it option allows small penalties to overcome social dilemmas

PubMed Central

Sasaki, Tatsuya; Brännström, Åke; Dieckmann, Ulf; Sigmund, Karl

2012-01-01

Self-interest frequently causes individuals engaged in joint enterprises to choose actions that are counterproductive. Free-riders can invade a society of cooperators, causing a tragedy of the commons. Such social dilemmas can be overcome by positive or negative incentives. Even though an incentive-providing institution may protect a cooperative society from invasion by free-riders, it cannot always convert a society of free-riders to cooperation. In the latter case, both norms, cooperation and defection, are stable: To avoid a collapse to full defection, cooperators must be sufficiently numerous initially. A society of free-riders is then caught in a social trap, and the institution is unable to provide an escape, except at a high, possibly prohibitive cost. Here, we analyze the interplay of (a) incentives provided by institutions and (b) the effects of voluntary participation. We show that this combination fundamentally improves the efficiency of incentives. In particular, optional participation allows institutions punishing free-riders to overcome the social dilemma at a much lower cost, and to promote a globally stable regime of cooperation. This removes the social trap and implies that whenever a society of cooperators cannot be invaded by free-riders, it will necessarily become established in the long run, through social learning, irrespective of the initial number of cooperators. We also demonstrate that punishing provides a “lighter touch” than rewarding, guaranteeing full cooperation at considerably lower cost. PMID:22232694

Economic aspect of health care systems. Advantage and disadvantage incentives in different systems.

PubMed

Chen, G J; Feldman, S R

2000-04-01

European health care delivery systems illustrate the effect of economic incentives on health care delivery. Each country faces the issue of trying to balance the desire for economic efficiency with comprehensive, quality medical care. Without careful use of economic incentives achievable with central control, one gets to pick only two of the three desired goods--high quality, low cost, and comprehensive coverage. In the United States, payment approaches for health care have been undergoing tremendous changes since the early 1980s. These changes have escalated during the 1990s. The basic approach for reimbursing hospital care has been completely restructured by many payers for care, and payment approaches for physicians and long-term care providers also are being restructured. Financing approaches vary from provider to provider and payer to payer, and financing approaches will continue to evolve over time. In the traditional fee-for-service reimbursement system, the incentive to physicians is to do more because more services lead to more revenue. The use of incentives to influence health care practitioners' behavior is common. Incentives are generally financial in nature and expose health care providers to some risk or reward for certain patterns of behavior. Some common incentives used in managed care include capitation payment, in which a physician is paid a fixed fee, regardless of the number of services administered; bonus distribution; and withhold accounts, through which a practitioner stands to gain or lose some amount of money for overuse or underuse of medical resources against budget. In many countries, a strengthening of the position of primary care providers can be observed: Finland, Germany, Greece, Italy, the Netherlands, Norway, Sweden, the United Kingdom, and now the United States. General practitioners are assumed to function as a gatekeeper to second-line care, such as specialist care, prescription drugs, and hospital care. A further step is to give the primary care providers financial responsibility for the costs of the follow-up care provided by others to their patients. By examining the health care systems of other countries, the potential negative impact of such an approach on the use of specialists can be seen. The negative impact of these approaches on patient care is clear when dermatologists and general practitioners are compared in the delivery of dermatologic health care.

Key drivers for market penetration of biosimilars in Europe.

PubMed

Rémuzat, Cécile; Dorey, Julie; Cristeau, Olivier; Ionescu, Dan; Radière, Guerric; Toumi, Mondher

2017-01-01

Background & Objectives : Potential drivers and barriers of biosimilar uptake were mainly analysed through qualitative approaches. The study objective was to conduct a quantitative analysis and identify drivers of biosimilar uptake of all available biosimilars in the European Union (EU). Methods : A three-step process was established to identify key drivers for the uptake of biosimilars in the top 10 EU member states (MS) pharmaceutical markets (Belgium, France, Germany, Greece, Hungary, Italy, Poland, Spain, Sweden, and the UK): (1) literature review to identify incentive policies in place to enhance biosimilars adoption; (2) assessment of biosimilar market dynamics based on database analysis; (3) regression model analysis on price using the following explicative variables: incentive policies; price difference between the biosimilar and the originator product; distribution channel; generic uptake and generic price cut; pharmaceutical expenditure per capita; and market competition. Results : At the study cut-off date, 20 biosimilars were available on the market. Incentive policies applied to biosimilars were found to be heterogeneous across countries, and uptakes of biosimilars were also very heterogeneous between different therapeutic classes and countries. Results from the model demonstrated that incentive policies and the date of first biosimilar market entry were correlated to biosimilar uptake. Pharmaceutical expenditure per capita and the highest generic uptake were inversely correlated with biosimilar uptake. Average generic price discount over originator and the number of biosimilars showed a trend toward statistical significance for correlation with biosimilar uptake, but did not reach the significance threshold. Biosimilar price discount over original biologic price, the number of analogues, and the distribution channel were not correlated with the biosimilar uptake. Conclusions : Understanding drivers of biosimilar uptake becomes a critical issue to inform policy decision-makers. This study showed that incentive policies to enhance uptake remain an important driver of biosimilar penetration, while biosimilar price discounts have no impact. Future research is warranted when the biosimilar market gains maturity.

Key drivers for market penetration of biosimilars in Europe

PubMed Central

Rémuzat, Cécile; Dorey, Julie; Cristeau, Olivier; Ionescu, Dan; Radière, Guerric; Toumi, Mondher

2017-01-01

ABSTRACT Background & Objectives: Potential drivers and barriers of biosimilar uptake were mainly analysed through qualitative approaches. The study objective was to conduct a quantitative analysis and identify drivers of biosimilar uptake of all available biosimilars in the European Union (EU). Methods: A three-step process was established to identify key drivers for the uptake of biosimilars in the top 10 EU member states (MS) pharmaceutical markets (Belgium, France, Germany, Greece, Hungary, Italy, Poland, Spain, Sweden, and the UK): (1) literature review to identify incentive policies in place to enhance biosimilars adoption; (2) assessment of biosimilar market dynamics based on database analysis; (3) regression model analysis on price using the following explicative variables: incentive policies; price difference between the biosimilar and the originator product; distribution channel; generic uptake and generic price cut; pharmaceutical expenditure per capita; and market competition. Results: At the study cut-off date, 20 biosimilars were available on the market. Incentive policies applied to biosimilars were found to be heterogeneous across countries, and uptakes of biosimilars were also very heterogeneous between different therapeutic classes and countries. Results from the model demonstrated that incentive policies and the date of first biosimilar market entry were correlated to biosimilar uptake. Pharmaceutical expenditure per capita and the highest generic uptake were inversely correlated with biosimilar uptake. Average generic price discount over originator and the number of biosimilars showed a trend toward statistical significance for correlation with biosimilar uptake, but did not reach the significance threshold. Biosimilar price discount over original biologic price, the number of analogues, and the distribution channel were not correlated with the biosimilar uptake. Conclusions: Understanding drivers of biosimilar uptake becomes a critical issue to inform policy decision-makers. This study showed that incentive policies to enhance uptake remain an important driver of biosimilar penetration, while biosimilar price discounts have no impact. Future research is warranted when the biosimilar market gains maturity. PMID:28265349

Deal or no deal: can incentives encourage widespread adoption of intelligent speed adaptation devices?

PubMed

Chorlton, Kathryn; Hess, Stephane; Jamson, Samantha; Wardman, Mark

2012-09-01

Given the burden of injury, economic, environmental and social consequences associated with speeding, reducing road traffic speed remains a major priority. Intelligent speed adaptation (ISA) is a promising but controversial new in-vehicle system that provides drivers with support on the speed-control task. In order to model potential system uptake, this paper explores drivers' preferences for two different types of ISA given a number of alternative fiscal incentives and non-fiscal measures, using a stated preference approach. As would be expected with such a contentious issue, the analysis revealed the presence of significant variations in sensitivities and preferences in the sample. While a non-negligible part of the sample population has such strong opposition to ISA that no reasonable discounts or incentives would lead to them buying or accepting such a system, there is also a large part of the population that, if given the right incentives, would be willing or even keen to equip their vehicle with an ISA device. Copyright © 2011. Published by Elsevier Ltd.

Customer Engagement in AEP gridSMART Residential Transactive System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Widergren, Steven E.; Marinovici, Maria C.; Fuller, Jason C.

— In 2013, AEP Ohio (AEP) operated a 5-minute real-time price (RTP) electricity market system on 4 distribution feeders as part of their gridSMART® demonstration project. The RTP households were billed for their electricity usage according to an RTP tariff approved by the Public Utility Commission of Ohio. They were given the incentive that their annual bill would be no greater than if they were on the flat-rate tariff, but they had financial incentives to shift consumption from high price periods to low price periods. Incentives were also available for response under high prices from local events, such as reachingmore » the distribution feeder capacity or a critical peak pricing event. An analysis of this transactive system experiment was completed in early 2014. This paper describes the incentive provided to the customer, the nature of their interaction with the smart thermostat that provided automated response to the transactive signal, and their level of satisfaction with the program.« less

Improving Human Resources for Health means Retaining Health-Workers: Application of the WHO-Recommendations for the Retention of Health-Workers in Rural Northern-Nigeria.

PubMed

Afenyadu, Godwin Y; Adegoke, Adetoro A; Findley, Sally

2017-01-01

Nigeria is one of 57 countries with critical shortage of health workers (HWs). Strategies to increase and equitably distribute HWs are critical to the achievement of Health Millennium/Sustainable Development Goals. We describe how three Northern Nigeria states adapted World Health Organisation (WHO)-recommended incentives to attract, recruit, and retain midwives. Secondary analysis of data from two surveys assessing midwife motivation, retention, and attrition in Northern Nigeria; and expert consultations. Midwives highlighted financial and non-financial incentives as key factors in their decisions to renew their contracts. Their perspectives informed the consensus positions of health managers, policymakers and heads of institutions, and led to the adaptation of the WHO recommendations into appropriate state-specific incentive packages. The feedback from midwives combined with an expert consultation approach allowed stakeholders to consider and use available evidence to select appropriate incentive packages that offer the greatest potential for helping to address inadequate numbers of rural midwives.

Influence of raw milk quality on processed dairy products: How do raw milk quality test results relate to product quality and yield?

PubMed

Murphy, Steven C; Martin, Nicole H; Barbano, David M; Wiedmann, Martin

2016-12-01

This article provides an overview of the influence of raw milk quality on the quality of processed dairy products and offers a perspective on the merits of investing in quality. Dairy farmers are frequently offered monetary premium incentives to provide high-quality milk to processors. These incentives are most often based on raw milk somatic cell and bacteria count levels well below the regulatory public health-based limits. Justification for these incentive payments can be based on improved processed product quality and manufacturing efficiencies that provide the processor with a return on their investment for high-quality raw milk. In some cases, this return on investment is difficult to measure. Raw milks with high levels of somatic cells and bacteria are associated with increased enzyme activity that can result in product defects. Use of raw milk with somatic cell counts >100,000cells/mL has been shown to reduce cheese yields, and higher levels, generally >400,000 cells/mL, have been associated with textural and flavor defects in cheese and other products. Although most research indicates that fairly high total bacteria counts (>1,000,000 cfu/mL) in raw milk are needed to cause defects in most processed dairy products, receiving high-quality milk from the farm allows some flexibility for handling raw milk, which can increase efficiencies and reduce the risk of raw milk reaching bacterial levels of concern. Monitoring total bacterial numbers in regard to raw milk quality is imperative, but determining levels of specific types of bacteria present has gained increasing importance. For example, spores of certain spore-forming bacteria present in raw milk at very low levels (e.g., <1/mL) can survive pasteurization and grow in milk and cheese products to levels that result in defects. With the exception of meeting product specifications often required for milk powders, testing for specific spore-forming groups is currently not used in quality incentive programs in the United States but is used in other countries (e.g., the Netherlands). Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Malpractice liability, technology choice and negative defensive medicine.

PubMed

Feess, Eberhard

2012-04-01

We extend the theoretical literature on the impact of malpractice liability by allowing for two treatment technologies, a safe and a risky one. The safe technology bears no failure risk, but leads to patient-specific disutility since it cannot completely solve the health problems. By contrast, the risky technology (for instance a surgery) may entirely cure patients, but fail with some probability depending on the hospital's care level. Tight malpractice liability increases care levels if the risky technology is chosen at all, but also leads to excessively high incentives for avoiding the liability exposure by adopting the safe technology. We refer to this distortion toward the safe technology as negative defensive medicine. Taking the problem of negative defensive medicine seriously, the second best optimal liability needs to balance between the over-incentive for the safe technology in case of tough liability and the incentive to adopt little care for the risky technology in case of weak liability. In a model with errors in court, we find that gross negligence where hospitals are held liable only for very low care levels outperforms standard negligence, even though standard negligence would implement the first best efficient care level.

Integrating cobenefits produced with water quality BMPs into credits markets: Conceptualization and experimental illustration for EPRI's Ohio River Basin Trading

NASA Astrophysics Data System (ADS)

Liu, Pengfei; Swallow, Stephen K.

2016-05-01

This paper develops a method that incorporates the public value for environmental cobenefits when a conservation buyer can purchase water quality credits based on nonmarket valuation results. We demonstrate this approach through an experiment with adult students in a classroom laboratory environment. Our application contributes to the study of individual preference and willingness to pay for cobenefits associated with the production of water quality credits in relation to the Ohio River Basin Trading Project. We use three different methods to elicit individuals' willingness to pay (WTP), including (1) a hypothetical referendum, (2) a real referendum lacking incentive compatibility, and (3) a real choice with incentive compatibility. Methodologically, our WTP estimates suggest individuals are more sensitive to the cost changes and reveal the lowest value in the real choice with incentive compatibility. Practically, we find individuals value certain cobenefits and credits as public goods. Incorporating public value toward cobenefits may improve the overall efficiency of a water quality trading market. Based on our specification of a planner's welfare function, results suggest a substantial welfare improvement after identifying an optimal allocation of a buyer's budget across credits derived from agricultural management practices producing different portfolios of cobenefits.

Cognitive control under contingencies in anxious and depressed adolescents: an antisaccade task.

PubMed

Jazbec, Sandra; McClure, Erin; Hardin, Michael; Pine, Daniel S; Ernst, Monique

2005-10-15

Emotion-related perturbations in cognitive control characterize adult mood and anxiety disorders. Fewer data are available to confirm such deficits in youth. Studies of cognitive control and error processing can provide an ideal template to examine these perturbations. Antisaccade paradigms are particularly well suited for this endeavor because they provide exquisite behavioral measures of modulation of response errors. A new monetary reward antisaccade task was used with 28 healthy, 11 anxious, and 12 depressed adolescents. Performance accuracy, saccade latency, and peak velocity of incorrect responses were analyzed. Performance accuracy across all groups was improved by incentives (obtain reward, avoid punishment). However, modulation of saccade errors by incentives differed by groups. In incentive trials relative to neutral trials, inhibitory efficiency (saccade latency) was enhanced in healthy, unaffected in depressed, and diminished in anxious adolescents. Modulation of errant actions (saccade peak velocity) was improved in the healthy group and unchanged in both the anxious and depressed groups. These findings provide grounds for testing hypotheses related to the impact of motivation deficits and emotional interference on directed action in adolescents with mood and anxiety disorders. Furthermore, neural mechanisms can now be examined by using this task paired with functional neuroimaging.

Design of effective interventions for smoking cessation through financial and non-financial incentives.

PubMed

Balderrama, Fanor; Longo, Christopher J

2017-11-01

Smoking has a tremendous negative impact on the Canadian economy and contributes to growing costs in the healthcare system. Efforts to reduce smoking rates may therefore reduce strain on the healthcare system and free up scarce resources. Academic literature on economic smoking cessation incentives presents a countless variety of interventions that have met with varying degrees of success. This study reviews six different variables used in the design of incentives in smoking cessation interventions: direction, form, magnitude, certainty, recipient grouping, and target demographic. The purpose of this study is to provide analysis and recommendations about the contribution of each variable into the overall effectiveness of smoking cessation programs and help health leaders design better interventions according to their specific needs.

Understanding the Adoption Process of National Security Technology: An Integration of Diffusion of Innovations and Volitional Behavior Theories.

PubMed

Iles, Irina A; Egnoto, Michael J; Fisher Liu, Brooke; Ackerman, Gary; Roberts, Holly; Smith, Daniel

2017-11-01

After the 9/11 terrorist attacks, the U.S. government initiated several national security technology adoption programs. The American public, however, has been skeptical about these initiatives and adoption of national security technologies has been mandated, rather than voluntary. We propose and test a voluntary behavioral intention formation model for the adoption of one type of new security technology: portable radiation detectors. Portable radiation detectors are an efficient way of detecting radiological and nuclear threats and could potentially prevent loss of life and damage to individuals' health. However, their functioning requires that a critical mass of individuals use them on a daily basis. We combine the explanatory advantages of diffusion of innovation with the predictive power of two volitional behavior frameworks: the theory of reasoned action and the health belief model. A large sample survey (N = 1,482) investigated the influence of factors identified in previous diffusion of innovation research on portable radiation detector adoption intention. Results indicated that nonfinancial incentives, as opposed to financial incentives, should be emphasized in persuasive communications aimed at fostering adoption. The research provides a new integration of diffusion of innovation elements with determinants of volitional behavior from persuasion literature, and offers recommendations on effective communication about new security technologies to motivate public adoption and enhance national safety. © 2017 Society for Risk Analysis.

Incentives for retaining and motivating health workers in Pacific and Asian countries.

PubMed

Henderson, Lyn N; Tulloch, Jim

2008-09-15

This paper was initiated by the Australian Agency for International Development (AusAID) after identifying the need for an in-depth synthesis and analysis of available literature and information on incentives for retaining health workers in the Asia-Pacific region. The objectives of this paper are to: 1. Highlight the situation of health workers in Pacific and Asian countries to gain a better understanding of the contributing factors to health worker motivation, dissatisfaction and migration. 2. Examine the regional and global evidence on initiatives to retain a competent and motivated health workforce, especially in rural and remote areas. 3. Suggest ways to address the shortages of health workers in Pacific and Asian countries by using incentives. The review draws on literature and information gathered through a targeted search of websites and databases. Additional reports were gathered through AusAID country offices, UN agencies, and non-government organizations. The severe shortage of health workers in Pacific and Asian countries is a critical issue that must be addressed through policy, planning and implementation of innovative strategies--such as incentives--for retaining and motivating health workers. While economic factors play a significant role in the decisions of workers to remain in the health sector, evidence demonstrates that they are not the only factors. Research findings from the Asia-Pacific region indicate that salaries and benefits, together with working conditions, supervision and management, and education and training opportunities are important. The literature highlights the importance of packaging financial and non-financial incentives. Each country facing shortages of health workers needs to identify the underlying reasons for the shortages, determine what motivates health workers to remain in the health sector, and evaluate the incentives required for maintaining a competent and motivated health workforce. Decision-making factors and responses to financial and non-financial incentives have not been adequately monitored and evaluated in the Asia-Pacific region. Efforts must be made to build the evidence base so that countries can develop appropriate workforce strategies and incentive packages.

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design.

PubMed

Morgan, Heather; Hoddinott, Pat; Thomson, Gill; Crossland, Nicola; Farrar, Shelley; Yi, Deokhee; Hislop, Jenni; Moran, Victoria Hall; MacLennan, Graeme; Dombrowski, Stephan U; Rothnie, Kieran; Stewart, Fiona; Bauld, Linda; Ludbrook, Anne; Dykes, Fiona; Sniehotta, Falko F; Tappin, David; Campbell, Marion

2015-04-01

Smoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby. To understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design. Evidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout. UK. The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking. (1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test. Out of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A 'ladder' logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical 'ladder' towards smoking cessation and breastfeeding. Incentive interventions provide opportunity 'rungs' to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women's capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave 'healthily' risk them feeling pressurised and failing. To avoid 'losing face', women may disengage. Included studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population. Incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important. This study is registered as PROSPERO CRD42012001980. The National Institute for Health Research Health Technology Assessment programme.

Better quality of life in patients offered financial incentives for taking anti-psychotic medication: Linked to improved adherence or more money?

PubMed

Moran, Katherine; Priebe, Stefan

2016-08-01

In a randomised controlled trial, patients were offered financial incentives to improve their adherence to anti-psychotic maintenance medication. Compared to a control group without the incentives, they had an improved adherence and also better subjective quality of life (SQOL) after 1 year. This paper explores the question as to whether this improvement in SQOL was associated with the amount of money received or with the improved adherence itself. A secondary analysis was performed using data of the experimental group in the trial. Adherence was assessed as the percentage of all prescribed long-acting anti-psychotic injections that were taken by the patient. In regression models, we tested whether changes in medication adherence and/or the amount of incentives received over the 12-month period was associated with SQOL, as rated on the DIALOG scale. Adherence changed from 68.49 % at baseline to 88.23 % (mean difference in adherence = 19.59 %, SD = 17.52 %). The total amount of incentives received within the 1-year study period varied between £75 and £735, depending on the treatment cycle and the number of long-acting injections taken. Improvement in adherence was found to be a significant predictor of better subjective quality of life (β = 0.014, 95 % CI 0.003-0.025, p = 0.014), whilst the amount of incentives received was not (β = 0.0002, 95 % CI -0.002 to 0.002, p = 0.818). Improved medication adherence is associated with a more favourable SQOL. This underlines the clinical relevance of improved adherence in response to financial incentives in this patient group.

Financial Incentives for Chronic Disease Management: Results and Limitations of 2 Randomized Clinical Trials With New York Medicaid Patients.

PubMed

VanEpps, Eric M; Troxel, Andrea B; Villamil, Elizabeth; Saulsgiver, Kathryn A; Zhu, Jingsan; Chin, Jo-Yu; Matson, Jacqueline; Anarella, Joseph; Roohan, Patrick; Gesten, Foster; Volpp, Kevin G

2018-01-01

To identify whether financial incentives promote improved disease management in Medicaid recipients diagnosed with hypertension or diabetes, respectively. Four-group, multicenter, randomized clinical trials. Between 2013 and 2016, New York State Medicaid managed care members diagnosed with hypertension (N = 920) or with diabetes (N = 959). Participants in each 6-month trial were randomly assigned to 1 of 4 arms: (1) process incentives-earned by attending primary care visits and/or receiving prescription medication refills, (2) outcome incentives-earned by reducing systolic blood pressure (hypertension) or hemoglobin A 1c (HbA 1c ; diabetes) levels, (3) combined process and outcome incentives, and (4) control (no incentives). Systolic blood pressure (hypertension) and HbA 1c (diabetes) levels, primary care visits, and medication prescription refills. Analysis and Results: At 6 months, there were no statistically significant differences between intervention arms and the control arm in the change in systolic blood pressure, P = .531. Similarly, there were no significant differences in blood glucose control (HbA 1c ) between the intervention arms and control after 6 months, P = .939. The majority of participants had acceptable systolic blood pressure (<140 mm Hg) or blood glucose (<8.0%) levels at baseline and throughout the study. Financial incentives-regardless of whether they were delivered based on disease-relevant outcomes, process activities, or a combination of the two-have a negligible impact on health outcomes for Medicaid recipients diagnosed with either hypertension or diabetes in 2 studies in which, among other design and operational limitations, the majority of recipients had relatively well-controlled diseases at the time of enrollment.

Ethical imperatives of timely access to orphan drugs: is possible to reconcile economic incentives and patients' health needs?

PubMed

Rodriguez-Monguio, R; Spargo, T; Seoane-Vazquez, E

2017-01-05

More than 6,800 rare diseases and conditions have been identified in the US, which affect 25-30 million Americans. In 1983, the US Congress enacted the Orphan Drug Act (ODA) to encourage the development and marketing of drugs to treat rare diseases and conditions. This study analyzed all orphan designations and FDA approvals since 1983 through 2015, discussed the effectiveness of incentives for the development of treatments for rare diseases, and reflected on the ethical imperatives for timely access to orphan drugs. Study data were derived from the Food and Drug Administration (FDA) Orange Book and the Office of Orphan Drugs Development. A search was conducted to assess literature on the ethical principles and economic incentives for the development of orphan drugs. In the period 1983-2015, the FDA granted 3,647 orphan drug designations and 554 orphan drug approvals. The orphan drug approvals corresponded to 438 different brand names. Cancer was the therapeutic area with the highest number of approvals. The increased number of patients with rare diseases and the growth in the cost of orphan drugs pose a significant economic burden for patients, public programs and private third party payers. Regulatory differences to qualify for orphan designation and various population thresholds employed by the FDA and the European Medicines Agency lead to further unmet health needs for patients with rare diseases and aggravate health inequities. There is no societal consensus on the population and economic thresholds, the drug effectiveness indicator(s), or the societal value to be placed for the approval and reimbursement of orphan drugs. Orphan drug development and marketing in the US concentrate in few therapeutic areas. Despite the increase in the number of FDA approved orphan drugs, the unmet needs of patients with rare diseases evidence that the current incentives are not efficiently stimulating orphan drug development. There is need to balance economic incentives to stimulate the development and marketing of orphan drugs without jeopardizing patients' access to treatment. Thus, aligning pharmaceutical companies' incentives with societal budgetary constraints is necessary and the ethical imperatives of timely access to orphan drugs need to be agreed upon.

An R package for analyzing and modeling ranking data

PubMed Central

2013-01-01

Background In medical informatics, psychology, market research and many other fields, researchers often need to analyze and model ranking data. However, there is no statistical software that provides tools for the comprehensive analysis of ranking data. Here, we present pmr, an R package for analyzing and modeling ranking data with a bundle of tools. The pmr package enables descriptive statistics (mean rank, pairwise frequencies, and marginal matrix), Analytic Hierarchy Process models (with Saaty’s and Koczkodaj’s inconsistencies), probability models (Luce model, distance-based model, and rank-ordered logit model), and the visualization of ranking data with multidimensional preference analysis. Results Examples of the use of package pmr are given using a real ranking dataset from medical informatics, in which 566 Hong Kong physicians ranked the top five incentives (1: competitive pressures; 2: increased savings; 3: government regulation; 4: improved efficiency; 5: improved quality care; 6: patient demand; 7: financial incentives) to the computerization of clinical practice. The mean rank showed that item 4 is the most preferred item and item 3 is the least preferred item, and significance difference was found between physicians’ preferences with respect to their monthly income. A multidimensional preference analysis identified two dimensions that explain 42% of the total variance. The first can be interpreted as the overall preference of the seven items (labeled as “internal/external”), and the second dimension can be interpreted as their overall variance of (labeled as “push/pull factors”). Various statistical models were fitted, and the best were found to be weighted distance-based models with Spearman’s footrule distance. Conclusions In this paper, we presented the R package pmr, the first package for analyzing and modeling ranking data. The package provides insight to users through descriptive statistics of ranking data. Users can also visualize ranking data by applying a thought multidimensional preference analysis. Various probability models for ranking data are also included, allowing users to choose that which is most suitable to their specific situations. PMID:23672645

An R package for analyzing and modeling ranking data.

PubMed

Lee, Paul H; Yu, Philip L H

2013-05-14

In medical informatics, psychology, market research and many other fields, researchers often need to analyze and model ranking data. However, there is no statistical software that provides tools for the comprehensive analysis of ranking data. Here, we present pmr, an R package for analyzing and modeling ranking data with a bundle of tools. The pmr package enables descriptive statistics (mean rank, pairwise frequencies, and marginal matrix), Analytic Hierarchy Process models (with Saaty's and Koczkodaj's inconsistencies), probability models (Luce model, distance-based model, and rank-ordered logit model), and the visualization of ranking data with multidimensional preference analysis. Examples of the use of package pmr are given using a real ranking dataset from medical informatics, in which 566 Hong Kong physicians ranked the top five incentives (1: competitive pressures; 2: increased savings; 3: government regulation; 4: improved efficiency; 5: improved quality care; 6: patient demand; 7: financial incentives) to the computerization of clinical practice. The mean rank showed that item 4 is the most preferred item and item 3 is the least preferred item, and significance difference was found between physicians' preferences with respect to their monthly income. A multidimensional preference analysis identified two dimensions that explain 42% of the total variance. The first can be interpreted as the overall preference of the seven items (labeled as "internal/external"), and the second dimension can be interpreted as their overall variance of (labeled as "push/pull factors"). Various statistical models were fitted, and the best were found to be weighted distance-based models with Spearman's footrule distance. In this paper, we presented the R package pmr, the first package for analyzing and modeling ranking data. The package provides insight to users through descriptive statistics of ranking data. Users can also visualize ranking data by applying a thought multidimensional preference analysis. Various probability models for ranking data are also included, allowing users to choose that which is most suitable to their specific situations.

Impact of early incentive spirometry in an enhanced recovery program after laparoscopic donor nephrectomy.

PubMed

Rollins, K E; Aggarwal, S; Fletcher, A; Knight, A; Rigg, K; Williams, A R; Bhattacharjya, S

2013-05-01

This study aimed to assess the impact of early incentive spirometry on the incidence of chest infection in patients undergoing laparoscopic donor nephrectomy. A retrospective review on all consecutive laparoscopic donor nephrectomies (LDN) performed at a single institution from January 2008 to August 2012 was performed. We performed 84 LDN. Seventy patients had epidural analgesia continued for 48 hours postoperatively and 14 had a combination of spinal followed by oral analgesia. Incentive spirometry was introduced from July 2010 and 45 of the 84 donors used the spirometer as taught, both pre- and postoperatively. We performed 84 LDN; 39 patients did not receive incentive spirometers and had postoperative chest physiotherapy started on postoperative day 1. Of the 45 patients given incentive spirometers, 44 started using their spirometers as taught, after recovery once they were settled in the ward, 1 patient started the exercises the following day. In the group who received no spirometer, 5 patients had a chest infection. In the group of patients who started using their spirometers in the early perioperative period (44/45), no patient developed a chest infection. One patient in this group was excluded from the analysis because he started spirometer exercises on postoperative day 1. This patient did develop a chest infection. Our results suggest that early introduction of incentive spirometry after LDN significantly reduces the incidence of chest infection (P < .05); however, this benefit may be lost if the introduction of spirometry is delayed. Copyright © 2013 Elsevier Inc. All rights reserved.

Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis.

PubMed

Lavergne, M Ruth; Law, Michael R; Peterson, Sandra; Garrison, Scott; Hurley, Jeremiah; Cheng, Lucy; McGrail, Kimberlyn

2018-02-01

We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods. We observed no increases in primary care visits or continuity of care after incentives were introduced. Rates of ACR testing and antihypertensive dispensing increased among patients with hypertension, but none of the other modest increases in laboratory testing or prescriptions dispensed reached statistical significance. Rates of hospitalizations for stroke and heart failure among patients with hypertension fell relative to pre-intervention patterns, while hospitalizations for COPD increased. Total hospitalizations and hospitalizations via the emergency department did not change. Health care spending increased for patients with hypertension. This large-scale incentive scheme for primary care physicians showed some positive effects for patients with hypertension, but we observe no similar changes in patient management, reductions in hospitalizations, or changes in spending for patients with diabetes and COPD. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Barriers to sustainable tuberculosis control in the Russian Federation health system.

PubMed Central

Atun, R. A.; Samyshkin, Y. A.; Drobniewski, F.; Skuratova, N. M.; Gusarova, G.; Kuznetsov, S. I.; Fedorin, I. M.; Coker, R. J.

2005-01-01

The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in the Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes. PMID:15798846

The efficiency of voluntary incentive policies for preventing biodiversity loss

Treesearch

David J. Lewis; Andrew J. Plantinga; Erik Nelson; Stephen Polasky

2011-01-01

Habitat loss is a primary cause of loss of biodiversity but conserving habitat for species presents challenges. Land parcels differ in their ability to produce returns for landowners and landowners may have private information about the value of the land to them. Land parcels also differ in the type and quality of habitat and the spatial pattern of land use across...

Iowa State University: Live Green Revolving Loan Fund. Green Revolving Funds in Action: Case Study Series

ERIC Educational Resources Information Center

Billingsley, Christina

2011-01-01

The $3 million Live Green Revolving Loan Fund (LGRLF) at Iowa State University (ISU) was launched in 2008. The LGRLF is unique in its decentralized implementation structure which allows each department and building to reap the benefits of their own efficiency measures and gives individual departments the incentive to propose resource-saving…

Emergency department throughput, crowding, and financial outcomes for hospitals.

PubMed

Handel, Daniel A; Hilton, Joshua A; Ward, Michael J; Rabin, Elaine; Zwemer, Frank L; Pines, Jesse M

2010-08-01

Emergency department (ED) crowding has been identified as a major public health problem in the United States by the Institute of Medicine. ED crowding not only is associated with poorer patient outcomes, but it also contributes to lost demand for ED services when patients leave without being seen and hospitals must go on ambulance diversion. However, somewhat paradoxically, ED crowding may financially benefit hospitals. This is because ED crowding allows hospitals to maximize occupancy with well-insured, elective patients while patients wait in the ED. In this article, the authors propose a more holistic model of hospital flow and revenue that contradicts this notion and offer suggestions for improvements in ED and hospital management that may not only reduce crowding and improve quality, but also increase hospital revenues. Also proposed is that increased efficiency and quality in U.S. hospitals will require changes in systematic microeconomic and macroeconomic incentives that drive the delivery of health services in the United States. Finally, the authors address several questions to propose mutually beneficial solutions to ED crowding that include the realignment of hospital incentives, changing culture to promote flow, and several ED-based strategies to improve ED efficiency.

The Effect of Incentives and Meta-incentives on the Evolution of Cooperation.

PubMed

Okada, Isamu; Yamamoto, Hitoshi; Toriumi, Fujio; Sasaki, Tatsuya

2015-05-01

Although positive incentives for cooperators and/or negative incentives for free-riders in social dilemmas play an important role in maintaining cooperation, there is still the outstanding issue of who should pay the cost of incentives. The second-order free-rider problem, in which players who do not provide the incentives dominate in a game, is a well-known academic challenge. In order to meet this challenge, we devise and analyze a meta-incentive game that integrates positive incentives (rewards) and negative incentives (punishments) with second-order incentives, which are incentives for other players' incentives. The critical assumption of our model is that players who tend to provide incentives to other players for their cooperative or non-cooperative behavior also tend to provide incentives to their incentive behaviors. In this paper, we solve the replicator dynamics for a simple version of the game and analytically categorize the game types into four groups. We find that the second-order free-rider problem is completely resolved without any third-order or higher (meta) incentive under the assumption. To do so, a second-order costly incentive, which is given individually (peer-to-peer) after playing donation games, is needed. The paper concludes that (1) second-order incentives for first-order reward are necessary for cooperative regimes, (2) a system without first-order rewards cannot maintain a cooperative regime, (3) a system with first-order rewards and no incentives for rewards is the worst because it never reaches cooperation, and (4) a system with rewards for incentives is more likely to be a cooperative regime than a system with punishments for incentives when the cost-effect ratio of incentives is sufficiently large. This solution is general and strong in the sense that the game does not need any centralized institution or proactive system for incentives.

The Effect of Incentives and Meta-incentives on the Evolution of Cooperation

PubMed Central

Okada, Isamu; Yamamoto, Hitoshi; Toriumi, Fujio; Sasaki, Tatsuya

2015-01-01

Although positive incentives for cooperators and/or negative incentives for free-riders in social dilemmas play an important role in maintaining cooperation, there is still the outstanding issue of who should pay the cost of incentives. The second-order free-rider problem, in which players who do not provide the incentives dominate in a game, is a well-known academic challenge. In order to meet this challenge, we devise and analyze a meta-incentive game that integrates positive incentives (rewards) and negative incentives (punishments) with second-order incentives, which are incentives for other players’ incentives. The critical assumption of our model is that players who tend to provide incentives to other players for their cooperative or non-cooperative behavior also tend to provide incentives to their incentive behaviors. In this paper, we solve the replicator dynamics for a simple version of the game and analytically categorize the game types into four groups. We find that the second-order free-rider problem is completely resolved without any third-order or higher (meta) incentive under the assumption. To do so, a second-order costly incentive, which is given individually (peer-to-peer) after playing donation games, is needed. The paper concludes that (1) second-order incentives for first-order reward are necessary for cooperative regimes, (2) a system without first-order rewards cannot maintain a cooperative regime, (3) a system with first-order rewards and no incentives for rewards is the worst because it never reaches cooperation, and (4) a system with rewards for incentives is more likely to be a cooperative regime than a system with punishments for incentives when the cost-effect ratio of incentives is sufficiently large. This solution is general and strong in the sense that the game does not need any centralized institution or proactive system for incentives. PMID:25974684

The Mental Health Nurse Incentive Program: desirable knowledge, skills and attitudes from the perspective of nurses.

PubMed

Happell, Brenda; Palmer, Christine; Tennent, Rebeka

2011-03-01

To enhance the understanding of the skills and attitudes of mental health nurses working in the Australian Mental Health Nurse Incentive Program. The Mental Health Nurse Incentive Program places qualified mental health nurses alongside community-based general practitioners, private psychiatric practices and other appropriate organisations to provide clients with mental health conditions with a more integrated treatment plan. An exploratory, qualitative approach was undertaken, given the paucity of relevant research in this area. Exploratory individual interviews were conducted with ten mental health nurses working in this scheme. Data analysis was organised and managed using QSR NVivo qualitative analysis software. Respondents identified specific skills and attitudes required for practice under the Mental Health Nurse Incentive Program. Eight areas of skill and attitude were identified as essential for mental health nurses working in this field. This study highlights that many of these skills and attitudes are specific to the setting where mental health nurses are working. Mental health nurses working under this programme have a role to play in the dissemination of knowledge about their practice. More needs to be done by governments and other institutions to ensure that general practitioners and other health professionals understand the role played by mental health nurses in the provision of care. The extent to which the Mental Health Nurse Incentive Program becomes a sustainable strategy to promote quality and accessible mental health care will depend to some degree on the capacity to identify the skills and attitudes necessary for practice. The findings presented in this paper provide a significant contribution to articulating the essential characteristics required for this area of practice. © 2011 Blackwell Publishing Ltd.

Are health workers motivated by income? Job motivation of Cambodian primary health workers implementing performance-based financing.

PubMed

Khim, Keovathanak

2016-01-01

Financial incentives are widely used in performance-based financing (PBF) schemes, but their contribution to health workers' incomes and job motivation is poorly understood. Cambodia undertook health sector reform from the middle of 2009 and PBF was employed as a part of the reform process. This study examines job motivation for primary health workers (PHWs) under PBF reform in Cambodia and assesses the relationship between job motivation and income. A cross-sectional self-administered survey was conducted on 266 PHWs, from 54 health centers in the 15 districts involved in the reform. The health workers were asked to report all sources of income from public sector jobs and provide answers to 20 items related to job motivation. Factor analysis was conducted to identify the latent variables of job motivation. Factors associated with motivation were identified through multivariable regression. PHWs reported multiple sources of income and an average total income of US$190 per month. Financial incentives under the PBF scheme account for 42% of the average total income. PHWs had an index motivation score of 4.9 (on a scale from one to six), suggesting they had generally high job motivation that was related to a sense of community service, respect, and job benefits. Regression analysis indicated that income and the perception of a fair distribution of incentives were both statistically significant in association with higher job motivation scores. Financial incentives used in the reform formed a significant part of health workers' income and influenced their job motivation. Improving job motivation requires fixing payment mechanisms and increasing the size of incentives. PBF is more likely to succeed when income, training needs, and the desire for a sense of community service are addressed and institutionalized within the health system.

European health policy challenges.

PubMed

Maynard, Alan

2005-09-01

Few countries are immune to the international health care 'virus' of reform, with many countries regularly re-cycling changes that shift costs and benefits in ways that are arbitrary, inefficient and offer short term political palliation. Much of this activity has little evidence base and reveals lack of clarity in defining public policy goals, establishing trade-offs and aligning incentive structures with these objectives. Well established failures in health care delivery systems such as variations in medical practice and continuing absence of systematic outcome measurement, have persisted for decades as nations grapple inefficiently with recurring problems of expenditure inflation and waiting times. The lack of emphasis on evidence to inform the efficient management of chronic disease and the reduction of health inequalities is a product of perverse incentives and managerial inertia that maintains the incomes of powerful interest groups. Copyright (c) 2005 John Wiley & Sons, Ltd.

The dynamics of human behavior in the public goods game with institutional incentives.

PubMed

Dong, Yali; Zhang, Boyu; Tao, Yi

2016-06-24

The empirical research on the public goods game (PGG) indicates that both institutional rewards and institutional punishment can curb free-riding and that the punishment effect is stronger than the reward effect. Self-regarding models that are based on Nash equilibrium (NE) strategies or evolutionary game dynamics correctly predict which incentives are best at promoting cooperation, but individuals do not play these rational strategies overall. The goal of our study is to investigate the dynamics of human decision making in the repeated PGG with institutional incentives. We consider that an individual's contribution is affected by four factors, which are self-interest, the behavior of others, the reaction to rewards, and the reaction to punishment. We find that people on average do not react to rewards and punishment, and that self-interest and the behavior of others sufficiently explain the dynamics of human behavior. Further analysis suggests that institutional incentives promote cooperation by affecting the self-regarding preference and that the other-regarding preference seems to be independent of incentive schemes. Because individuals do not change their behavioral patterns even if they were not rewarded or punished, the mere potential to punish defectors and reward cooperators can lead to considerable increases in the level of cooperation.

Is Exposure to an Effective Contingency Management Intervention Associated with More Positive Provider Beliefs?

PubMed Central

Kirby, Kimberly C.; Carpenedo, Carolyn M.; Stitzer, Maxine L.; Dugosh, Karen L.; Petry, Nancy M.; Roll, John M.; Saladin, Michael E.; Cohen, Allan J.; Hamilton, John; Reese, Karen; Sillo, Gina R.; Stabile, Patricia Quinn; Sterling, Robert C.

2011-01-01

This study empirically examined opinions of treatment providers regarding Contingency Management (CM) programs while controlling for experience with a specific efficacious CM program. In addition to empirically describing provider opinions, we examined whether the opinions of providers at the sites that implemented the CM program were more positive than those of matched providers at sites that did not implement it. Participants from 7 CM treatment sites (n = 76) and 7 matched non-participating sites (n = 69) within the same nodes of NIDA's Clinical Trials Network completed the Provider Survey of Incentives (PSI), which assesses positive and negative beliefs about incentive programs. An intent-to-treat analysis found no differences in the PSI summary scores of providers in CM program vs. matched sites, but correcting for experience with tangible incentives showed significant differences, with providers from CM sites reporting more positive opinions than those from matched sites. Some differences were found in opinions regarding costs of incentives and these generally indicated that participants from CM sites were more likely to see the costs as worthwhile. The results from the study suggest that exposing community treatment providers to incentive programs may itself be an effective strategy in prompting the dissemination of CM interventions. PMID:22116009

Truthful Incentive Mechanisms for Social Cost Minimization in Mobile Crowdsourcing Systems

PubMed Central

Duan, Zhuojun; Yan, Mingyuan; Cai, Zhipeng; Wang, Xiaoming; Han, Meng; Li, Yingshu

2016-01-01

With the emergence of new technologies, mobile devices are capable of undertaking computational and sensing tasks. A large number of users with these mobile devices promote the formation of the Mobile Crowdsourcing Systems (MCSs). Within a MCS, each mobile device can contribute to the crowdsourcing platform and get rewards from it. In order to achieve better performance, it is important to design a mechanism that can attract enough participants with mobile devices and then allocate the tasks among participants efficiently. In this paper, we are interested in the investigation of tasks allocation and price determination in MCSs. Two truthful auction mechanisms are proposed for different working patterns. A Vickrey–Clarke–Groves (VCG)-based auction mechanism is proposed to the continuous working pattern, and a suboptimal auction mechanism is introduced for the discontinuous working pattern. Further analysis shows that the proposed mechanisms have the properties of individual rationality and computational efficiencies. Experimental results suggest that both mechanisms guarantee all the mobile users bidding with their truthful values and the optimal maximal social cost can be achieved in the VCG-based auction mechanism. PMID:27058541

Prioritizing health services research: an economic perspective.

PubMed

Gandjour, Afschin

2016-05-01

Given limited resources policymakers need to decide about how much and in what areas of health services research (HSR) to invest. The purpose of this study is to provide guidance for priority setting of HSR projects based on economic theory. The conceptual analysis starts from the premise that competition in health care is valuable-a position that seems to predominate among Western policymakers. The principle of competition rests on economic theory and, in particular, its branch of welfare economics. Based on economic theory, the role of HSR is to detect and alleviate information asymmetry, negative externalities, and harm caused by competition and inappropriate incentives for competition. A hierarchy of HSR projects is provided; following the ethical principle of harm ('do not harm'), the detection and prevention of harm would receive highest priority among HSR projects. Agreeing that competition is valuable in achieving efficiency and quality of care (and therefore agreeing to the assumptions of economic theory) implies accepting the role of HSR in detecting market failure and the HSR hierarchy as suggested. Disagreement would require an alternative coherent concept of improving efficiency and quality of care.

Lifting the weight of a diagnosis-related groups family change: a comparison between refined and non-refined DRG systems for top-down cost accounting and efficiency indicators.

PubMed

Zlotnik, Alexander; Cuchi, Miguel Alfaro; Pérez Pérez, Maria Carmen

Public healthcare providers in all Spanish Regions - Autonomous Communities (ACs) use All Patients Diagnosis-Related Groups (AP-DRGs) for billing non-insured patients, cost accounting and inpatient efficiency indicators. A national migration to All Patients Refined Diagnosis-Related Groups (APR-DRGs) has been scheduled for 2016. The analysis was performed on 202,912 inpatient care episodes ranging from 2005 to 2010. All episodes were grouped using AP-DRG v25.0 and APR-DRG v24.0. Normalised DRG weight variations for an AP-DRG to APR-DRG migration scenario were calculated and compared. Major differences exist between normalised weights for inpatient episodes depending on the DRGs family used. The usage of the APR-DRG system in Spain without any adjustments, as it was developed in the United States, should be approached with care. In order to avoid reverse incentives and provider financial risks, coding practices should be reviewed and structural differences between DRG families taken into account.

Analyzing The Impacts of the Biogas-to-Electricity Purchase Incentives on Electric Vehicle Deployment with the MA3T Vehicle Choice Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Podkaminer, Kara; Xie, Fei; Lin, Zhenhong

This analysis represents the biogas-to-electricity pathway under the Renewable Fuel Standard (RFS) as a point of purchase incentive and tests the impact of this incentive on EV deployment using a vehicle consumer choice model. The credit value generated under this policy was calculated in a number of scenarios based on electricity use of each power train choice on a yearly basis over the 15 year vehicle lifetime, accounting for the average electric vehicle miles travelled and vehicle efficiency, competition for biogas-derived electricity among electric vehicles (EVs), the RIN equivalence value and the time value of money. The credit value calculationmore » in each of these scenarios is offered upfront as a point of purchase incentive for EVs using the Market Acceptance of Advanced Automotive Technologies (MA3T) vehicle choice model, which tracks sales, fleet size and energy use over time. The majority of the scenarios use a proposed RIN equivalence value, which increases the credit value as a way to explore the analysis space. Additional model runs show the relative impact of the equivalence value on EV deployment. The MA3T model output shows that a consumer incentive accelerates the deployment of EVs for all scenarios relative to the baseline (no policy) case. In the scenario modeled to represent the current biogas-to-electricity generation capacity (15 TWh/year) with a 5.24kWh/RIN equivalence value, the policy leads to an additional 1.4 million plug-in hybrid electric vehicles (PHEVs) and 3.5 million battery electric vehicles (BEVs) in 2025 beyond the no-policy case of 1.3 million PHEVs and 2.1 million BEVs when the full value of the credit is passed on to the consumer. In 2030, this increases to 2.4 million PHEVs and 7.3 million BEVs beyond the baseline. This larger impact on BEVs relative to PHEVs is due in part to the larger credit that BEVs receive in the model based on the greater percentage of electric vehicle miles traveled by BEVs relative to PHEVs. In this scenario 2025 also represents the last year in which biogas-derived electricity is able to fully supply the transportation electricity demand in the model. After 2025, the credit value declines on a per vehicle basis. At the same time a larger fraction of the credit may shift towards biogas producers in order to incent additional biogas production. The expanded 41 TWh/year biogas availability scenarios represent an increase beyond today s generation capacity and allow greater eRIN generation. With a 5.24kWh/RIN equivalence value, when all of the credit is directed towards reducing vehicle purchase prices, the 41 TWh/year biogas scenario results in 4.1 million additional PHEVs and 12.2 million additional BEVs on the road in 2030 beyond the baseline of 2.5 million PHEVs and 6.1 million BEVs. Under this expanded biogas capacity, biogas-derived electricity generation is able to fully supply electricity for a fleet of over 21 million EVs (15.6 million BEVs and 5.8 million PHEVs) on a yearly basis. In addition to assessing the full value credit scenarios described above, multiple scenarios were analyzed to determine the impact if only a fraction of the credit value was passed on to the consumer. In all of these cases, the EV deployment was scaled back as the fraction of the credit that was passed on to the consumer was reduced. These scenarios can be used to estimate the impact if the credit value is reduced in other ways as well, as demonstrated by the scenarios where the current (22.6 kWh/RIN) equivalence value was used. The EV deployment that results from an equivalence value of 22.6 kWh/RIN equivalence value is roughly equivalent to the EV deployment observed in the 25% case using the 5.24 kWh/RIN equivalence value. A higher equivalence value means that a smaller number of credits, and therefore value, is created for each kWh, and therefore the impact on EV deployment is reduced. This analysis shows several of the drivers that will impact eRIN generation and credit value, and tests the impact of an eRIN point of purchase incentive on EV deployment. This additional incentive can accelerate the deployment of EVs when it is used to reduce vehicle purchase prices. However, the ultimate impact of this policy, as modeled here, will be determined by future RIN prices, the extent to which eRIN credit value can be passed on to the consumer as a point of purchase incentive and the equivalence value.« less

Creating a market: an economic analysis of the purchaser-provider model.

PubMed

Shackley, P; Healey, A

1993-09-01

The focus of this paper is the extent to which the purchaser-provider split and the creation of a market in the provision of health care can be expected to bring about greater efficiency within the new NHS. The starting point is a theoretical discussion of markets and competition. In particular, emphasis is placed upon the economic model of perfect competition. It is argued that because of the existence of externalities, uncertainty and a lack of perfect information, an unregulated market in health care will almost certainly fail. In view of this, the imperfect provider markets of monopoly and contestable markets, which are of particular relevance to health care, are discussed. A description of the new health care market and the principal actors within it is followed by an evaluation of the new health care market. It is argued that in view of the restrictions to competition that exist between providers, some form of price regulation will be necessary to prevent monopolistic behaviour in the hospital sector. Regulation of purchasers is also suggested as a means of improving efficiency. It is concluded that competition may be a necessary condition for increased efficiency in health care provision, but is not sufficient in itself. Other incentives in the hospital sector are necessary to assist the market process and to enhance its impact on efficiency.

The good, bad, and ugly of online recruitment of parents for health-related focus groups: lessons learned.

PubMed

Quach, Susan; Pereira, Jennifer A; Russell, Margaret L; Wormsbecker, Anne E; Ramsay, Hilary; Crowe, Lois; Quan, Sherman D; Kwong, Jeff

2013-11-14

We describe our experiences with identifying and recruiting Ontario parents through the Internet, primarily, as well as other modes, for participation in focus groups about adding the influenza vaccine to school-based immunization programs. Our objectives were to assess participation rates with and without incentives and software restrictions. We also plan to examine study response patterns of unique and multiple submissions and assess efficiency of each online advertising mode. We used social media, deal forum websites, online classified ads, conventional mass media, and email lists to invite parents of school-aged children from Ontario, Canada to complete an online questionnaire to determine eligibility for focus groups. We compared responses and paradata when an incentive was provided and there were no software restrictions to the questionnaire (Period 1) to a period when only a single submission per Internet protocol (IP) address (ie, software restrictions invoked) was permitted and no incentive was provided (Period 2). We also compared the median time to complete a questionnaire, response patterns, and percentage of missing data between questionnaires classified as multiple submissions from the same Internet protocol (IP) address or email versus unique submissions. Efficiency was calculated as the total number of hours study personnel devoted to an advertising mode divided by the resultant number of unique eligible completed questionnaires . Of 1346 submitted questionnaires, 223 (16.6%) were incomplete and 34 (2.52%) did not meet the initial eligibility criteria. Of the remaining 1089 questionnaires, 246 (22.6%) were not from Ontario based on IP address and postal code, and 469 (43.1%) were submitted from the same IP address or email address (multiple submissions). In Period 2 vs Period 1, a larger proportion of questionnaires were submitted from Ontario (92.8%, 141/152 vs 75.1%, 702/937, P<.001), and a smaller proportion of same IP addresses (7.9%, 12/152 vs 47.1%, 441/937, P<.001) were received. Compared to those who made unique submissions, those who made multiple submissions spent less time per questionnaire (166 vs 215 seconds, P<.001), and had a higher percentage of missing data among their responses (15.0% vs 7.6%, P=.004). Advertisements posted on RedFlagDeals were the most efficient for recruitment (0.03 hours of staff time per questionnaire), whereas those placed on Twitter were the least efficient (3.64 hours of staff time per questionnaire). Using multiple online advertising strategies was effective for recruiting a large sample of participants in a relatively short period time with minimal resources. However, risks such as multiple submissions and potentially fraudulent information need to be considered. In our study, these problems were associated with providing an incentive for responding, and could have been partially avoided by activating restrictive software features for online questionnaires.

Incentives for solar energy in industry

NASA Astrophysics Data System (ADS)

Bergeron, K. D.

1981-05-01

Several issues are analyzed on the effects that government subsidies and other incentives have on the use of solar energy in industry, as well as on other capital-intensive alternative energy supplies. Discounted cash flow analysis is used to compare tax deductions for fuel expenses with tax credits for capital investments for energy. The result is a simple expression for tax equity. The effects that market penetration of solar energy has on conventional energy prices are analyzed with a free market model. It is shown that net costs of a subsidy program to the society can be significantly reduced by price. Several government loan guarantee concepts are evaluated as incentives that may not require direct outlays of government funds; their relative effectiveness in achieving loan leverage through project financing, and their cost and practicality, are discussed.

Domestic water conservation potential in Saudi Arabia

NASA Astrophysics Data System (ADS)

Abdulrazzak, Mohammed J.; Khan, Muhammad Z. A.

1990-03-01

Domestic water conservation in arid climates can result in efficient utilization of existing water supplies. The impacts of conservation measures such as the installation of water-saving devices, water metering and pricing schemes, water rationing and public awareness programs, strict plumbing codes, penalties for wasting water, programs designed to reduce leakage from public water lines and within the home, water-efficient landscaping, economic and ethical incentives are addressed in detail. Cost savings in arid climates, with particular reference to Saudi Arabia, in relation to some conservation techniques, are presented. Water conservation technology and tentative demonstration and implementation of water conservation programs are discussed.

Clean Cities Strategic Planning White Paper: Light Duty Vehicle Fuel Economy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saulsbury, Bo; Hopson, Dr Janet L; Greene, David

2015-04-01

Increasing the energy efficiency of motor vehicles is critical to achieving national energy goals of reduced petroleum dependence, protecting the global climate, and promoting continued economic prosperity. Even with fuel economy and greenhouse gas emissions standards and various economic incentives for clean and efficient vehicles, providing reliable and accurate fuel economy information to the public is important to achieving these goals. This white paper reviews the current status of light-duty vehicle fuel economy in the United States and the role of the Department of Energy (DOE) Clean Cities Program in disseminating fuel economy information to the public.

Personalized medicine: the absence of 'model-changing' financial incentives.

PubMed

Keeling, Peter

2007-02-01

This perspective biases on the side that personalized medicine can contribute to a more efficient collective model; however, the hard economics need and deserve significantly more critical analysis and new data input than they are currently being given, to determine their role, or not, in driving change. Put simply, as with the birth of all new and promising developments in healthcare, myth, hope and trend-spotting are driving this market forward, rather than any hard evidence of a sustainable commercial business model for all stakeholders. While there are clear economic benefits to aspects of delivery along the way to personalized care, there may in fact be no compelling economic drivers for radical change for payers and the pharmaceutical industry. The best they can hope to achieve is that the balance sheet is, just that, in balance.

5 CFR 575.306 - Authorizing a retention incentive.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Authorizing a retention incentive. 575... RECRUITMENT, RELOCATION, AND RETENTION INCENTIVES; SUPERVISORY DIFFERENTIALS; AND EXTENDED ASSIGNMENT INCENTIVES Retention Incentives § 575.306 Authorizing a retention incentive. (a) Authority of authorized...

5 CFR 575.109 - Payment of recruitment incentives.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Payment of recruitment incentives. 575... RECRUITMENT, RELOCATION, AND RETENTION INCENTIVES; SUPERVISORY DIFFERENTIALS; AND EXTENDED ASSIGNMENT INCENTIVES Recruitment Incentives § 575.109 Payment of recruitment incentives. (a) An authorized agency...

Incentives and enablers to improve adherence in tuberculosis

PubMed Central

Lutge, Elizabeth E; Wiysonge, Charles Shey; Knight, Stephen E; Sinclair, David; Volmink, Jimmy

2015-01-01

Background Patient adherence to medications, particularly for conditions requiring prolonged treatment such as tuberculosis (TB), is frequently less than ideal and can result in poor treatment outcomes. Material incentives to reward good behaviour and enablers to remove economic barriers to accessing care are sometimes given in the form of cash, vouchers, or food to improve adherence. Objectives To evaluate the effects of material incentives and enablers in patients undergoing diagnostic testing, or receiving prophylactic or curative therapy, for TB. Search methods We undertook a comprehensive search of the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; LILACS; Science Citation Index; and reference lists of relevant publications up to 5 June 2015. Selection criteria Randomized controlled trials of material incentives in patients being investigated for TB, or on treatment for latent or active TB. Data collection and analysis At least two review authors independently screened and selected studies, extracted data, and assessed the risk of bias in the included trials. We compared the effects of interventions using risk ratios (RR), and presented RRs with 95% confidence intervals (CI). The quality of the evidence was assessed using GRADE. Main results We identified 12 eligible trials. Ten were conducted in the USA: in adolescents (one trial), in injection drug or cocaine users (four trials), in homeless adults (three trials), and in prisoners (two trials). The remaining two trials, in general adult populations, were conducted in Timor-Leste and South Africa. Sustained incentive programmes Only two trials have assessed whether material incentives and enablers can improve long-term adherence and completion of treatment for active TB, and neither demonstrated a clear benefit (RR 1.04, 95% CI 0.97 to 1.14; two trials, 4356 participants; low quality evidence). In one trial, the incentive, given as a daily hot meal, was not well received by the population due to the inconvenience of attending the clinic at midday, whilst in the other trial, nurses distributing the vouchers chose to "ration" their distribution among eligible patients, giving only to those whom they felt were most deprived. Three trials assessed the effects of material incentives and enablers on completion of TB prophylaxis with mixed results (low quality evidence). A large effect was seen with regular cash incentives given to drug users at each clinic visit in a setting with extremely low treatment completion in the control group (treatment completion 52.8% intervention versus 3.6% control; RR 14.53, 95% CI 3.64 to 57.98; one trial, 108 participants), but no effects were seen in one trial assessing a cash incentive for recently released prisoners (373 participants), or another trial assessing material incentives offered by parents to teenagers (388 participants). Single once-only incentives However in specific populations, such as recently released prisoners, drug users, and the homeless, trials show that material incentives probably do improve one-off clinic re-attendance for initiation or continuation of anti-TB prophylaxis (RR 1.58, 95% CI 1.27 to 1.96; three trials, 595 participants; moderate quality evidence), and may increase the return rate for reading of tuberculin skin test results (RR 2.16, 95% CI 1.41 to 3.29; two trials, 1371 participants; low quality evidence). Comparison of different types of incentives Single trials in specific sub-populations suggest that an immediate cash incentive may be more effective than delaying the incentive until completion of treatment (RR 1.11, 95% CI 0.98 to 1.24; one trial, 300 participants; low quality evidence), cash incentives may be more effective than non-cash incentives (completion of TB prophylaxis: RR 1.26, 95% CI 1.02 to 1.56; one trial, 141 participants; low quality evidence; return for skin test reading: RR 1.13, 95% CI 1.07 to 1.19; one trial, 652 participants; low quality evidence); and higher cash incentives may be more effective than lower cash incentives (RR 1.08, 95% CI 1.01 to 1.16; one trial, 404 participants; low quality evidence). Authors' conclusions Material incentives and enablers may have some positive short term effects on clinic attendance, particularly for marginal populations such as drug users, recently released prisoners, and the homeless, but there is currently insufficient evidence to know if they can improve long term adherence to TB treatment. PLAIN LANGUAGE SUMMARY Incentives and enablers for improving patient adherence to tuberculosis diagnosis, prophylaxis, and treatment Cochrane researchers conducted a review of the effects of material (economic) incentives or enablers on the adherence and outcomes of patients being tested or treated for latent or active tuberculosis (TB). After searching up to 5 June 2015 for relevant trials, they included 12 randomized controlled trials in this Cochrane review. What are material incentives and enablers and how might they improve patient care? Material incentives and enablers are economic interventions which may be given to patients to reward healthy behaviour (incentives) or remove economic barriers to accessing healthcare (enablers). Incentives and enablers may be given directly as cash or vouchers, or indirectly in the provision of a service for which the patient might otherwise have to pay (like transport to a health facility). What the research says Material incentives and enablers may have little or no effect in improving the outcomes of patients on treatment for active TB (low quality evidence), but further trials of alternative incentives and enablers are needed. Material incentives and enablers may have some effects on completion of prophylaxis for latent TB in some circumstances but trial results were mixed, with one trial showing a large effect, and two trials showing no effect (low quality evidence). One-off material incentives and enablers probably improve rates of return to a single clinic appointment for patients starting or continuing prophylaxis for TB (moderate quality evidence) and may improve the rate of return to the clinic for the reading of diagnostic tests for TB (low quality evidence). Thus although material incentives and enablers may improve some patients' attendance at the clinic in the short term, more research is needed to determine if they have an important positive effect in patients on long term treatment for TB. PMID:26333525

Analysis of the United States Marine Corps’ Utilization of Defense Logistics Agency Disposition Services as a Source of Supply

DTIC Science & Technology

2011-12-03

difficult within the DoD because “most incentives and motivations are not apparent for either government or industry ” (p. 84). Doane and Spencer (1997...stated that industry incentives and motivation seem to be based on the same profit and loss theories that were present before acquisition reform...purchased items needed for the unit’s day-to-day operations, such as digital cameras, commercial tactical clothing and eyewear , plasma televisions, lawn

Analysis of the United States Marine Corps Utilization of Defense Logistics Agency Disposition Services as a Source of Supply

DTIC Science & Technology

2011-12-01

initiatives. However, this alignment is difficult within the DoD because “most incentives and motivations are not apparent for either government or industry ...p. 84). 12 Doane and Spencer (1997) stated that industry incentives and motivation seem to be based on the same profit and loss theories that were...clothing and eyewear , plasma televisions, lawn equipment, and so forth. These items could potentially be sourced from DDS on a free-issue basis

An Evaluation of the Consumer Costs and Benefits of Energy Efficiency Resource Standards

NASA Astrophysics Data System (ADS)

Lessans, Mark D.

Of the modern-day policies designed to encourage energy efficiency, one with a significant potential for impact is that of Energy Efficiency Resource Standards (EERS). EERS policies place the responsibility for meeting an efficiency target on the electric and gas utilities, typically setting requirements for annual reductions in electricity generation or gas distribution to customers as a percentage of sales. To meet these requirements, utilities typically implement demand-side management (DSM) programs, which encourage energy efficiency at the customer level through incentives and educational initiatives. In Maryland, a statewide EERS has provided for programs which save a significant amount of energy, but is ultimately falling short in meeting the targets established by the policy. This study evaluates residential DSM programs offered by Pepco, a utility in Maryland, for cost-effectiveness. However, unlike most literature on the topic, analysis focuses on the costs-benefit from the perspective of the consumer, and not the utility. The results of this study are encouraging: the majority of programs analyzed show that the cost of electricity saved, or levelized cost of saved energy (LCSE), is less expensive than the current retail cost of electricity cost in Maryland. A key goal of this study is to establish a metric for evaluating the consumer cost-effectiveness of participation in energy efficiency programs made available by EERS. In doing so, the benefits of these programs can be effectively marketed to customers, with the hope that participation will increase. By increasing consumer awareness and buy-in, the original goals set out through EERS can be realized and the policies can continue to receive support.

Cities and “budget-based” management of the energy-water-climate nexus: Case studies in transportation policy, infrastructure systems, and urban utility risk management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sperling, Joshua B.; Ramaswami, Anu

This article reviews city case studies to inform a framework for developing urban infrastructure design standards and policy instruments that together aim to pursue energy efficiency and greenhouse gas mitigation through city carbon budgets and water use efficiency and climate risk adaptation through city water budgets. Here, this article also proposes combining carbon and water budgeting at the city-scale for achieving successful coupled city carbon and water budget (CCCWB) programs. Under a CCCWB program, key actors including local governments, infrastructure designers/operators, and households would be assigned a GHG emissions and water 'budget' and be required by state or federal levelsmore » to keep within this budget through the use of flexibility mechanisms, incentive programs, and sanctions. Multiple incentives and cross-scale governance arrangements would be tied to energy-water systems integration, resource-efficient transportation and infrastructure development, and effective monitoring and management of energy use, emissions, climate risks to, and security of energy-water-transport-food and other critical systems. As a first step to promote strategies for CCCWB development, we systematically review approaches of and shortcomings to existing budget-based programs in the UK and US, and suggest improvements in three areas: measurement, modeling effectiveness of interventions for staying within a budget, and governance. To date, the majority of climate action or sustainability plans by cities, while mentioning climate impacts as a premise for the plan, do not address these impacts in the plan. They focus primarily on GHG mitigation while ignoring resource depletion challenges and energy-climate-water linkages, whereby water supplies can begin to limit energy production and energy shifts to mitigate climate change can limit water availability. Coupled carbon-water budget plans, programs, and policies - described in this study- may address these concerns as well as the emerging trends that will exacerbate these problems - e.g., including population growth, climatic changes, and emerging policy choices that are not coordinated. Cities and 'Budget-Based' Management of the Energy-Water-Climate Nexus: Case Studies to Inform Strategy for Integrated Performance- and Incentive-Based Design and Policy Instruments.« less

Cities and “budget-based” management of the energy-water-climate nexus: Case studies in transportation policy, infrastructure systems, and urban utility risk management

DOE PAGES

Sperling, Joshua B.; Ramaswami, Anu

2017-11-03

This article reviews city case studies to inform a framework for developing urban infrastructure design standards and policy instruments that together aim to pursue energy efficiency and greenhouse gas mitigation through city carbon budgets and water use efficiency and climate risk adaptation through city water budgets. Here, this article also proposes combining carbon and water budgeting at the city-scale for achieving successful coupled city carbon and water budget (CCCWB) programs. Under a CCCWB program, key actors including local governments, infrastructure designers/operators, and households would be assigned a GHG emissions and water 'budget' and be required by state or federal levelsmore » to keep within this budget through the use of flexibility mechanisms, incentive programs, and sanctions. Multiple incentives and cross-scale governance arrangements would be tied to energy-water systems integration, resource-efficient transportation and infrastructure development, and effective monitoring and management of energy use, emissions, climate risks to, and security of energy-water-transport-food and other critical systems. As a first step to promote strategies for CCCWB development, we systematically review approaches of and shortcomings to existing budget-based programs in the UK and US, and suggest improvements in three areas: measurement, modeling effectiveness of interventions for staying within a budget, and governance. To date, the majority of climate action or sustainability plans by cities, while mentioning climate impacts as a premise for the plan, do not address these impacts in the plan. They focus primarily on GHG mitigation while ignoring resource depletion challenges and energy-climate-water linkages, whereby water supplies can begin to limit energy production and energy shifts to mitigate climate change can limit water availability. Coupled carbon-water budget plans, programs, and policies - described in this study- may address these concerns as well as the emerging trends that will exacerbate these problems - e.g., including population growth, climatic changes, and emerging policy choices that are not coordinated. Cities and 'Budget-Based' Management of the Energy-Water-Climate Nexus: Case Studies to Inform Strategy for Integrated Performance- and Incentive-Based Design and Policy Instruments.« less

Parent training plus contingency management for substance abusing families: A Complier Average Causal Effects (CACE) analysis*

PubMed Central

Stanger, Catherine; Ryan, Stacy R.; Fu, Hongyun; Budney, Alan J.

2011-01-01

Background Children of substance abusers are at risk for behavioral/emotional problems. To improve outcomes for these children, we developed and tested an intervention that integrated a novel contingency management (CM) program designed to enhance compliance with an empirically-validated parent training curriculum. CM provided incentives for daily monitoring of parenting and child behavior, completion of home practice assignments, and session attendance. Methods Forty-seven mothers with substance abuse or dependence were randomly assigned to parent training + incentives (PTI) or parent training without incentives (PT). Children were 55% male, ages 2-7 years. Results Homework completion and session attendance did not differ between PTI and PT mothers, but PTI mothers had higher rates of daily monitoring. PTI children had larger reductions in child externalizing problems in all models. Complier Average Causal Effects (CACE) analyses showed additional significant effects of PTI on child internalizing problems, parent problems and parenting. These effects were not significant in standard Intent-to-Treat analyses. Conclusion Results suggest our incentive program may offer a method for boosting outcomes. PMID:21466925

Reward Motivation Enhances Task Coding in Frontoparietal Cortex.

PubMed

Etzel, Joset A; Cole, Michael W; Zacks, Jeffrey M; Kay, Kendrick N; Braver, Todd S

2016-04-01

Reward motivation often enhances task performance, but the neural mechanisms underlying such cognitive enhancement remain unclear. Here, we used a multivariate pattern analysis (MVPA) approach to test the hypothesis that motivation-related enhancement of cognitive control results from improved encoding and representation of task set information. Participants underwent two fMRI sessions of cued task switching, the first under baseline conditions, and the second with randomly intermixed reward incentive and no-incentive trials. Information about the upcoming task could be successfully decoded from cue-related activation patterns in a set of frontoparietal regions typically associated with task control. More critically, MVPA classifiers trained on the baseline session had significantly higher decoding accuracy on incentive than non-incentive trials, with decoding improvement mediating reward-related enhancement of behavioral performance. These results strongly support the hypothesis that reward motivation enhances cognitive control, by improving the discriminability of task-relevant information coded and maintained in frontoparietal brain regions. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Influence of subthalamic deep-brain stimulation on cognitive action control in incentive context.

PubMed

Houvenaghel, Jean-François; Duprez, Joan; Argaud, Soizic; Naudet, Florian; Dondaine, Thibaut; Robert, Gabriel Hadrien; Drapier, Sophie; Haegelen, Claire; Jannin, Pierre; Drapier, Dominique; Vérin, Marc; Sauleau, Paul

2016-10-01

Subthalamic nucleus deep-brain stimulation (STN-DBS) is an effective treatment in Parkinson's disease (PD), but can have cognitive side effects, such as increasing the difficulty of producing appropriate responses when a habitual but inappropriate responses represent strong alternatives. STN-DBS also appears to modulate representations of incentives such as monetary rewards. Furthermore, conflict resolution can be modulated by incentive context. We therefore used a rewarded Simon Task to assess the influence of promised rewards on cognitive action control in 50 patients with PD, half of whom were being treated with STN-DBS. Results were analyzed according to the activation-suppression model. We showed that STN-DBS (i) favored the expression of motor impulsivity, as measured with the Barratt Impulsiveness Scale, (ii) facilitated the expression of incentive actions as observed with a greater increase in speed according to promised reward in patients with versus without DBS and (iii) may increase impulsive action selection in an incentive context. In addition, analysis of subgroups of implanted patients suggested that those who exhibited the most impulsive action selection had the least severe disease. This may indicate that patients with less marked disease are more at risk of developing impulsivity postoperatively. Finally, in these patients, incentive context increased the difficulty of resolving conflict situations. As a whole, the current study revealed that in patients with PD, STN-DBS affects the cognitive processes involved in conflict resolution, reward processing and the influence of promised rewards on conflict resolution. Copyright © 2016 Elsevier Ltd. All rights reserved.

5 CFR 575.107 - Agency recruitment incentive plan and approval levels.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Agency recruitment incentive plan and... SERVICE REGULATIONS RECRUITMENT, RELOCATION, AND RETENTION INCENTIVES; SUPERVISORY DIFFERENTIALS; AND EXTENDED ASSIGNMENT INCENTIVES Recruitment Incentives § 575.107 Agency recruitment incentive plan and...

WashWise cleans up the Northwest: Lessons learned from the Northwest high-efficiency clothes washer initiative

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gordon, L.M.; Banks, D.L.; Brenneke, M.E.

1998-07-01

WashWise is a regional market transformation program designed to promote the sale and acceptance or resource-efficient clothes washers (RECWs) in the Northwest through financial incentives, education, and marketing. The Program is sponsored by the Northwest Energy Efficiency Alliance (the Alliance), a non-profit regional consortium of utilities, government, public interest groups, and private sector organizations. WashWise started in May 1997 and will continue through the end of 1999. WashWise works to transform the clothes washer market primarily at the retail level through an in-store instant rebate and a retailer bonus. In addition to financial incentives, WashWise has undertaken a collaborative marketingmore » and promotional campaign to educate consumers about the financial savings and other benefits of RECWs. The program promotes only RECWs that meet strict energy and water savings criteria. WashWise has far exceeded initial expectations; annual program sales goals were met in the first three months. As of June 1998, 30,000 RECWs have been sold through the program (representing approximately 13 percent of the Northwest residential clothes washer market). In addition, over 540 retailers, including national and regional chains, are participating in the program. Preliminary survey results also have also provided evidence of broad customer satisfaction. This paper reviews the key elements that have contributed to the success of the WashWise program. In addition, the paper provides program results and indicates future directions for WashWise and the RECW market.« less

Basic sanitation policy in Brazil: discussion of a path.

PubMed

Sousa, Ana Cristina A de; Costa, Nilson do Rosário

2016-01-01

This article demonstrates that the position of dominance enjoyed by state sanitation companies dictates the public policy decision-making process for sanitation in Brazil. These companies' hegemony is explained here through the analysis of a path that generated political and economic incentives that have permitted its consolidation over time. Through the content analysis of the legislation proposed for the sector and the material produced by the stakeholders involved in the approval of new regulations for the sector in 2007, the study identifies the main sources of incentive introduced by the adoption of the National Sanitation Plan, which explain certain structural features of the current sanitation policy and its strong capacity to withstand the innovations proposed under democratic rule.

A comparative study of European insurance schemes for extreme weather risks and incentives for risk reduction

NASA Astrophysics Data System (ADS)

de Ruiter, Marleen; Hudson, Paul; de Ruig, Lars; Kuik, Onno; Botzen, Wouter

2017-04-01

This paper provides an analysis of the insurance schemes that cover extreme weather events in twelve different EU countries and the risk reduction incentives offered by these schemes. Economic impacts of extreme weather events in many regions in Europe and elsewhere are on the rise due to climate change and increasing exposure as driven by urban development. In an attempt to manage impacts from extreme weather events, natural disaster insurance schemes can provide incentives for taking measures that limit weather-related risks. Insurance companies can influence public risk management policies and risk-reducing behaviour of policyholders by "rewarding behaviour that reduces risks and potential damages" (Botzen and Van den Bergh, 2008, p. 417). Examples of insurance market systems that directly or indirectly aim to incentivize risk reduction with varying degrees of success are: the U.S. National Flood Insurance Programme; the French Catastrophes Naturelles system; and the U.K. Flood Re program which requires certain levels of protection standards for properties to be insurable. In our analysis, we distinguish between four different disaster types (i.e. coastal and fluvial floods, droughts and storms) and three different sectors (i.e. residential, commercial and agriculture). The selected case studies also provide a wide coverage of different insurance market structures, including public, private and public-private insurance provision, and different methods of coping with extreme loss events, such as re-insurance, governmental aid and catastrophe bonds. The analysis of existing mechanisms for risk reduction incentives provides recommendations about incentivizing adaptive behaviour, in order to assist policy makers and other stakeholders in designing more effective insurance schemes for extreme weather risks.

Group Qigong for Adolescent Inpatients with Anorexia Nervosa: Incentives and Barriers

PubMed Central

Gueguen, Juliette; Piot, Marie-Aude; Orri, Massimiliano; Gutierre, Andrea; Le Moan, Jocelyne; Berthoz, Sylvie; Falissard, Bruno; Godart, Nathalie

2017-01-01

Background Qigong is a mind-body intervention focusing on interoceptive awareness that appears to be a promising approach in anorexia nervosa (AN). In 2008, as part of our multidimensional treatment program for adolescent inpatients with AN, we began a weekly qigong workshop that turned out to be popular among our adolescent patients. Moreover psychiatrists perceived clinical benefits that deserved further exploration. Methods and findings A qualitative study therefore sought to obtain a deeper understanding of how young patients with severe AN experience qigong and to determine the incentives and barriers to adherence to qigong, to understanding its meaning, and to applying it in other contexts. Data were collected through 16 individual semi-structured face-to-face interviews and analyzed with the interpretative phenomenological analysis method. Eleven themes emerged from the analysis, categorized in 3 superordinate themes describing the incentives and barriers related to the patients themselves (individual dimension), to others (relational dimension), and to the setting (organizational dimension). Individual dimensions associated with AN (such as excessive exercise and mind-body cleavage) may curb adherence, whereas relational and organizational dimensions appear to provide incentives to join the activity in the first place but may also limit its post-discharge continuation. Once barriers are overcome, patients reported positive effects: satisfaction associated with relaxation and with the experience of mind-body integration. Conclusions Qigong appears to be an interesting therapeutic tool that may potentiate psychotherapy and contribute to the recovery process of patients with AN. Further analysis of the best time window for initiating qigong and of its place in overall management might help to overcome some of the barriers, limit the risks, and maximize its benefits. PMID:28152083

Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

PubMed

2017-01-03

This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

Efficiency of incentives to jointly increase carbon sequestration and species conservation on a landscape

PubMed Central

Nelson, Erik; Polasky, Stephen; Lewis, David J.; Plantinga, Andrew J.; Lonsdorf, Eric; White, Denis; Bael, David; Lawler, Joshua J.

2008-01-01

We develop an integrated model to predict private land-use decisions in response to policy incentives designed to increase the provision of carbon sequestration and species conservation across heterogeneous landscapes. Using data from the Willamette Basin, Oregon, we compare the provision of carbon sequestration and species conservation under five simple policies that offer payments for conservation. We evaluate policy performance compared with the maximum feasible combinations of carbon sequestration and species conservation on the landscape for various conservation budgets. None of the conservation payment policies produce increases in carbon sequestration and species conservation that approach the maximum potential gains on the landscape. Our results show that policies aimed at increasing the provision of carbon sequestration do not necessarily increase species conservation and that highly targeted policies do not necessarily do as well as more general policies. PMID:18621703

Organ procurement expenditures and the role of financial incentives.

PubMed

Evans, R W

To evaluate the billed charges for organ procurement and to consider the role of financial incentives to encourage organ donation. Observational study. Data were obtained on donor organ acquisition charges from a random sample of kidney, heart, liver, heart-lung, and pancreas transplants. The data were based on 28.7% of all transplants performed in the United States in 1988. Total charges for donor organ acquisition. The median charges (1988 dollars) for donor organs were as follows: kidney, $12,290; heart, $12,578; liver, $16,281; heart-lung, $12,028; and pancreas, $15,400. Since 1983, kidney acquisition charges have increased by 12.9%, heart charges by 64.1%, and liver charges by 61.8%, after adjusting for inflation. Between 9% and 31% of total transplant procedure-specific charges were associated with donor organ acquisition. There is wide unexplained variation in organ procurement charges. Data on actual costs are required to establish the appropriateness of current charges. Prevailing billing and payment methods should be reevaluated in an effort to address a variety of issues related to reimbursement. Current payment methods may actually contribute to cost inefficiency. Finally, while financial incentives may enhance the efficiency of organ procurement efforts, they will adversely affect the cost-effectiveness of transplantation.

Incentive Compatible Online Scheduling of Malleable Parallel Jobs with Individual Deadlines

DOE Office of Scientific and Technical Information (OSTI.GOV)

Carroll, Thomas E.; Grosu, Daniel

2010-09-13

We consider the online scheduling of malleable jobs on parallel systems, such as clusters, symmetric multiprocessing computers, and multi-core processor computers. Malleable jobs is a model of parallel processing in which jobs adapt to the number of processors assigned to them. This model permits the scheduler and resource manager to make more efficient use of the available resources. Each malleable job is characterized by arrival time, deadline, and value. If the job completes by its deadline, the user earns the payoff indicated by the value; otherwise, she earns a payoff of zero. The scheduling objective is to maximize the summore » of the values of the jobs that complete by their associated deadlines. Complicating the matter is that users in the real world are rational and they will attempt to manipulate the scheduler by misreporting their jobs’ parameters if it benefits them to do so. To mitigate this behavior, we design an incentive compatible online scheduling mechanism. Incentive compatibility assures us that the users will obtain the maximum payoff only if they truthfully report their jobs’ parameters to the scheduler. Finally, we simulate and study the mechanism to show the effects of misreports on the cheaters and on the system.« less

Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

PubMed

Kesteloot, K; Voet, N

1998-12-01

Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

Participant Satisfaction with a Food Benefit Program with Restrictions and Incentives.

PubMed

Rydell, Sarah A; Turner, Rachael M; Lasswell, Tessa A; French, Simone A; Oakes, J Michael; Elbel, Brian; Harnack, Lisa J

2018-02-01

Policy makers are considering changes to the Supplemental Nutrition Assistance Program (SNAP). Proposed changes include financially incentivizing the purchase of healthier foods and prohibiting the use of funds for purchasing foods high in added sugars. SNAP participant perspectives may be useful in understanding the consequences of these proposed changes. To determine whether food restrictions and/or incentives are acceptable to food benefit program participants. Data were collected as part of an experimental trial in which lower-income adults were randomly assigned to one of four financial food benefit conditions: (1) Incentive: 30% financial incentive on eligible fruits and vegetables purchased using food benefits; (2) Restriction: not allowed to buy sugar-sweetened beverages, sweet baked goods, or candies with food benefits; (3) Incentive plus Restriction; or (4) Control: no incentive/restriction. Participants completed closed- and open-ended questions about their perceptions on completion of the 12-week program. Adults eligible or nearly eligible for SNAP were recruited between 2013 and 2015 by means of events or flyers in the Minneapolis/St Paul, MN, metropolitan area. Of the 279 individuals who completed baseline measures, 265 completed follow-up measures and are included in these analyses. χ 2 analyses were conducted to assess differences in program satisfaction. Responses to open-ended questions were qualitatively analyzed using principles of content analysis. There were no statistically significant or meaningful differences between experimental groups in satisfaction with the program elements evaluated in the study. Most participants in all conditions found the food program helpful in buying nutritious foods (94.1% to 98.5%) and in buying the kinds of foods they wanted (85.9% to 95.6%). Qualitative data suggested that most were supportive of restrictions, although a few were dissatisfied. Participants were uniformly supportive of incentives. Findings suggest a food benefit program that includes incentives for purchasing fruits and vegetables and/or restrictions on the use of program funds for purchasing foods high in added sugars appears to be acceptable to most participants. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Incentives for retaining and motivating health workers in Pacific and Asian countries

PubMed Central

Henderson, Lyn N; Tulloch, Jim

2008-01-01

This paper was initiated by the Australian Agency for International Development (AusAID) after identifying the need for an in-depth synthesis and analysis of available literature and information on incentives for retaining health workers in the Asia-Pacific region. The objectives of this paper are to: 1. Highlight the situation of health workers in Pacific and Asian countries to gain a better understanding of the contributing factors to health worker motivation, dissatisfaction and migration. 2. Examine the regional and global evidence on initiatives to retain a competent and motivated health workforce, especially in rural and remote areas. 3. Suggest ways to address the shortages of health workers in Pacific and Asian countries by using incentives. The review draws on literature and information gathered through a targeted search of websites and databases. Additional reports were gathered through AusAID country offices, UN agencies, and non-government organizations. The severe shortage of health workers in Pacific and Asian countries is a critical issue that must be addressed through policy, planning and implementation of innovative strategies – such as incentives – for retaining and motivating health workers. While economic factors play a significant role in the decisions of workers to remain in the health sector, evidence demonstrates that they are not the only factors. Research findings from the Asia-Pacific region indicate that salaries and benefits, together with working conditions, supervision and management, and education and training opportunities are important. The literature highlights the importance of packaging financial and non-financial incentives. Each country facing shortages of health workers needs to identify the underlying reasons for the shortages, determine what motivates health workers to remain in the health sector, and evaluate the incentives required for maintaining a competent and motivated health workforce. Decision-making factors and responses to financial and non-financial incentives have not been adequately monitored and evaluated in the Asia-Pacific region. Efforts must be made to build the evidence base so that countries can develop appropriate workforce strategies and incentive packages. PMID:18793436

Cost-effectiveness of prize-based incentives for stimulant abusers in outpatient psychosocial treatment programs.

PubMed

Olmstead, Todd A; Sindelar, Jody L; Petry, Nancy M

2007-03-16

To evaluate the cost-effectiveness of a prize-based intervention as an addition to usual care for stimulant abusers. This cost-effectiveness analysis is based on a randomized clinical trial implemented within the National Drug Abuse Treatment Clinical Trials Network. The trial was conducted at eight community-based outpatient psychosocial drug abuse treatment clinics. Four hundred and fifteen stimulant abusers were assigned to usual care (N=206) or usual care plus abstinence-based incentives (N=209) for 12 weeks. Participants randomized to the incentive condition earned the chance to draw for prizes for submitting substance negative samples; the number of draws earned increased with continuous abstinence time. Incremental cost-effectiveness ratios were estimated to compare prize-based incentives relative to usual care. The primary patient outcome was longest duration of confirmed stimulant abstinence (LDA). Unit costs were obtained via surveys administered at the eight participating clinics. Resource utilizations and patient outcomes were obtained from the clinical trial. Acceptability curves are presented to illustrate the uncertainty due to the sample and to provide policy relevant information. The incremental cost to lengthen the LDA by 1 week was 258 US dollars (95% confidence interval, 191-401 US dollars). Sensitivity analyses on several key parameters show that this value ranges from 163 to 269 US dollars. Compared with the usual care group, the incentive group had significantly longer LDAs and significantly higher costs.

The transmission system as main actor in electricity market development in Romania

DOE Office of Scientific and Technical Information (OSTI.GOV)

Petrescu, A.M.; Mihailescu, F.

1998-07-01

At the beginning of 1998, Romanian Electricity Authority (RENEL) was a fully integrated generation, transmission and distribution company, which managed all aspects of planning, design, and operation of Romania' s electricity sector. This form of vertically integrated organization has enabled to develop the high voltage transmission system in order to transfer electricity from the large power plants on indigenous coal (lignite) to the deficit electricity areas. An analysis based on specific characteristics of Romanian Transmission System allows the identification of a suitable model cost for transmission services evaluation. The transmission electricity tariff as a market tool has become a necessitymore » for the heterogeneous Romanian power systems from the repartition of the generation against the demand location point of view. The experience of the power system development planner shows that the most suitable model for the transmission electricity system cost assessment is the rated zones in order to reflect the geographical imbalance of generation and demand and the ability of the transmission system to accommodate this imbalance. Setting principles for the cost evaluation has to be sustained by the service evaluation on the grid nodes at the interface between transmission system and distribution system. This cost evaluation under the form of incentives for new producers has to be reconsidered year by year taking into account the evolution in time both production side and demand side. The incentives have to be addressed directly to the producers and must be strong enough to provide an efficient reliable operation of the whole power system. Transmission planners have to develop new approaches to deal with the uncertainties of the market; a combination of market forces and regulation seems to ensure the best way for the quality and security of the power system beside of the efficiency of all actors from the electricity market.« less

A Novel and Cost-Effective Monitoring Approach for Outcomes in an Australian Biodiversity Conservation Incentive Program

PubMed Central

Lindenmayer, David B.; Zammit, Charles; Attwood, Simon J.; Burns, Emma; Shepherd, Claire L.; Kay, Geoff; Wood, Jeff

2012-01-01

We report on the design and implementation of ecological monitoring for an Australian biodiversity conservation incentive scheme – the Environmental Stewardship Program. The Program uses competitive auctions to contract individual land managers for up to 15 years to conserve matters of National Environmental Significance (with an initial priority on nationally threatened ecological communities). The ecological monitoring was explicitly aligned with the Program’s policy objective and desired outcomes and was applied to the Program’s initial Project which targeted the critically endangered White Box-Yellow Box-Blakely's Red Gum Grassy Woodland and Derived Native Grassland ecological community in south eastern Australia. These woodlands have been reduced to <3% of their original extent and persist mostly as small remnants of variable condition on private farmland. We established monitoring sites on 153 farms located over 172,232 sq km. On each farm we established a monitoring site within the woodland patch funded for management and, wherever possible, a matched control site. The monitoring has entailed gathering data on vegetation condition, reptiles and birds. We also gathered data on the costs of experimental design, site establishment, field survey, and data analysis. The costs of monitoring are approximately 8.5% of the Program’s investment in the first four years and hence are in broad accord with the general rule of thumb that 5–10% of a program’s funding should be invested in monitoring. Once initial monitoring and site benchmarking are completed we propose to implement a novel rotating sampling approach that will maintain scientific integrity while achieving an annual cost-efficiency of up to 23%. We discuss useful lessons relevant to other monitoring programs where there is a need to provide managers with reliable early evidence of program effectiveness and to demonstrate opportunities for cost-efficiencies. PMID:23236399

Static and dynamic efficiency of irreversible health care investments under alternative payment rules.

PubMed

Levaggi, R; Moretto, M; Pertile, P

2012-01-01

The paper studies the incentive for providers to invest in new health care technologies under alternative payment systems, when the patients' benefits are uncertain. If the reimbursement by the purchaser includes both a variable (per patient) and a lump-sum component, efficiency can be ensured both in the timing of adoption (dynamic) and the intensity of use of the technology (static). If the second instrument is unavailable, a trade-off may emerge between static and dynamic efficiency. In this context, we also discuss how the regulator could use control of the level of uncertainty faced by the provider as an instrument to mitigate the trade-off between static and dynamic efficiency. Finally, we calibrate the model to study a specific technology and estimate the cost of a regulatory failure. Copyright © 2011 Elsevier B.V. All rights reserved.

The effect of timing of incentive payments on response rates for cohort study telephone interviews in primary care setting with cost-minimization analysis, a randomized controlled trial.

PubMed

Chin, Weng-Yee; Choi, Edmond P H; Lam, Cindy L K

2015-10-06

The effect of timing of incentive payments on the response rate of telephone surveys is unknown. This study examined whether up-front or delayed incentive payments were associated with higher response rates for participation in a telephone interview administered longitudinal cohort study amongst primary care patients with lower urinary tract symptoms, and to compare the costs between the two timing methods. This study was conducted as part of a naturalistic observation study on the health-related quality of life and health outcomes of Chinese primary care patients with lower urinary tract symptoms. The incentive payment was in the form of a supermarket gift voucher to the value of HD$50 (US$6.50) and could be used in lieu of cash at a major supermarket chain.720 subjects with lower urinary tract symptoms were randomly assigned into two groups. One group was offered an incentive of supermarket cash voucher at time of recruitment ('up-front' payment). The other group was told that the voucher would be sent to them after the complete of their 1-year follow-up telephone interview ('delayed' payment). Primary outcomes were the baseline and 1-year follow-up telephone survey response rates. There was no statistical difference in response rates at baseline (p-value = 0.938) or at the 1-year follow-up (p-value = 0.751) between groups. Cost per completed subject interviews for the up-front payment method was USD16.64, whilst cost for the delayed payment was USD 13.85. It appears the timing of incentive payments does not affect response rates for telephone interview surveys conducted on primary care patients in Hong Kong at baseline or at 1-year follow-up. Delayed incentive payments can reduce the overall cost per successful case. ClinicalTrials.gov Identifier: NCT02307929 Registered 28 August 2013.

Can Economic Analysis Contribute to Disease Elimination and Eradication? A Systematic Review.

PubMed

Sicuri, Elisa; Evans, David B; Tediosi, Fabrizio

2015-01-01

Infectious diseases elimination and eradication have become important areas of focus for global health and countries. Due to the substantial up-front investments required to eliminate and eradicate, and the overall shortage of resources for health, economic analysis can inform decision making on whether elimination/eradication makes economic sense and on the costs and benefits of alternative strategies. In order to draw lessons for current and future initiatives, we review the economic literature that has addressed questions related to the elimination and eradication of infectious diseases focusing on: why, how and for whom? A systematic review was performed by searching economic literature (cost-benefit, cost-effectiveness and economic impact analyses) on elimination/eradication of infectious diseases published from 1980 to 2013 from three large bibliographic databases: one general (SCOPUS), one bio-medical (MEDLINE/PUBMED) and one economic (IDEAS/REPEC). A total of 690 non-duplicate papers were identified from which only 43 met the inclusion criteria. In addition, only one paper focusing on equity issues, the "for whom?" question, was found. The literature relating to "why?" is the largest, much of it focusing on how much it would cost. A more limited literature estimates the benefits in terms of impact on economic growth with mixed results. The question of how to eradicate or eliminate was informed by an economic literature highlighting that there will be opportunities for individuals and countries to free-ride and that forms of incentives and/or disincentives will be needed. This requires government involvement at country level and global coordination. While there is little doubt that eliminating infectious diseases will eventually improve equity, it will only happen if active steps to promote equity are followed on the path to elimination and eradication. The largest part of the literature has focused on costs and economic benefits of elimination/eradication. To a lesser extent, challenges associated with achieving elimination/eradication and ensuring equity have also been explored. Although elimination and eradication are, for some diseases, good investments compared with control, countries' incentives to eliminate do not always align with the global good and the most efficient elimination strategies may not prioritize the poorest populations. For any infectious disease, policy-makers will need to consider realigning contrasting incentives between the individual countries and the global community and to assure that the process towards elimination/eradication considers equity.

US DOE EECBG BBNP REPORT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Driscoll, Brian; Conkey, Todd; Edgar, George

2013-12-31

The Wisconsin Energy Efficiency (WE2) Program delivered residential and commercial programming for the City of Milwaukee (Me2) and the City of Madison (Green Madison) as well as commercial only programming for the City of Racine (Re2). Direct incentives and loan products for homeowners and business owners were offered, with the goal to achieve at least 15 percent in energy savings. At the time of this report, there were more than 2,000 residential energy efficiency upgrades completed and more than 300 commercial energy efficiency upgrades completed. The average energy savings for the WE2 Program’s portfolio of residential and commercial projects exceedsmore » 15 percent and is closer to 30 percent energy savings. Combined energy savings of both residential and commercial activities were: 20,937,369 kWh; 1,018,907 Therms; and 31,655 gallons of heating oil; or at least 332,788 MMBTUs; or at least $3,444,828 in estimated energy costs saved. Conservative economic impact estimates include the employment of more than 100 residential auditors and contractors, more than 90 commercial contractors, and more than $41 million in total project costs expended in the targeted communities. WECC, along with the Partner Cities, attempted to create energy efficiency programming that helped to increase economic activity, increase workforce opportunities, and save energy in three of the largest communities in Wisconsin. Homeowners were assisted through the residential process by Energy Advocates, consultants, and contractors. Business owners were assisted through the commercial process by Program Advocates, contractors and trade allies. Contractors in both the residential and commercial programs were educated and trained by the many offerings provided by WECC. Together, all parties involved made the WE2 Program successful. The most prominent innovative approaches employed in the Me2 and Green Madison programs for residential retrofits were: use of a loan loss reserve approach to improve access to lower cost financing; a primary focus on “community-based” marketing and outreach through local organizations to attract program participants; use of Energy Advocates to facilitate homeowner understanding during participation of the retrofit process; increase in financial incentives, especially to achieve higher project savings; and additional building science and sales training for participating contractors, as well as the use of a Community Workforce Agreement (CWA). The most prominent innovative approaches used in the commercial building retrofit programs for the Me2, Green Madison and Re2 programs were: development and use of innovative customer financing through loan-loss reserves for small commercial building retrofits; cash collateral advance account for larger projects which mitigated the financial risk of lenders; and the ultimate development of a Commercial Property Assessed Clean Energy (C-PACE) program in the City of Milwaukee. Other approaches included: increased customer financial incentives, especially for small commercial projects, in excess of the incentives available from the Focus on Energy program. Each Partner City’s commercial program was built on existing Focus on Energy programming, which allowed the WE2 Program to leverage experience from Focus on Energy personnel to help promote participation, and encourage more extensive retrofits. Several legacy items will continue into the future, while there will be ongoing attempts to create a sustainable program. In the future, homeowners in Milwaukee and Madison will continue to have opportunities for incentives through the Focus on Energy program, as well as loan products being offered through Me2 and Green Madison. Similarly, business owners will continue to benefit from incentives through the Focus on Energy program, as well as loan products being offered through Me2 and Green Madison. Finally, the most recent development and implementation of C-PACE for large commercial building owners or business owners in Milwaukee may have substantial economic impacts. C-PACE may have similar impacts in Madison should they choose to implement the program in the near future. The WE2 Program’s immediate economic activity, workforce development, and energy savings coupled with long-term opportunities such as C-PACE provide a strong platform for the future, and could have only been created through meaningful collaboration.« less

Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis

PubMed Central

Brueton, V C; Tierney, J F; Stenning, S; Meredith, S; Harding, S; Nazareth, I; Rait, G

2014-01-01

Objective To quantify the effect of strategies to improve retention in randomised trials. Design Systematic review and meta-analysis. Data sources Sources searched: MEDLINE, EMBASE, PsycINFO, DARE, CENTRAL, CINAHL, C2-SPECTR, ERIC, PreMEDLINE, Cochrane Methodology Register, Current Controlled Trials metaRegister, WHO trials platform, Society for Clinical Trials (SCT) conference proceedings and a survey of all UK clinical trial research units. Review methods Included trials were randomised evaluations of strategies to improve retention embedded within host randomised trials. The primary outcome was retention of trial participants. Data from trials were pooled using the fixed-effect model. Subgroup analyses were used to explore the heterogeneity and to determine whether there were any differences in effect by the type of strategy. Results 38 retention trials were identified. Six broad types of strategies were evaluated. Strategies that increased postal questionnaire responses were: adding, that is, giving a monetary incentive (RR 1.18; 95% CI 1.09 to 1.28) and higher valued incentives (RR 1.12; 95% CI 1.04 to 1.22). Offering a monetary incentive, that is, an incentive given on receipt of a completed questionnaire, also increased electronic questionnaire response (RR 1.25; 95% CI 1.14 to 1.38). The evidence for shorter questionnaires (RR 1.04; 95% CI 1.00 to 1.08) and questionnaires relevant to the disease/condition (RR 1.07; 95% CI 1.01 to 1.14) is less clear. On the basis of the results of single trials, the following strategies appeared effective at increasing questionnaire response: recorded delivery of questionnaires (RR 2.08; 95% CI 1.11 to 3.87); a ‘package’ of postal communication strategies (RR 1.43; 95% CI 1.22 to 1.67) and an open trial design (RR 1.37; 95% CI 1.16 to 1.63). There is no good evidence that the following strategies impact on trial response/retention: adding a non-monetary incentive (RR=1.00; 95% CI 0.98 to 1.02); offering a non-monetary incentive (RR=0.99; 95% CI 0.95 to 1.03); ‘enhanced’ letters (RR=1.01; 95% CI 0.97 to 1.05); monetary incentives compared with offering prize draw entry (RR=1.04; 95% CI 0.91 to 1.19); priority postal delivery (RR=1.02; 95% CI 0.95 to 1.09); behavioural motivational strategies (RR=1.08; 95% CI 0.93 to 1.24); additional reminders to participants (RR=1.03; 95% CI 0.99 to 1.06) and questionnaire question order (RR=1.00, 0.97 to 1.02). Also based on single trials, these strategies do not appear effective: a telephone survey compared with a monetary incentive plus questionnaire (RR=1.08; 95% CI 0.94 to 1.24); offering a charity donation (RR=1.02, 95% CI 0.78 to 1.32); sending sites reminders (RR=0.96; 95% CI 0.83 to 1.11); sending questionnaires early (RR=1.10; 95% CI 0.96 to 1.26); longer and clearer questionnaires (RR=1.01, 0.95 to 1.07) and participant case management by trial assistants (RR=1.00; 95% CI 0.97 to 1.04). Conclusions Most of the trials evaluated questionnaire response rather than ways to improve participants return to site for follow-up. Monetary incentives and offers of monetary incentives increase postal and electronic questionnaire response. Some strategies need further evaluation. Application of these results would depend on trial context and follow-up procedures. PMID:24496696

5 CFR 575.101 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... payment of recruitment incentives. An agency may pay a recruitment incentive to a newly appointed employee... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS RECRUITMENT, RELOCATION, AND RETENTION INCENTIVES; SUPERVISORY DIFFERENTIALS; AND EXTENDED ASSIGNMENT INCENTIVES Recruitment Incentives...

Electric power restructuring in iran: achievements and challenges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Khosroshahi, Kaveh Aflaki; Jadid, Shahram; Shahidehpour, Mohammad

2009-03-15

Although the power market in Iran is not fully constructed, several key steps have been taken to meet privatization and restructuring objectives. The addition of a power exchange sector has placed the power market on par with that in other countries. Operational concerns that still need to be addressed include technical and non-technical losses, enhancing new investment, and providing incentives for introducing energy efficiency and promoting green power generation. (author)

Security and Interdependency in a Public Cloud: A Game Theoretic Approach

DTIC Science & Technology

2014-08-29

maximum utility can be reached (i.e., Pareto efficiency). However, the examples of perverse incentives and information inequality (where this feedback...interdependent structure. Cloud computing gives way to two types of interdependent relationships: cloud host-to- client and cloud client -to- client ... Client -to- client interdependency is much less studied than to the above-mentioned cloud host-to- client relationship. Although, it can still carry the

Water scarcity, market-based incentives, and consumer response

NASA Astrophysics Data System (ADS)

Krause, K.; Chermak, J. M.; Brookshire, D. S.

2003-04-01

Water is an increasingly scarce resource and the future viability of many regions will depend in large part on how efficiently resources are utilized. A key factor to this success will be a thorough understanding of consumers and the characteristics that drive their water use. In this research test and find support for the hypothesis that residential water consumers are heterogeneous. We combine experimental and survey responses to test for statistically significant consumer characteristics that are observable factors of demand for water. Significant factors include "stage of life" (i.e., student versus workforce versus retired), as well as various social and cultural factors including age, ethnicity, political affiliation and religious affiliation. Identification of these characteristics allows us to econometrically estimate disaggregated water demand for a sample of urban water consumers in Albuquerque, New Mexico, USA. The results provide unique parameter estimates for different consumer types. Using these results we design an incentive compatible, non-linear pricing program that allows individual consumers to choose a fixed fee/commodity charge from a menu that not only allows the individual to maximize his or her utility, while meeting the conservation goals of the program. We show that this program, with the attention to consumer differences is more efficient than the traditional "one size fits all" programs commonly employed by many water utilities.

Agricultural production and nutrient runoff in the Corn Belt ...

EPA Pesticide Factsheets

Agricultural production in the Corn Belt region of the Upper Mississippi River Basin (UMRB) remains a leading source of nitrogen runoff that contributes to the annual hypoxic 'Dead Zone' in the Gulf of Mexico. The rise of corn production, land conversion, and fertilizer use in response to ethanol policy incentives in recent years is well documented and may worsen this effect. We develop a spatially distributed dynamic environmental performance index (EPI), accounting for both desirable agricultural outputs and undesirable nonpoint source emissions from farm production, to examine the corresponding changes in environmental performance within the UMRB between 2002 and 2007, which is characterized by increasing policy incentives for ethanol production. County-level production data from the USDA agricultural census are aggregated to hydrologic unit code (HUC8) boundaries using a geographic information system (GIS), and a previously developed statistical model, which includes net anthropogenic nitrogen inputs (NANI) as well as precipitation and land use characteristics as inputs, is used to estimate annual nitrogen loadings delivered to streams from HUC8 watersheds. The EPI allows us to decompose performance of each HUC8 region over time into changes in productive efficiency and emissions efficiency. To our knowledge, this is the first study to examine the corresponding changes in environmental performance for producers in this region at the watershed scale. The resu

Acceptability of Financial Incentives for Health Behaviours: A Discrete Choice Experiment.

PubMed

Giles, Emma L; Becker, Frauke; Ternent, Laura; Sniehotta, Falko F; McColl, Elaine; Adams, Jean

2016-01-01

Healthy behaviours are important determinants of health and disease, but many people find it difficult to perform these behaviours. Systematic reviews support the use of personal financial incentives to encourage healthy behaviours. There is concern that financial incentives may be unacceptable to the public, those delivering services and policymakers, but this has been poorly studied. Without widespread acceptability, financial incentives are unlikely to be widely implemented. We sought to answer two questions: what are the relative preferences of UK adults for attributes of financial incentives for healthy behaviours? Do preferences vary according to the respondents' socio-demographic characteristics? We conducted an online discrete choice experiment. Participants were adult members of a market research panel living in the UK selected using quota sampling. Preferences were examined for financial incentives for: smoking cessation, regular physical activity, attendance for vaccination, and attendance for screening. Attributes of interest (and their levels) were: type of incentive (none, cash, shopping vouchers or lottery tickets); value of incentive (a continuous variable); schedule of incentive (same value each week, or value increases as behaviour change is sustained); other information provided (none, written information, face-to-face discussion, or both); and recipients (all eligible individuals, people living in low-income households, or pregnant women). Cash or shopping voucher incentives were preferred as much as, or more than, no incentive in all cases. Lower value incentives and those offered to all eligible individuals were preferred. Preferences for additional information provided alongside incentives varied between behaviours. Younger participants and men were more likely to prefer incentives. There were no clear differences in preference according to educational attainment. Cash or shopping voucher-type financial incentives for healthy behaviours are not necessarily less acceptable than no incentives to UK adults.

The Promise of Tailoring Incentives for Healthy Behaviors.

PubMed

Kullgren, Jeffrey T; Williams, Geoffrey C; Resnicow, Kenneth; An, Lawrence C; Rothberg, Amy; Volpp, Kevin G; Heisler, Michele

2016-01-01

To describe how tailoring financial incentives for healthy behaviors to employees' goals, values, and aspirations might improve the efficacy of incentives. We integrate insights from self-determination theory (SDT) with principles from behavioral economics in the design of financial incentives by linking how incentives could help meet an employee's life goals, values, or aspirations. Tailored financial incentives could be more effective than standard incentives in promoting autonomous motivation necessary to initiate healthy behaviors and sustain them after incentives are removed. Previous efforts to improve the design of financial incentives have tested different incentive designs that vary the size, schedule, timing, and target of incentives. Our strategy for tailoring incentives builds on strong evidence that difficult behavior changes are more successful when integrated with important life goals and values. We outline necessary research to examine the effectiveness of this approach among at-risk employees. Instead of offering simple financial rewards for engaging in healthy behaviors, existing programs could leverage incentives to promote employees' autonomous motivation for sustained health improvements. Effective application of these concepts could lead to programs more effective at improving health, potentially at lower cost. Our approach for the first time integrates key insights from SDT, behavioral economics, and tailoring to turn an extrinsic reward for behavior change into an internalized, self-sustaining motivator for long-term engagement in risk-reducing behaviors.

Global economic trade-offs between wild nature and tropical agriculture.

PubMed

Carrasco, Luis R; Webb, Edward L; Symes, William S; Koh, Lian P; Sodhi, Navjot S

2017-07-01

Global demands for agricultural and forestry products provide economic incentives for deforestation across the tropics. Much of this deforestation occurs with a lack of information on the spatial distribution of benefits and costs of deforestation. To inform global sustainable land-use policies, we combine geographic information systems (GIS) with a meta-analysis of ecosystem services (ES) studies to perform a spatially explicit analysis of the trade-offs between agricultural benefits, carbon emissions, and losses of multiple ecosystem services because of tropical deforestation from 2000 to 2012. Even though the value of ecosystem services presents large inherent uncertainties, we find a pattern supporting the argument that the externalities of destroying tropical forests are greater than the current direct economic benefits derived from agriculture in all cases bar one: when yield and rent potentials of high-value crops could be realized in the future. Our analysis identifies the Atlantic Forest, areas around the Gulf of Guinea, and Thailand as areas where agricultural conversion appears economically efficient, indicating a major impediment to the long-term financial sustainability of Reducing Emissions from Deforestation and forest Degradation (REDD+) schemes in those countries. By contrast, Latin America, insular Southeast Asia, and Madagascar present areas with low agricultural rents (ARs) and high values in carbon stocks and ES, suggesting that they are economically viable conservation targets. Our study helps identify optimal areas for conservation and agriculture together with their associated uncertainties, which could enhance the efficiency and sustainability of pantropical land-use policies and help direct future research efforts.

[Factors Influencing Participation in Financial Incentive Programmes of Health Insurance Funds. Results of the Study 'German Health Update'].

PubMed

Jordan, S; von der Lippe, E; Starker, A; Hoebel, J; Franke, A

2015-11-01

The statutory health insurance can offer their insured incentive programmes that will motivate for healthy behaviour through a financial or material reward. This study will show results about what factors influence financial incentive programme participation (BPT) including all sorts of statutory health insurance funds and taking into account gender differences. For the cross-sectional analysis, data were used from 15,858 participants in the study 'Germany Health Update' (GEDA) from 2009, who were insured in the statutory health insurance. The selection of potential influencing variables for a BPT is based on the "Behavioural Model for Health Service Use" of Andersen. Accordingly, various factors were included in logistic regression models, which were calculated separately by gender: predisposing factors (age, education, social support, and health awareness), enabling factors (income, statutory health insurance fund, and family physician), and need factors (smoking, fruit and vegetable consumption, sports, body mass index, and general health status). In consideration of all factors, for both sexes, BPT is associated with age, health awareness, education, use of a family physician, smoking, and sports activities. In addition, income, body mass index, and diet are significant in women and social support and kind of statutory health insurance fund in men. It is found that predisposing, enabling and need factors are relevant. Financial incentive programmes reach population groups with greatest need less than those groups who already have a health-conscious behaviour, who receive a reward for this. In longitudinal studies, further research on financial incentive programmes should investigate the existence of deadweight effects and whether incentive programmes can contribute to the reduction of the inequity in health. © Georg Thieme Verlag KG Stuttgart · New York.

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

PubMed Central

Liu, Jiannong; Gilbertson, David T.; Arneson, Thomas J.; Collins, Allan J.

2012-01-01

Frequent hemodialysis improves cardiovascular surrogates and quality-of-life indicators, but its effect on survival remains unclear. We used a matched-cohort design to assess relative mortality in daily home hemodialysis and thrice-weekly in-center hemodialysis patients between 2005 and 2008. We matched 1873 home hemodialysis patients with 9365 in-center patients (i.e., 1:5 ratio) selected from the prevalent population in the US Renal Data System database. Matching variables included first date of follow-up, demographic characteristics, and measures of disease severity. The cumulative incidence of death was 19.2% and 21.7% in the home hemodialysis and in-center patients, respectively. In the intention-to-treat analysis, home hemodialysis associated with a 13% lower risk for all-cause mortality than in-center hemodialysis (hazard ratio [HR], 0.87; 95% confidence interval [95% CI], 0.78–0.97). Cause-specific mortality HRs were 0.92 (95% CI, 0.78–1.09) for cardiovascular disease, 1.13 (95% CI, 0.84–1.53) for infection, 0.63 (95% CI, 0.41–0.95) for cachexia/dialysis withdrawal, 1.06 (95% CI, 0.81–1.37) for other specified cause, and 0.59 (95% CI, 0.44–0.79) for unknown cause. Findings were similar using as-treated analyses. We did not detect statistically significant evidence of heterogeneity of treatment effects in subgroup analyses. In summary, these data suggest that relative to thrice-weekly in-center hemodialysis, daily home hemodialysis associates with modest improvements in survival. Continued surveillance should strengthen inference about causes of mortality and determine whether treatment effects are homogeneous throughout the dialysis population. PMID:22362906

Assessment of commercially available energy-efficient room air conditioners including models with low global warming potential (GWP) refrigerants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shah, N. K.; Park, W. Y.; Gerke, B.

Improving the energy efficiency of room air conditioners (RACs) while transitioning to low global-warming-potential (GWP) refrigerants will be a critical step toward reducing the energy, peak load, and emissions impacts of RACs while keeping costs low. Previous research quantified the benefits of leapfrogging to high efficiency in tandem with the transition to low-GWP refrigerants for RACs (Shah et al., 2015) and identified opportunities for initial action to coordinate energy efficiency with refrigerant transition in economies constituting about 65% of the global RAC market (Shah et al., 2017). This report describes further research performed to identify the best-performing (i.e., most efficientmore » and low-GWP-refrigerant using) RACs on the market, to support an understanding of the best available technology (BAT). Understanding BAT can help support market-transformation programs for high-efficiency and low-GWP equipment such as minimum energy performance standards (MEPS), labeling, procurement, and incentive programs. We studied RACs available in six economies—China, Europe, India, Japan, South Korea, and the United States—that together account for about 70% of global RAC demand, as well as other emerging economies. The following are our key findings: • Highly efficient RACs using low-GWP refrigerants, e.g., HFC-32 (R-32) and HC-290 (R-290), are commercially available today at prices comparable to similar RACs using high-GWP HCFC-22 (R-22) or HFC-410A (R-410A). • High efficiency is typically a feature of high-end products. However, highly efficient, cost-competitive (less than 1,000 or 1,500 U.S. dollars in retail price, depending on size) RACs are available. • Where R-22 is being phased out, high GWP R-410A still dominates RAC sales in most mature markets except Japan, where R-32 dominates. • In all of the economies studied except Japan, only a few models are energy efficient and use low-GWP refrigerants. For example, in Europe, India, and Indonesia, the highest-efficiency RAC models employ the low-GWP refrigerants R-32 or R-290. • RACs are available in most regions and worldwide that surpass the highest efficiency levels recognized by labeling programs. • Fixed-speed RACs using high-GWP and ozone-depleting R-22 refrigerant still dominate the market in many emerging economies. There is significant scope to improve RAC efficiency and transition to low-GWP refrigerants using commercially available technology and to design market-transformation programs for high-efficiency, low-GWP equipment including standards, labeling, procurement, and incentive programs.« less

41 CFR 302-14.6 - How much may my agency pay me for a home marketing incentive?

Code of Federal Regulations, 2011 CFR

2011-07-01

... pay me for a home marketing incentive? 302-14.6 Section 302-14.6 Public Contracts and Property... MARKETING INCENTIVE PAYMENTS Payment of Incentive to the Employee § 302-14.6 How much may my agency pay me for a home marketing incentive? Your agency will determine the amount of your home marketing incentive...

Evidence acquisition and evaluation for evidence summit on enhancing provision and use of maternal health services through financial incentives.

PubMed

Higgs, Elizabeth S; Stammer, Emily; Roth, Rebecca; Balster, Robert L

2013-12-01

Recognizing the need for evidence to inform US Government and governments of the low- and middle-income countries on efficient, effective maternal health policies, strategies, and programmes, the US Government convened the Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives in April 2012 in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used for achieving the goals of the Summit. The goal of the Summit was to obtain multidisciplinary expert review of literature to inform both US Government and governments of the low- and middle-income countries on evidence-informed practice, policies, and strategies for financial incentives. Several steps were undertaken to define the tasks for the Summit and identify the appropriate evidence for review. The process began by identifying focal questions intended to inform governments of the low-and middle-income countries and the US Government about the efficacy of supply- and demand-side financial incentives for enhanced provision and use of quality maternal health services. Experts were selected representing the research and programme communities, academia, relevant non-governmental organizations, and government agencies and were assembled into Evidence Review Teams. This was followed by a systematic process to gather relevant peer-reviewed literature that would inform the focal questions. Members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliography. The Evidence Review Teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. Details of the search processes and methods used for screening and quality reviews are described.

The Impact of Incentives on Exercise Behavior: A Systematic Review of Randomized Controlled Trials

PubMed Central

Strohacker, Kelley; Galarraga, Omar; Williams, David M.

2015-01-01

Background The effectiveness of reinforcing exercise behavior with material incentives is unclear. Purpose Conduct a systematic review of existing research on material incentives for exercise, organized by incentive strategy. Methods Ten studies conducted between January 1965 and June 2013 assessed the impact of incentivizing exercise compared to a non-incentivized control. Results There was significant heterogeneity between studies regarding reinforcement procedures and outcomes. Incentives tended to improve behavior during the intervention while findings were mixed regarding sustained behavior after incentives were removed. Conclusions The most effective incentive procedure is unclear given the limitations of existing research. The effectiveness of various incentive procedures in promoting initial behavior change and habit formation, as well as the use of sustainable incentive procedures should be explored in future research. PMID:24307474

Dynamics of Aviation Biofuel Investment, Incentives, and Market Growth: An Exploration Using the Biomass Scenario Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vimmerstedt, Laura; Newes, Emily

The Federal Aviation Administration promotes the development of an aviation biofuel market, and has pursued a goal of 1 billion gallons of production annually by 2018. Although this goal is unlikely to be met, this analysis applies the Biomass Scenario Model to explore conditions affecting market growth, and identifies policy incentive and oil price conditions under which this level of production might occur, and by what year. Numerous combinations of conditions that are more favorable than current conditions can reach the goal before 2030.

The Optimal Allocation of Army Enlistment Incentives by MOS; Analyses of CY 86-87 Experience, Impacts of Nonmonetary Guidance Counselor Incentives, and PC Software

DTIC Science & Technology

1989-05-01

0 ELECTE VARSHA P. RAO SEP11190 AND U DONNA ROBERTS MAY 1989 APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED O Research & Studies Division U.S...DAKF 15-87-0-0144 Subcontract Sub-Hi 88-12, Do No. 88-007, with the Research and Studies Division, Program Analysis and Evaluation Directorate of...Toomepuu, Chief, Research and Studies Division, for their helpful counsel. ii TABLE OF CONTENTS PAGE DISCLAIMER ii ACKNOWLEDGMENTS ii LIST OF FIGURES v

Medicare incentive payments for meaningful use of electronic health records: accounting and reporting developments.

PubMed

2012-02-01

The Healthcare Financial Management Association through its Principles and Practices (P&P) Board publishes issue analyses to provide short-term practical assistance on emerging issues in healthcare financial management. In a new issue analysis excerpted in this article, HFMA's P&P Board provides some clarity to the healthcare industry on certain accounting and reporting issues resulting from incentive payments under the Medicare program for the meaningful use of electronic health record (EHR) technology. Consultation on these matters with independent auditors is highly recommended.

Are health workers motivated by income? Job motivation of Cambodian primary health workers implementing performance-based financing

PubMed Central

Khim, Keovathanak

2016-01-01

Background Financial incentives are widely used in performance-based financing (PBF) schemes, but their contribution to health workers’ incomes and job motivation is poorly understood. Cambodia undertook health sector reform from the middle of 2009 and PBF was employed as a part of the reform process. Objective This study examines job motivation for primary health workers (PHWs) under PBF reform in Cambodia and assesses the relationship between job motivation and income. Design A cross-sectional self-administered survey was conducted on 266 PHWs, from 54 health centers in the 15 districts involved in the reform. The health workers were asked to report all sources of income from public sector jobs and provide answers to 20 items related to job motivation. Factor analysis was conducted to identify the latent variables of job motivation. Factors associated with motivation were identified through multivariable regression. Results PHWs reported multiple sources of income and an average total income of US$190 per month. Financial incentives under the PBF scheme account for 42% of the average total income. PHWs had an index motivation score of 4.9 (on a scale from one to six), suggesting they had generally high job motivation that was related to a sense of community service, respect, and job benefits. Regression analysis indicated that income and the perception of a fair distribution of incentives were both statistically significant in association with higher job motivation scores. Conclusions Financial incentives used in the reform formed a significant part of health workers’ income and influenced their job motivation. Improving job motivation requires fixing payment mechanisms and increasing the size of incentives. PBF is more likely to succeed when income, training needs, and the desire for a sense of community service are addressed and institutionalized within the health system. PMID:27319575

Performance-based Incentives to Improve Health Status of Mothers and Newborns: What Does the Evidence Show?

PubMed Central

Agarwal, Koki; Askew, Ian; Iriarte, Emma; Morgan, Lindsay; Watson, Julia

2013-01-01

Performance-based incentives (PBIs) aim to counteract weak providers’ performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. Translating funding into better health requires many actions by a large number of people. The actions span from community to the national level. While different forms of PBIs are being implemented in a number of countries to improve health outcomes, there has not been a systematic review of the evidence of their impact on the health of mothers and newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting. Some initiatives focus on safe deliveries, and others reward a broader package of results that include deliveries. The Evidence Review Team that focused on supply-side incentives for the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives, reviewed published research reports and papers and added studies from additional grey literature that were deemed relevant. After collecting and reviewing 17 documents, nine studies were included in this review, three of which used before-after designs; four included comparison or control groups; one applied econometric methods to a five-year time series; and one reported results from a large-scale impact evaluation with randomly-assigned intervention and control facilities. The available evidence suggests that incentives that reward providers for institutional deliveries result in an increase in the number of institutional deliveries. There is some evidence that the content of antenatal care can improve with PBI. We found no direct evidence on the impact of PBI on neonatal health services or on mortality of mothers and newborns, although intention of the study was not to document impact on mortality. A number of studies describe approaches to rewarding quality as well as increases in the quantities of services provided, although how quality is defined and monitored is not always clear. Because incentives exist in all health systems, considering how to align the incentives of the many health workers and their supervisors so that they focus efforts on achieving health goals for mothers and newborns is critical if the health system is to perform more effectively and efficiently. A wide range of PBI models is being developed and tested, and there is still much to learn about what works best. Future studies should include a larger focus on rewarding quality and measuring its impact. Finally, more qualitative research to better understand PBI implementation and how various incentive models function in different settings is needed to help practitioners refine and improve their programmes.

Performance-based incentives to improve health status of mothers and newborns: what does the evidence show?

PubMed

Eichler, Rena; Agarwal, Koki; Askew, Ian; Iriarte, Emma; Morgan, Lindsay; Watson, Julia

2013-12-01

Performance-based incentives (PBIs) aim to counteract weak providers' performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. Translating funding into better health requires many actions by a large number of people. The actions span from community to the national level. While different forms of PBIs are being implemented in a number of countries to improve health outcomes, there has not been a systematic review of the evidence of their impact on the health of mothers and newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting. Some initiatives focus on safe deliveries, and others reward a broader package of results that include deliveries. The Evidence Review Team that focused on supply-side incentives for the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives, reviewed published research reports and papers and added studies from additional grey literature that were deemed relevant. After collecting and reviewing 17 documents, nine studies were included in this review, three of which used before-after designs; four included comparison or control groups; one applied econometric methods to a five-year time series; and one reported results from a large-scale impact evaluation with randomly-assigned intervention and control facilities. The available evidence suggests that incentives that reward providers for institutional deliveries result in an increase in the number of institutional deliveries. There is some evidence that the content of antenatal care can improve with PBI. We found no direct evidence on the impact of PBI on neonatal health services or on mortality of mothers and newborns, although intention of the study was not to document impact on mortality. A number of studies describe approaches to rewarding quality as well as increases in the quantities of services provided, although how quality is defined and monitored is not always clear. Because incentives exist in all health systems, considering how to align the incentives of the many health workers and their supervisors so that they focus efforts on achieving health goals for mothers and newborns is critical if the health system is to perform more effectively and efficiently. A wide range of PBI models is being developed and tested, and there is still much to learn about what works best. Future studies should include a larger focus on rewarding quality and measuring its impact. Finally, more qualitative research to better understand PBI implementation and how various incentive models function in different settings is needed to help practitioners refine and improve their programmes.

The Promise of Tailoring Incentives for Healthy Behaviors

PubMed Central

Kullgren, Jeffrey T.; Williams, Geoffrey C.; Resnicow, Kenneth; An, Lawrence C.; Rothberg, Amy; Volpp, Kevin G.; Heisler, Michele

2017-01-01

Purpose To describe how tailoring financial incentives for healthy behaviors to employees’ goals, values, and aspirations might improve the efficacy of incentives. Design/methodology/approach We integrate insights from self-determination theory (SDT) with principles from behavioral economics in the design of financial incentives by linking how incentives could help meet an employee’s life goals, values, or aspirations. Findings Tailored financial incentives could be more effective than standard incentives in promoting autonomous motivation necessary to initiate healthy behaviors and sustain them after incentives are removed. Research implications Previous efforts to improve the design of financial incentives have tested different incentive designs that vary the size, schedule, timing, and target of incentives. Our strategy for tailoring incentives builds on strong evidence that difficult behavior changes are more successful when integrated with important life goals and values. We outline necessary research to examine the effectiveness of this approach among at-risk employees. Practical implications Instead of offering simple financial rewards for engaging in healthy behaviors, existing programs could leverage incentives to promote employees’ autonomous motivation for sustained health improvements. Social implications Effective application of these concepts could lead to programs more effective at improving health, potentially at lower cost. Originality/value Our approach for the first time integrates key insights from SDT, behavioral economics, and tailoring to turn an extrinsic reward for behavior change into an internalized, self-sustaining motivator for long-term engagement in risk-reducing behaviors. PMID:29242715

When do financial incentives reduce intrinsic motivation? comparing behaviors studied in psychological and economic literatures.

PubMed

Promberger, Marianne; Marteau, Theresa M

2013-09-01

To review existing evidence on the potential of incentives to undermine or "crowd out" intrinsic motivation, in order to establish whether and when it predicts financial incentives to crowd out motivation for health-related behaviors. We conducted a conceptual analysis to compare definitions and operationalizations of the effect, and reviewed existing evidence to identify potential moderators of the effect. In the psychological literature, we find strong evidence for an undermining effect of tangible rewards on intrinsic motivation for simple tasks when motivation manifest in behavior is initially high. In the economic literature, evidence for undermining effects exists for a broader variety of behaviors, in settings that involve a conflict of interest between parties. By contrast, for health related behaviors, baseline levels of incentivized behaviors are usually low, and only a subset involve an interpersonal conflict of interest. Correspondingly, we find no evidence for crowding out of incentivized health behaviors. The existing evidence does not warrant a priori predictions that an undermining effect would be found for health-related behaviors. Health-related behaviors and incentives schemes differ greatly in moderating characteristics, which should be the focus of future research. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Health spending, illicit financial flows and tax incentives in Malawi.

PubMed

O'Hare, B; Curtis, M

2014-12-01

This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps. It begins with an assessment of the disease burden and government health expenditure. Then it analyses the tax revenues foregone by the government of Malawi by two main routes: Illicit financial flows (IFF) from the country, Tax incentives. We find that there are significant financing gaps in the health sector; for example, government expenditure is United States Dollars (USD) 177 million for 2013/2014 while projected donor contribution in 2013/2014 is USD 207 million and the total cost for the minimal health package is USD 535 million. Thus the funding gap between the government budget for health and the required spending to provide the minimal package for 2013/2014 is USD 358 million. On the other hand we estimate that almost USD 400 million is lost through IFF and corporate utilization of tax incentives each year. The revenues foregone plus the current government health spending would be sufficient to cover the minimal public health package for all Malawians and would help tackle Malawi's disease burden. Every effort must be made, including improving transparency and revising laws, to curtail IFF and moderate tax incentives.

When Do Financial Incentives Reduce Intrinsic Motivation? Comparing Behaviors Studied in Psychological and Economic Literatures

PubMed Central

2013-01-01

Objective: To review existing evidence on the potential of incentives to undermine or “crowd out” intrinsic motivation, in order to establish whether and when it predicts financial incentives to crowd out motivation for health-related behaviors. Method: We conducted a conceptual analysis to compare definitions and operationalizations of the effect, and reviewed existing evidence to identify potential moderators of the effect. Results: In the psychological literature, we find strong evidence for an undermining effect of tangible rewards on intrinsic motivation for simple tasks when motivation manifest in behavior is initially high. In the economic literature, evidence for undermining effects exists for a broader variety of behaviors, in settings that involve a conflict of interest between parties. By contrast, for health related behaviors, baseline levels of incentivized behaviors are usually low, and only a subset involve an interpersonal conflict of interest. Correspondingly, we find no evidence for crowding out of incentivized health behaviors. Conclusion: The existing evidence does not warrant a priori predictions that an undermining effect would be found for health-related behaviors. Health-related behaviors and incentives schemes differ greatly in moderating characteristics, which should be the focus of future research. PMID:24001245

Towards lifetime electronic health record implementation.

PubMed

Gand, Kai; Richter, Peggy; Esswein, Werner

2015-01-01

Integrated care concepts can help to diminish demographic challenges. Hereof, the use of eHealth, esp. overarching electronic health records, is recognized as an efficient approach. The article aims at rigorously defining the concept of lifetime electronic health records (LEHRs) and the identification of core factors that need to be fulfilled in order to implement such. A literature review was conducted. Existing definitions were identified and relevant factors were categorized. The derived assessment categories are demonstrated by a case study on Germany. Seven dimensions to differentiate types of electronic health records were found. The analysis revealed, that culture, regulation, informational self-determination, incentives, compliance, ICT infrastructure and standards are important preconditions to successfully implement LEHRs. The article paves the way for LEHR implementation and therewith for integrated care. Besides the expected benefits of LEHRs, there are a number of ethical, legal and social concerns, which need to be balanced.

Meeting the challenges to European healthcare: lessons learned from the 'Stockholm Revolution'.

PubMed

Hjertqvist, Johan

2002-01-01

Healthcare is a political 'hot potato' in Sweden, just as it is throughout Europe. Regardless of whether the focus is on the 'Swedish model' or a 'European model', the operative term should be 'Culture - a set of values common to European healthcare systems'. An analysis of change and challenge in European healthcare systems must examine these values in the context of technological and societal forces before addressing the overarching concerns of where the money will come from. Discussion of the reform evidenced by the 'Stockholm Revolution' will serve as a model of how European healthcare systems can adapt to new conditions by the following approaches: modernising services through incentives; making the consumer a partner by focusing on consumer-related outcomes; building employee networks that encourage responsibility and problem solving; making healthcare an attractive labour market; and creating self-employment opportunities in the healthcare market to increase efficiency and emphasis on consumer satisfaction.

Seven Performance Drivers.

ERIC Educational Resources Information Center

Ross, Linda

2003-01-01

Recent work with automotive e-commerce clients led to the development of a performance analysis methodology called the Seven Performance Drivers, including: standards, incentives, capacity, knowledge and skill, measurement, feedback, and analysis. This methodology has been highly effective in introducing and implementing performance improvement.…

The response of physician groups to P4P incentives.

PubMed

Mehrotra, Ateev; Pearson, Steven D; Coltin, Kathryn L; Kleinman, Ken P; Singer, Janice A; Rabson, Barbra; Schneider, Eric C

2007-05-01

Despite substantial enthusiasm among insurers and federal policy makers for pay-for-performance incentives, little is known about the current scope of these incentives or their influence on the delivery of care. To assess the scope and magnitude of pay-for-performance (P4P) incentives among physician groups and to examine whether such incentives are associated with quality improvement initiatives. Structured telephone survey of leaders of physician groups delivering primary care in Massachusetts. ASSESSED METHODS: Prevalence of P4P incentives among physician groups tied to specific measures of quality or utilization and prevalence of physician group quality improvement initiatives. Most group leaders (89%) reported P4P incentives in at least 1 commercial health plan contract. Incentives were tied to performance on Health Employer Data and Information Set (HEDIS) quality measures (89% of all groups), utilization measures (66%), use of information technology (52%), and patient satisfaction (37%). Among the groups with P4P and knowledge of all revenue streams, the incentives accounted for 2.2% (range, 0.3%-8.8%) of revenue. P4P incentives tied to HEDIS quality measures were positively associated with groups' quality improvement initiatives (odds ratio, 1.6; P = .02). Thirty-six percent of group leaders with P4P incentives reported that they were very important or moderately important to the group's financial success. P4P incentives are now common among physician groups in Massachusetts, and these incentives most commonly reward higher clinical quality or lower utilization of care. Although the scope and magnitude of incentives are still modest for many groups, we found an association between P4P incentives and the use of quality improvement initiatives.

Optimizing the performance of Ice-storage Systems in Electricity Load Management through a credit mechanism. An analytical work for Jiangsu, China

DOE PAGES

Han, Yafeng; Shen, Bo; Hu, Huajin; ...

2015-01-12

Ice-storage air-conditioning is a technique that uses ice for thermal energy storage. Replacing existing air conditioning systems with ice storage has the advantage of shifting the load from on-peak times to off-peak times that often have excess generation. However, increasing the use of ice-storage faces significant challenges in China. One major barrier is the inefficiency in the current electricity tariff structure. There is a lack of effective incentive mechanism that induces ice-storage systems from achieving optimal load-shifting results. This study presents an analysis that compares the potential impacts of ice-storage systems on load-shifting under a new credit-based incentive scheme andmore » the existing incentive arrangement in Jiangsu, China. The study indicates that by changing how ice-storage systems are incentivized in Jiangsu, load-shifting results can be improved.« less

Initiation and Maintenance of Fitness Center Utilization in an Incentive-Based Employer Wellness Program

PubMed Central

Abraham, Jean Marie; Crespin, Daniel; Rothman, Alexander

2015-01-01

Objective Investigate the initiation and maintenance of participation in an employer-based wellness program that provides financial incentives for fitness center utilization. Methods Using multivariate analysis, we investigated how employees’ demographics, health status, exercise-related factors, and lifestyle change preferences affect program participation. Results Forty-two percent of eligible employees participated in the program and 24% earned a $20 incentive at least once by utilizing a gym 8 times or more in a month. On average, participants utilized fitness centers 7.0 months each year and earned credit 4.5 months. Participants’ utilization diminished after their first year in the program. Conclusions Factors associated with initiation and maintenance of fitness center utilization were similar. Declining utilization over time raises concern about the long-run effectiveness of fitness-focused wellness programs. Employers may want to consider additional levers to positively reinforce participation. PMID:26340283

A healthy trend: less food used in fundraising and as rewards and incentives in Minnesota middle and high schools.

PubMed

Kubik, Martha Y; Farbakhsh, Kian; Lytle, Leslie A

2013-04-01

To assess change in the 4-year prevalence (2006-2009) of the use of food in school fundraising and as rewards and incentives for students, following implementation of federal legislation in the USA in 2006. Serial cross-sectional design using trend analysis to assess school-level data collected over four consecutive years from 2006/2007 to 2009/2010. Minneapolis/St. Paul, MN. Convenience sample of middle and high schools participating in two longitudinal, aetiological studies that examined youth, their environment and obesity-related factors. A significant and sustained decrease was demonstrated in the use of low-nutrient, energy-dense foods in school fundraising activities and the use of food and food coupons as rewards and incentives by teachers and school staff. Results support the utility of policy and legislative action as a tool for creating healthy, sustainable environmental change.

Public ideas and values concerning the commercialization of organ donation in four European countries.

PubMed

Schweda, Mark; Schicktanz, Silke

2009-03-01

Against the background of the increasing academic and political debate on financial incentives for organ donation, we conducted a qualitative investigation on the conditions under which European citizens would actually consider or refuse financial incentives for organ donation. Our paper combines an analysis of data that were collected in eight Focus Group discussions on transplantation medicine with lay people and patients from four European countries (Cyprus, Germany, the Netherlands, and Sweden) with a critical re-assessment of the dichotomy between gift and commodity in the recent political and academic discourse. We find that the distinction between living and post mortem donation on the one hand, and between different models of financial incentives on the other, plays a crucial role for the participants' values and ideas about organ donation. We discuss the significance of our results with particular respect to the central role of reciprocity and draw conclusions for the bioethical and biopolitical debate.

How to establish business office incentive programs.

PubMed

Wilkerson, L J

1991-01-01

Incentive programs to help increase collections or reduce days in receivables are becoming popular among healthcare business offices. A successful incentive program addresses major issues during the planning stage and includes realistic incentive goals, simple measurement tools, meaningful incentive payments, and proper monitoring of results.

48 CFR 16.402-2 - Performance incentives.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Performance incentives. 16... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-2 Performance incentives. (a) Performance incentives may be considered in connection with specific product characteristics (e.g...

48 CFR 16.402-2 - Performance incentives.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Performance incentives. 16... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-2 Performance incentives. (a) Performance incentives may be considered in connection with specific product characteristics (e.g...

48 CFR 1852.216-88 - Performance incentive.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Performance incentive... 1852.216-88 Performance incentive. As prescribed in 1816.406-70(f), insert the following clause: Performance Incentive (JAN 1997) (a) A performance incentive applies to the following hardware item(s...

48 CFR 1852.216-88 - Performance incentive.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Performance incentive... 1852.216-88 Performance incentive. As prescribed in 1816.406-70(f), insert the following clause: Performance Incentive (JAN 1997) (a) A performance incentive applies to the following hardware item(s...

48 CFR 16.402-2 - Performance incentives.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Performance incentives. 16... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-2 Performance incentives. (a) Performance incentives may be considered in connection with specific product characteristics (e.g...

Effects of Mental Fatigue on Physical Endurance Performance and Muscle Activation Are Attenuated by Monetary Incentives.

PubMed

Brown, Denver M Y; Bray, Steven R

2017-12-01

Physical performance is impaired following cognitive control exertion. Incentives can ameliorate adverse carryover effects of cognitive control exertion but have not been investigated for physical endurance. This study examined the effect of monetary incentives on physical performance and muscle activation following exposure to a mentally fatiguing, cognitive control task. Participants (N = 82) performed two isometric endurance handgrip trials separated by a 12-min cognitive control manipulation using a 2 (high cognitive control [HCC]/low cognitive control [LCC]) × 2 (incentive/no incentive) design. Mental fatigue was significantly higher in the HCC conditions. Performance decreased in the HCC/no incentive condition but was unaffected in the HCC/incentive condition, which did not differ from the low cognitive control conditions. Electromyography data revealed increased muscle activation in the HCC/no incentive condition, which was also attenuated in the HCC/incentive condition. Findings show that incentives counteract the negative effects of HCC on physical endurance and alter central drive to motor units.

Global Potential of Energy Efficiency Standards and Labeling Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

McNeil, Michael A; McNeil, Michael A.; Letschert, Virginie

2008-06-15

This report estimates the global potential reductions in greenhouse gas emissions by 2030 for energy efficiency improvements associated with equipment (appliances, lighting, and HVAC) in buildings by means of energy efficiency standards and labels (EES&L). A consensus has emerged among the world's scientists and many corporate and political leaders regarding the need to address the threat of climate change through emissions mitigation and adaptation. A further consensus has emerged that a central component of these strategies must be focused around energy, which is the primary generator of greenhouse gas emissions. Two important questions result from this consensus: 'what kinds ofmore » policies encourage the appropriate transformation to energy efficiency' and 'how much impact can these policies have'? This report aims to contribute to the dialogue surrounding these issues by considering the potential impacts of a single policy type, applied on a global scale. The policy addressed in this report is Energy Efficient Standards and Labeling (EES&L) for energy-consuming equipment, which has now been implemented in over 60 countries. Mandatory energy performance standards are important because they contribute positively to a nation's economy and provide relative certainty about the outcome (both timing and magnitudes). Labels also contribute positively to a nation's economy and importantly increase the awareness of the energy-consuming public. Other policies not analyzed here (utility incentives, tax credits) are complimentary to standards and labels and also contribute in significant ways to reducing greenhouse gas emissions. We believe the analysis reported here to be the first systematic attempt to evaluate the potential of savings from EES&L for all countries and for such a large set of products. The goal of the analysis is to provide an assessment that is sufficiently well-quantified and accurate to allow comparison and integration with other strategies under consideration.« less

Horizontal equity and efficiency at primary health care facilities in rural Afghanistan: a seemingly unrelated regression approach.

PubMed

Johns, Benjamin; Steinhardt, Laura; Walker, Damian G; Peters, David H; Bishai, David

2013-07-01

Producing services efficiently and equitably are important goals for health systems. Many countries pursue horizontal equity - providing people with the same illnesses equal access to health services - by locating facilities in remote areas. Staff are often paid incentives to work at such facilities. However, there is little evidence on how many fewer people are treated at remote facilities than facilities in more densely settled areas. This research explores if there is an association between the efficiency of health centers in Afghanistan and the remoteness of their location. Survey teams collected data on facility level inputs and outputs at a stratified random sample of 579 health centers in 2005. Quality of care was measured by observing staff interact with patients and determining if staff completed a set of normative patient care tasks. We used seemingly unrelated regression to determine if facilities in remote areas have fewer outpatient visits than other rural facilities. In this analysis, one equation compares the number of outpatient visits to facility inputs, while another compares quality of care to determinants of quality. The results indicate remote facilities have about 13% fewer outpatient visits than non-remote facilities, holding inputs constant. Our analysis suggests that facilities in remote areas are realizing horizontal equity since their clients are receiving comparable quality of care to those at non-remote facilities. However, we find the average labor cost for a visit at a remote facility is $1.44, but only $0.97 at other rural facilities, indicating that a visit in a remote facility would have to be 'worth' 1.49 times a visit at a rural facility for there to be no equity - efficiency trade-off. In determining where to build or staff health centers, this loss of efficiency may be offset by progress toward a social policy objective of providing services to disadvantaged rural populations. Copyright © 2013 Elsevier Ltd. All rights reserved.

Influential Effects of Intrinsic-Extrinsic Incentive Factors on Management Performance in New Energy Enterprises.

PubMed

Wang, Ping; Lu, Zhengnan; Sun, Jihong

2018-02-08

Background : New energy has become a key trend for global energy industry development. Talent plays a very critical role in the enhancement of new energy enterprise competitiveness. As a key component of talent, managers have been attracting more and more attention. The increase in job performance relies on, to a certain extent, incentive mechanism. Based on the Two-factor Theory, differences in influences and effects of different incentives on management performance have been checked in this paper from an empirical perspective. Methods : This paper selects the middle and low level managers in new energy enterprises as research samples and classifies the managers' performance into task performance, contextual performance and innovation performance. It uses manager performance questionnaires and intrinsic-extrinsic incentive factor questionnaires to investigate and study the effects and then uses Amos software to analyze the inner link between the intrinsic-extrinsic incentives and job performance. Results : Extrinsic incentives affect task performance and innovation performance positively. Intrinsic incentives impose active significant effects on task performance, contextual performance, and innovation performance. The intrinsic incentive plays a more important role than the extrinsic incentive. Conclusions : Both the intrinsic-extrinsic incentives affect manager performance positively and the intrinsic incentive plays a more important role than the extrinsic incentive. Several suggestions to management should be given based on these results.

The fee-for-service shift to bundled payments: financial considerations for hospitals.

PubMed

Scamperle, Keely

2013-01-01

Skyrocketing health care costs are forcing payers to demand delivery efficiencies that preserve and promote quality care while reducing costs. Hospitals are challenged to meet the pressure from payers to deliver value and outcome-based health care while preserving sufficient financial margins. The fee-for-service (FFS) model with its perverse incentives to incur high-volume services is no longer, if ever, sufficient to ensure quality, cost-efficient health care. In response, payers have sought to force the issue through accelerated efforts to bundle payments to providers. It is theorized that by tying together providers throughout the continuum or episode of care for a patient, efficiencies in delivery inclusive of cost reductions will be obtained. This article examines the bundled payment models and the financial considerations for hospital facility providers.

Going national with HERS and EEMs: Issues and impacts. The collected papers of the national collaborative

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

This collection of papers is a companion volume to A National Program for Energy-Efficient Mortgages and Home Energy Rating Systems: A Blueprint for Action (NREL/TP-261-4677). The Blueprint reports the findings and recommendations of the National Collaborative on Home Energy Rating Systems and Mortgage Incentives for Energy Efficiency about a voluntary national program linking energy-efficient mortgages and home energy rating systems. This volume provides technical documentation for A Blueprint for Action. It consists of 55 technical issue papers and 13 special papers prepared by the technical advisory committees and some members of the Collaborative Consensus Committee of the National Collaborative. Itmore » also contains the bibliography and the glossary written by the members and staff of the National Collaborative.« less

A Mulit-State Model for Catalyzing the Home Energy Efficiency Market

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blackmon, Glenn

The RePower Kitsap partnership sought to jump-start the market for energy efficiency upgrades in Kitsap County, an underserved market on Puget Sound in Washington State. The Washington State Department of Commerce partnered with Washington State University (WSU) Energy Program to supplement and extend existing utility incentives offered by Puget Sound Energy (PSE) and Cascade Natural Gas and to offer energy efficiency finance options through the Kitsap Credit Union and Puget Sound Cooperative Credit Union (PSCCU). RePower Kitsap established a coordinated approach with a second Better Buildings Neighborhood Program project serving the two largest cities in the county – Bainbridge Islandmore » and Bremerton. These two projects shared both the “RePower” brand and implementation team (Conservation Services Group (CSG) and Earth Advantage).« less

What about money? Effect of small monetary incentives on enrollment, retention, and motivation to change behaviour in an HIV/STD prevention counselling intervention. The Project RESPECT Study Group.

PubMed

Kamb, M L; Rhodes, F; Hoxworth, T; Rogers, J; Lentz, A; Kent, C; MacGowen, R; Peterman, T A

1998-08-01

We studied the effect of small monetary incentives and non-monetary incentives of similar value on enrollment and participation in clinic based HIV/STD prevention counselling. We examined incident STDs to try to assess whether participants offered money may be less motivated to change risky behaviours than those offered other incentives. Patients from five US STD clinics were invited to enroll in a multisession risk reduction counselling intervention and, based on their enrollment date, were offered either $15 for each additional session or non-monetary incentives worth $15. The two incentive groups were compared on participants' enrollment, completion of intervention sessions, and new STDs over the 24 months after enrollment. Of 648 patients offered money, 198 (31%) enrolled compared with 160 (23%) of 696 patients offered other incentives (p = 0.002). Enrollees in the two incentive groups had similar baseline characteristics, including condom use. Of the 198 participants offered money, 109 (55%) completed all sessions compared with 59 (37%) of the participants offered other incentives (p < 0.0001). Comparing those offered money with those offered other incentives STD rates were similar after 6, 12, and 24 months. Small monetary incentives enhanced enrollment and participation compared with other incentives of similar value. Regardless of incentive offered, participants had similar post-enrollment STD rates, suggesting that the type of incentive does not adversely affect motivation to change behaviour. Money may be useful in encouraging high risk individuals to participate in and complete counselling or other public health interventions.