R&D incentives for neglected diseases.

PubMed

Dimitri, Nicola

2012-01-01

Neglected diseases are typically characterized as those for which adequate drug treatment is lacking, and the potential return on effort in research and development (R&D), to produce new therapies, is too small for companies to invest significant resources in the field. In recent years various incentives schemes to stimulate R&D by pharmaceutical firms have been considered. Broadly speaking, these can be classified either as 'push' or 'pull' programs. Hybrid options, that include push and pull incentives, have also become increasingly popular. Supporters and critics of these various incentive schemes have argued in favor of their relative merits and limitations, although the view that no mechanism is a perfect fit for all situations appears to be widely held. For this reason, the debate on the advantages and disadvantages of different approaches has been important for policy decisions, but is dispersed in a variety of sources. With this in mind, the aim of this paper is to contribute to the understanding of the economic determinants behind R&D investments for neglected diseases by comparing the relative strength of different incentive schemes within a simple economic model, based on the assumption of profit maximizing firms. The analysis suggests that co-funded push programs are generally more efficient than pure pull programs. However, by setting appropriate intermediate goals hybrid incentive schemes could further improve efficiency.

Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming

PubMed Central

Ierfino, Diana; Mantzari, Eleni; Hirst, Julie; Jones, Tina; Aveyard, Paul; Marteau, Theresa M

2015-01-01

Aims Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) ‘gaming’, i.e. false reporting of smoking status to enter the scheme or gain an incentive. Design Single-arm intervention study Setting Antenatal clinic and community Participants A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period. Measurements Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum. Findings Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers. Conclusions Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes. PMID:25727238

Economic and technological aspects of the market introduction of renewable power technologies

NASA Astrophysics Data System (ADS)

Worlen, Christine M.

Renewable energy, if developed and delivered with appropriate technologies, is cleaner, more evenly distributed, and safer than conventional energy systems. Many countries and several states in the United States promote the development and introduction of technologies for "green" electricity production. This dissertation investigates economic and technological aspects of this process for wind energy. In liberalized electricity markets, policy makers use economic incentives to encourage the adoption of renewables. Choosing from a large range of possible policies and instruments is a multi-criteria decision process. This dissertation evaluates the criteria used and the trade-offs among the criteria, and develops a hierarchical flow scheme that policy makers can use to choose the most appropriate policy for a given situation. Economic incentives and market transformation programs seek to reduce costs through mass deployment in order to make renewable technologies competitive. Cost reduction is measured in "experience curves" that posit negative exponential relationships between cumulative deployment and production cost. This analysis reveals the weaknesses in conventional experience curve analyses for wind turbines, and concludes that the concept is limited by data availability, a weak conceptual foundation, and inappropriate statistical estimation. A revised model specifies a more complete set of economic and technological forces that determine the cost of wind power. Econometric results indicate that experience and upscaling of turbine sizes accounted for the observed cost reduction in wind turbines in the United States, Denmark and Germany between 1983 and 2001. These trends are likely to continue. In addition, future cost reductions will result from economies of scale in production. Observed differences in the performance of theoretically equivalent policy instruments could arise from economic uncertainty. To test this hypothesis, a methodology for the quantitative comparison of economic incentive schemes and their effect on uncertainty and investor behavior in renewable power markets is developed using option value theory of investment. Critical investment thresholds compared with actual benefit-cost ratios for several case studies in Germany indicate that uncertainty in prices for wind power and green certificates would delay investment. In Germany, the fixed-tariff system effectively removes this barrier.

Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups.

PubMed

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

2015-01-31

There is evidence that financial incentive interventions, which include both financial rewards and also penalties, are effective in encouraging healthy behaviours. However, concerns about the acceptability of such interventions remain. We report on focus groups with a cross-section of adults from North East England exploring their acceptance of financial incentive interventions for encouraging healthy behaviours amongst adults. Such information should help guide the design and development of acceptable, and effective, financial incentive interventions. Eight focus groups with a total of 74 adults were conducted between November 2013 and January 2014 in Newcastle upon Tyne, UK. Focus groups lasted approximately 60 minutes and explored factors that made financial incentives acceptable and unacceptable to participants, together with discussions on preferred formats for financial incentives. Verbatim transcripts were thematically coded and analysed in Nvivo 10. Participants largely distrusted health promoting financial incentives, with a concern that individuals may abuse such schemes. There was, however, evidence that health promoting financial incentives may be more acceptable if they are fair to all recipients and members of the public; if they are closely monitored and evaluated; if they are shown to be effective and cost-effective; and if clear health education is provided alongside health promoting financial incentives. There was also a preference for positive rewards rather than negative penalties, and for shopping vouchers rather than cash incentives. This qualitative empirical research has highlighted clear suggestions on how to design health promoting financial incentives to maximise acceptability to the general public. It will also be important to determine the acceptability of health promoting financial incentives in a range of stakeholders, and in particular, those who fund such schemes, and policy-makers who are likely to be involved with the design, implementation and evaluation of health promoting financial incentive schemes.

R&D Incentives for Neglected Diseases

PubMed Central

Dimitri, Nicola

2012-01-01

Neglected diseases are typically characterized as those for which adequate drug treatment is lacking, and the potential return on effort in research and development (R&D), to produce new therapies, is too small for companies to invest significant resources in the field. In recent years various incentives schemes to stimulate R&D by pharmaceutical firms have been considered. Broadly speaking, these can be classified either as ‘push’ or ‘pull’ programs. Hybrid options, that include push and pull incentives, have also become increasingly popular. Supporters and critics of these various incentive schemes have argued in favor of their relative merits and limitations, although the view that no mechanism is a perfect fit for all situations appears to be widely held. For this reason, the debate on the advantages and disadvantages of different approaches has been important for policy decisions, but is dispersed in a variety of sources. With this in mind, the aim of this paper is to contribute to the understanding of the economic determinants behind R&D investments for neglected diseases by comparing the relative strength of different incentive schemes within a simple economic model, based on the assumption of profit maximizing firms. The analysis suggests that co-funded push programs are generally more efficient than pure pull programs. However, by setting appropriate intermediate goals hybrid incentive schemes could further improve efficiency. PMID:23284648

Pay-for-performance in disease management: a systematic review of the literature.

PubMed

de Bruin, Simone R; Baan, Caroline A; Struijs, Jeroen N

2011-10-14

Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs. © 2011 de Bruin et al; licensee BioMed Central Ltd.

Pay-for-performance in disease management: a systematic review of the literature

PubMed Central

2011-01-01

Background Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. Methods A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. Results Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. Conclusion The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs. PMID:21999234

Green Development Status in Zhejiang Province and the City of Ningbo, China: Examination of Policies, Strategies and Incentives at Multiple Levels

NASA Astrophysics Data System (ADS)

Cheshmehzangi, Ali; Deng, Wu; Zhang, Yun; Xie, Linjun

2017-05-01

China is undergoing the largest scale of urbanization in history and at an unprecedented pace. The construction and operation of buildings have inevitably brought severe pressures on resource conservation and environmental protection. China has initiated policies, strategies and financial incentive schemes at national level to address these issues. It is also seen that there is a growing interest in recent years at local government level in promoting green buildings. This paper will examine the current national policies, targets and standards and then discuss how these national initiatives are reflected at provincial and city level by taking Zhejiang Province and Ningbo City as case studies. A comparison between different levels of initiatives is conducted by reviewing incentive mechanisms, technological development and compliance requirements. It is concluded that the national initiatives may be not effective without local enhancement.

Incentives for telehealthcare deployment that support integrated care: a comparative analysis across eight European countries

PubMed Central

Lluch, Maria

2013-01-01

Introduction Health care systems are struggling to deal with the increasing demands of an older population. In an attempt to find a solution to these demands, there has been a shift towards integrated care supported by information and communication technologies. However, little is understood about the role played by incentives and reimbursement schemes in the development of integrated care and information and communication technologies uptake. The objective of this paper is to investigate this question, specifically as regards telehealthcare. Methods In order to identify the deployment of telehealthcare applications and their role in supporting integrated care, a case study approach was used. A clustering exercise was carried out and eight European countries were selected for in-depth study: Denmark, Estonia, Germany, France, Italy, the Netherlands, Spain and the UK. In total, 31 telehealthcare initiatives across eight countries involving over 20,000 patients were investigated. Results Reflecting on specific examples in each initiative, drivers promoting integrated care delivery supported by telehealthcare mainstreaming and associated incentive mechanisms were identified. Attention was also paid to other factors which acted as barriers for widespread deployment. Discussion and conclusions Trends towards telehealthcare mainstreaming were found in Denmark, the UK, and in some regions of Spain, Italy and France. Mainstreaming often went hand-in-hand with progress towards integrated care delivery and payment reforms. A general trend was found towards outcomes-based payments and bundled payment schemes, which aimed to promote integrated care supported by telehealthcare deployment. Their effectiveness in achieving these goals remains to be seen. In addition, a form of outpatient diagnostic-related group reimbursement for telehealthcare services was found to have emerged in a few countries. However, it is questionable how this incentive could promote integrated care delivery on its own. This research suggests that incentives which align social, primary and hospital care are rare and there is a need to design new payment paradigms. Finally, eHealth penetration, interoperability, governance, availability of evidence and reorganisation of services represent additional factors which can act as drivers or barriers for integrated care delivery. PMID:24250282

Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming.

PubMed

Ierfino, Diana; Mantzari, Eleni; Hirst, Julie; Jones, Tina; Aveyard, Paul; Marteau, Theresa M

2015-04-01

Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) 'gaming', i.e. false reporting of smoking status to enter the scheme or gain an incentive. Single-arm intervention study Antenatal clinic and community A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period. Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum. Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers. Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes. © 2015 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Monetary Incentives in Speeded Perceptual Decision: Effects of Penalizing Errors Versus Slow Responses

PubMed Central

Dambacher, Michael; Hübner, Ronald; Schlösser, Jan

2011-01-01

The influence of monetary incentives on performance has been widely investigated among various disciplines. While the results reveal positive incentive effects only under specific conditions, the exact nature, and the contribution of mediating factors are largely unexplored. The present study examined influences of payoff schemes as one of these factors. In particular, we manipulated penalties for errors and slow responses in a speeded categorization task. The data show improved performance for monetary over symbolic incentives when (a) penalties are higher for slow responses than for errors, and (b) neither slow responses nor errors are punished. Conversely, payoff schemes with stronger punishment for errors than for slow responses resulted in worse performance under monetary incentives. The findings suggest that an emphasis of speed is favorable for positive influences of monetary incentives, whereas an emphasis of accuracy under time pressure has the opposite effect. PMID:21980316

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…

Outcome of a grocery voucher incentive scheme for low-income tuberculosis patients on directly observed therapy in Singapore.

PubMed

Chua, Angeline Poh-Gek; Lim, Leo Kang-Yang; Ng, Huiyi; Chee, Cynthia Bin-Eng; Wang, Yee Tang

2015-05-01

The 'DOT & Shop' scheme is sponsored by SATA CommHealth, a local non-governmental organisation. It was launched in July 2009, in collaboration with Singapore's Tuberculosis Control Unit (TBCU). Under this scheme, grocery vouchers are disbursed to low-income patients with tuberculosis (TB) at each clinic visit if they have been adherent to directly observed therapy (DOT). This study aimed to determine the effect of this incentive scheme on treatment completion rates and to report the characteristics of patients who were non-adherent to the scheme. This descriptive study used data from the TBCU medical social worker database and the National TB Registry. From July 2009 to December 2012, a total of 883 TB patients were enrolled in the scheme. The overall treatment completion rates of the patients before (July 2006-June 2009) and after (July 2009-December 2012) the implementation of the scheme improved from 85.3% to 87.2% (p = 0.02). Patients under this scheme had a higher treatment completion rate (90.0%) than those not under this scheme (86.4%) (p < 0.01). It was found that the non-adherent patients were more likely to be of Malay ethnicity, younger and unemployed. We demonstrate the salutary effect of a non-governmental organisation-funded grocery voucher incentive scheme for low-income TB patients on DOT in Singapore.

Financial Incentives to Promote Active Travel

PubMed Central

Martin, Adam; Suhrcke, Marc; Ogilvie, David

2012-01-01

Context Financial incentives, including taxes and subsidies, can be used to encourage behavior change. They are common in transport policy for tackling externalities associated with use of motor vehicles, and in public health for influencing alcohol consumption and smoking behaviors. Financial incentives also offer policymakers a compromise between “nudging,” which may be insufficient for changing habitual behavior, and regulations that restrict individual choice. Evidence acquisition The literature review identified studies published between January 1997 and January 2012 of financial incentives relating to any mode of travel in which the impact on active travel, physical activity, or obesity levels was reported. It encompassed macroenvironmental schemes, such as gasoline taxes, and microenvironmental schemes, such as employer-subsidized bicycles. Five relevant reviews and 20 primary studies (of which nine were not included in the reviews) were identified. Evidence synthesis The results show that more-robust evidence is required if policymakers are to maximize the health impact of fiscal policy relating to transport schemes of this kind. Conclusions Drawing on a literature review and insights from the SLOTH (sleep, leisure, occupation, transportation, and home-based activities) time-budget model, this paper argues that financial incentives may have a larger role in promoting walking and cycling than is acknowledged generally. PMID:23159264

Financial risk-sharing in updating the National List of Health Services in Israel: stakeholders' perceived interests.

PubMed

Hammerman, Ariel; Feder-Bubis, Paula; Greenberg, Dan

2012-01-01

Risk-sharing is being considered by many health care systems to address the financial risk associated with the adoption of new technologies. We explored major stakeholders' views toward the potential implementation of a financial risk-sharing mechanism regarding budget-impact estimates for adding new technologies to the Israeli National List of Health Services. According to our proposed scheme, health plans will be partially compensated by technology sponsors if the actual use of a technology is substantially higher than what was projected and health plans will refund the government for budgets that were not fully utilized. By using a semi-structured protocol, we interviewed major stakeholders involved in the process of updating the National List of Health Services (N = 31). We inquired into participants' views toward our proposed risk-sharing mechanism, whether the proposed scheme would achieve its purpose, its feasibility of implementation, and their opinion on the other stakeholders' incentives. Participants' considerations were classified into four main areas: financial, administrative/managerial, impact on patients' health, and influence on public image. Most participants agreed that the conceptual risk-sharing scheme will improve the accuracy of early budget estimates and were in favor of the proposed scheme, although Ministry of Finance officials tended to object to it. The successful implementation of risk-sharing schemes depends mainly on their perception as a win-win situation by all stakeholders. The perception exposed by our participants that risk-sharing can be a tool for improving the accuracy of early budget-impact estimates and the challenges pointed by them are relevant to other health care systems also and should be considered when implementing similar schemes. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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.

Stabilizing the boundary between US politics and science: the role of the Office of Technology Transfer as a boundary organization.

PubMed

Guston, D H

1999-02-01

The sociological study of boundary-work and the political-ecomomic approach of principal-agent theory can be complementary ways of examining the relationship between society and science: boundary-work provides the empirical nuance to the principal-agent scheme, and principal-agent theory provides structure to the thick boundary description. This paper motivates this complementarity to examine domestic technology transfer in the USA from the intramural laboratories of the US National Institutes of Health (NIH). It casts US policy for technology transfer in the principal-agent framework, in which politicians attempt to manage the moral hazard of the productivity of research by providing specific incentives to the agents for engaging in measurable research-based innovation. Such incentives alter the previously negotiated boundary between politics and science. The paper identifies the crucial role of the NIH Office of Technology Transfer (OTT) as a boundary organization, which medicates the new boundary negotiations in its routine work, and stabilizes the boundary by performing successfully as an agent for both politicians and scientists. The paper hypothesizes that boundary organizations like OTT are general phenomena at the boundary between politics and science.

Decision Analysis and Policy Formulation for Technology-Specific Renewable Energy Targets

NASA Astrophysics Data System (ADS)

Okioga, Irene Teshamulwa

This study establishes a decision making procedure using Analytic Hierarchy Process (AHP) for a U.S. national renewable portfolio standard, and proposes technology-specific targets for renewable electricity generation for the country. The study prioritizes renewable energy alternatives based on a multi-perspective view: from the public, policy makers, and investors' points-of-view, and uses multiple criteria for ranking the alternatives to generate a unified prioritization scheme. During this process, it considers a 'quadruple bottom-line' approach (4P), i.e. reflecting technical "progress", social "people", economic 'profits", and environmental "planet" factors. The AHP results indicated that electricity generation from solar PV ranked highest, and biomass energy ranked lowest. A "Benefits/Cost Incentives/Mandates" (BCIM) model was developed to identify where mandates are needed, and where incentives would instead be required to bring down costs for technologies that have potential for profitable deployment. The BCIM model balances the development of less mature renewable energy technologies, without the potential for rising near-term electricity rates for consumers. It also ensures that recommended policies do not lead to growth of just one type of technology--the "highest-benefit, least-cost" technology. The model indicated that mandates would be suited for solar PV, and incentives generally for geothermal and concentrated solar power. Development for biomass energy, as a "low-cost, low-benefits" alternative was recommended at a local rather than national level, mainly due to its low resource potential values. Further, biomass energy generated from wastewater treatment plants (WWTPs) had the least resource potential compared to other biomass sources. The research developed methodologies and recommendations for biogas electricity targets at WWTPs, to take advantage of the waste-to-energy opportunities.

Establishing sustainable performance-based incentive schemes: views of rural health workers from qualitative research in three sub-Saharan African countries.

PubMed

Yé, M; Aninanya, G A; Sié, A; Kakoko, D C V; Chatio, S; Kagoné, M; Prytherch, H; Loukanova, S; Williams, J E; Sauerborn, R

2014-01-01

Performance-based incentives (PBIs) are currently receiving attention as a strategy for improving the quality of care that health providers deliver. Experiences from several African countries have shown that PBIs can trigger improvements, particularly in the area of maternal and neonatal health. The involvement of health workers in deciding how their performance should be measured is recommended. Only limited information is available about how such schemes can be made sustainable. This study explored the types of PBIs that rural health workers suggested, their ideas regarding the management and sustainability of such schemes, and their views on which indicators best lend themselves to the monitoring of performance. In this article the authors reported the findings from a cross-country survey conducted in Burkina Faso, Ghana and Tanzania. The study was exploratory with qualitative methodology. In-depth interviews were conducted with 29 maternal and neonatal healthcare providers, four district health managers and two policy makers (total 35 respondents) from one district in each of the three countries. The respondents were purposively selected from six peripheral health facilities. Care was taken to include providers who had a management role. By also including respondents from district and policy level a comparison of perspectives from different levels of the health system was facilitated. The data that was collected was coded and analysed with support of NVivo v8 software. The most frequently suggested PBIs amongst the respondents in Burkina Faso were training with per-diems, bonuses and recognition of work done. The respondents in Tanzania favoured training with per-diems, as well as payment of overtime, and timely promotion. The respondents in Ghana also called for training, including paid study leave, payment of overtime and recognition schemes for health workers or facilities. Respondents in the three countries supported the mobilisation of local resources to make incentive schemes more sustainable. There was a general view that it was easier to integrate the cost of non-financial incentives in local budgets. There were concerns about the fairness of such schemes from the provider level in all three countries. District managers were worried about the workload that would be required to manage the schemes. The providers themselves were less clear about which indicators best lent themselves to the purpose of performance monitoring. District managers and policy makers most commonly suggested indicators that were in line with national maternal and neonatal healthcare indicators. The study showed that health workers have considerable interest in performance-based incentive schemes and are concerned about their sustainability. There is a need to further explore the use of non-financial incentives in PBI schemes, as such incentives were considered to stand a greater chance of being integrated into local budgets. Ensuring participation of healthcare providers in the design of such schemes is likely to achieve buy-in and endorsement from the health workers involved. However, input from managers and policy makers is essential to keep expectations realistic and to ensure the indicators selected fit the purpose and are part of routine reporting systems.

Financial incentives to promote active travel: an evidence review and economic framework.

PubMed

Martin, Adam; Suhrcke, Marc; Ogilvie, David

2012-12-01

Financial incentives, including taxes and subsidies, can be used to encourage behavior change. They are common in transport policy for tackling externalities associated with use of motor vehicles, and in public health for influencing alcohol consumption and smoking behaviors. Financial incentives also offer policymakers a compromise between "nudging," which may be insufficient for changing habitual behavior, and regulations that restrict individual choice. The literature review identified studies published between January 1997 and January 2012 of financial incentives relating to any mode of travel in which the impact on active travel, physical activity, or obesity levels was reported. It encompassed macroenvironmental schemes, such as gasoline taxes, and microenvironmental schemes, such as employer-subsidized bicycles. Five relevant reviews and 20 primary studies (of which nine were not included in the reviews) were identified. The results show that more-robust evidence is required if policymakers are to maximize the health impact of fiscal policy relating to transport schemes of this kind. Drawing on a literature review and insights from the SLOTH (sleep, leisure, occupation, transportation, and home-based activities) time-budget model, this paper argues that financial incentives may have a larger role in promoting walking and cycling than is acknowledged generally. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The effect of financial incentives on the quality of health care provided by primary care physicians.

PubMed

Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris

2011-09-07

The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome measures, clinical behaviours, and intermediate clinical and physiological measures. Two review authors independently extracted data and assessed study quality, in consultation with two other review authors where there was disagreement. For each included study, we reported the estimated effect sizes and confidence intervals. Seven studies were included in this review. Three of the studies evaluated single-threshold target payments, one examined a fixed fee per patient achieving a specified outcome, one study evaluated payments based on the relative ranking of medical groups' performance (tournament-based pay), one study examined a mix of tournament-based pay and threshold payments, and one study evaluated changing from a blended payments scheme to salaried payment. Three cluster RCTs examined smoking cessation; one CBA examined patients' assessment of the quality of care; one CBA examined cervical screening, mammography screening, and HbA1c; one ITS focused on four outcomes in diabetes; and one controlled ITS (a difference-in-difference design) examined cervical screening, mammography screening, HbA1c, childhood immunisation, chlamydia screening, and appropriate asthma medication. Six of the seven studies showed positive but modest effects on quality of care for some primary outcome measures, but not all. One study found no effect on quality of care. Poor study design led to substantial risk of bias in most studies. In particular, none of the studies addressed issues of selection bias as a result of the ability of primary care physicians to select into or out of the incentive scheme or health plan. The use of financial incentives to reward PCPs for improving the quality of primary healthcare services is growing. However, there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care. Implementation should proceed with caution and incentive schemes should be more carefully designed before implementation. In addition to basing incentive design more on theory, there is a large literature discussing experiences with these schemes that can be used to draw out a number of lessons that can be learned and that could be used to influence or modify the design of incentive schemes. More rigorous study designs need to be used to account for the selection of physicians into incentive schemes. The use of instrumental variable techniques should be considered to assist with the identification of treatment effects in the presence of selection bias and other sources of unobserved heterogeneity. In randomised trials, care must be taken in using the correct unit of analysis and more attention should be paid to blinding. Studies should also examine the potential unintended consequences of incentive schemes by having a stronger theoretical basis, including a broader range of outcomes, and conducting more extensive subgroup analysis. Studies should more consistently describe i) the type of payment scheme at baseline or in the control group, ii) how payments to medical groups were used and distributed within the groups, and iii) the size of the new payments as a percentage of total revenue. Further research comparing the relative costs and effects of financial incentives with other behaviour change interventions is also required.

Mobile phone collection, reuse and recycling in the UK

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

Ongondo, F.O.; Williams, I.D., E-mail: idw@soton.ac.uk

Highlights: > We characterized the key features of the voluntary UK mobile phone takeback network via a survey. > We identified 3 flows: information; product (handsets and accessories); and incentives. > There has been a significant rise in the number of UK takeback schemes since 1997. > Most returned handsets are low quality; little data exists on quantities of mobile phones collected. > Takeback schemes increasingly divert EoL mobile phones from landfill and enable reuse/recycling. - Abstract: Mobile phones are the most ubiquitous electronic product on the globe. They have relatively short lifecycles and because of their (perceived) in-built obsolescence,more » discarded mobile phones represent a significant and growing problem with respect to waste electrical and electronic equipment (WEEE). An emerging and increasingly important issue for industry is the shortage of key metals, especially the types of metals found in mobile phones, and hence the primary aim of this timely study was to assess and evaluate the voluntary mobile phone takeback network in the UK. The study has characterised the information, product and incentives flows in the voluntary UK mobile phone takeback network and reviewed the merits and demerits of the incentives offered. A survey of the activities of the voluntary mobile phone takeback schemes was undertaken in 2008 to: identify and evaluate the takeback schemes operating in the UK; determine the target groups from whom handsets are collected; and assess the collection, promotion and advertising methods used by the schemes. In addition, the survey sought to identify and critically evaluate the incentives offered by the takeback schemes, evaluate their ease and convenience of use; and determine the types, qualities and quantities of mobile phones they collect. The study has established that the UK voluntary mobile phone takeback network can be characterised as three distinctive flows: information flow; product flow (handsets and related accessories); and incentives flow. Over 100 voluntary schemes offering online takeback of mobile phone handsets were identified. The schemes are operated by manufacturers, retailers, mobile phone network service operators, charities and by mobile phone reuse, recycling and refurbishing companies. The latter two scheme categories offer the highest level of convenience and ease of use to their customers. Approximately 83% of the schemes are either for-profit/commercial-oriented and/or operate to raise funds for charities. The voluntary schemes use various methods to collect mobile phones from consumers, including postal services, courier and in-store. The majority of schemes utilise and finance pre-paid postage to collect handsets. Incentives offered by the takeback schemes include monetary payments, donation to charity and entry into prize draws. Consumers from whom handsets and related equipment are collected include individuals, businesses, schools, colleges, universities, charities and clubs with some schemes specialising on collecting handsets from one target group. The majority (84.3%) of voluntary schemes did not provide information on their websites about the quantities of mobile phones they collect. The operations of UK takeback schemes are decentralised in nature. Comparisons are made between the UK's decentralised collection system versus Australia's centralised network for collection of mobile phones. The significant principal conclusions from the study are: there has been a significant rise in the number of takeback schemes operating in the UK since the initial scheme was launched in 1997; the majority of returned handsets seem to be of low quality; and there is very little available information on the quantities of mobile phones collected by the various schemes. Irrespective of their financial motives, UK takeback schemes increasingly play an important role in sustainable waste management by diverting EoL mobile phones from landfills and encouraging reuse and recycling. Recommendations for future actions to improve the management of end-of-life mobile phone handsets and related accessories are made.« less

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.

[Incentive for Regional Risk Selection in the German Risk Structure Compensation Scheme].

PubMed

Wende, Danny

2017-10-01

The introduction of the new law GKV-FQWG strengthens the competition between statutory health insurance. If incentives for risk selection exist, they may force a battle for cheap customers. This study aims to document and discuss incentives for regional risk selection in the German risk structure compensation scheme. Identify regional autocorrelation with Moran's l on financial parameters of the risk structure compensation schema. Incentives for regional risk selection do indeed exist. The risk structure compensation schema reduces 91% of the effect and helps to reduce risk selection. Nevertheless, a connection between regional situation and competition could be shown (correlation: 69.5%). Only the integration of regional control variables into the risk compensation eliminates regional autocorrelation. The actual risk structure compensation is leading to regional inequalities and as a consequence to risk selection and distortion in competition. © Georg Thieme Verlag KG Stuttgart · New York.

Mobile phone collection, reuse and recycling in the UK.

PubMed

Ongondo, F O; Williams, I D

2011-06-01

Mobile phones are the most ubiquitous electronic product on the globe. They have relatively short lifecycles and because of their (perceived) in-built obsolescence, discarded mobile phones represent a significant and growing problem with respect to waste electrical and electronic equipment (WEEE). An emerging and increasingly important issue for industry is the shortage of key metals, especially the types of metals found in mobile phones, and hence the primary aim of this timely study was to assess and evaluate the voluntary mobile phone takeback network in the UK. The study has characterised the information, product and incentives flows in the voluntary UK mobile phone takeback network and reviewed the merits and demerits of the incentives offered. A survey of the activities of the voluntary mobile phone takeback schemes was undertaken in 2008 to: identify and evaluate the takeback schemes operating in the UK; determine the target groups from whom handsets are collected; and assess the collection, promotion and advertising methods used by the schemes. In addition, the survey sought to identify and critically evaluate the incentives offered by the takeback schemes, evaluate their ease and convenience of use; and determine the types, qualities and quantities of mobile phones they collect. The study has established that the UK voluntary mobile phone takeback network can be characterised as three distinctive flows: information flow; product flow (handsets and related accessories); and incentives flow. Over 100 voluntary schemes offering online takeback of mobile phone handsets were identified. The schemes are operated by manufacturers, retailers, mobile phone network service operators, charities and by mobile phone reuse, recycling and refurbishing companies. The latter two scheme categories offer the highest level of convenience and ease of use to their customers. Approximately 83% of the schemes are either for-profit/commercial-oriented and/or operate to raise funds for charities. The voluntary schemes use various methods to collect mobile phones from consumers, including postal services, courier and in-store. The majority of schemes utilise and finance pre-paid postage to collect handsets. Incentives offered by the takeback schemes include monetary payments, donation to charity and entry into prize draws. Consumers from whom handsets and related equipment are collected include individuals, businesses, schools, colleges, universities, charities and clubs with some schemes specialising on collecting handsets from one target group. The majority (84.3%) of voluntary schemes did not provide information on their websites about the quantities of mobile phones they collect. The operations of UK takeback schemes are decentralised in nature. Comparisons are made between the UK's decentralised collection system versus Australia's centralised network for collection of mobile phones. The significant principal conclusions from the study are: there has been a significant rise in the number of takeback schemes operating in the UK since the initial scheme was launched in 1997; the majority of returned handsets seem to be of low quality; and there is very little available information on the quantities of mobile phones collected by the various schemes. Irrespective of their financial motives, UK takeback schemes increasingly play an important role in sustainable waste management by diverting EoL mobile phones from landfills and encouraging reuse and recycling. Recommendations for future actions to improve the management of end-of-life mobile phone handsets and related accessories are made. Copyright © 2011 Elsevier Ltd. All rights reserved.

Effects of Performance-Based Financial Incentives on Work Performance: A Study of Technical-Level Employees in the Private Sector in Sri Lanka

ERIC Educational Resources Information Center

Wickramasinghe, Vathsala; Dabere, Sampath

2012-01-01

The objective of the study is to investigate the effect of performance-based financial incentives on work performance. The study hypothesized that the design features of performance-based financial incentive schemes themselves may influence individuals' work performance. For the study, survey methodology was used and 93 technical-level employees…

Impact of Thailand universal coverage scheme on the country's health information systems and health information technology.

PubMed

Kijsanayotin, Boonchai

2013-01-01

Thailand achieved universal healthcare coverage with the implementation of the Universal Coverage Scheme (UCS) in 2001. This study employed qualitative method to explore the impact of the UCS on the country's health information systems (HIS) and health information technology (HIT) development. The results show that health insurance beneficiary registration system helps improve providers' service workflow and country vital statistics. Implementation of casemix financing tool, Thai Diagnosis-Related Groups, has stimulated health providers' HIS and HIT capacity building, data and medical record quality and the adoption of national administrative data standards. The system called "Disease Management Information Systems" aiming at reimbursement for select diseases increased the fragmentation of HIS and increase burden on data management to providers. The financial incentive of outpatient data quality improvement project enhance providers' HIS and HIT investment and also induce data fraudulence tendency. Implementation of UCS has largely brought favorable impact on the country HIS and HIT development. However, the unfavorable effects are also evident.

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.

Concentrating Solar Power Systems

NASA Astrophysics Data System (ADS)

Pitz-Paal, R.

2017-07-01

Development of Concentrating Solar Power Systems has started about 40 years ago. A first commercial implementation was performed between 1985 and 1991 in California. However, a drop in gas prices caused a longer period without further deployment. It was overcome in 2007 when new incentive schemes for renewables in Spain and the US enabled a commercial restart. In 2016, almost 100 commercial CSP plants with more than 5GW are installed worldwide. This paper describes the physical background of CSP technology, its technical characteristics and concepts. Furthermore, it discusses system performances, cost structures and the expected advancement.

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

Evolutional Optimization on Material Ordering and Inventory Control of Supply Chain through Incentive Scheme

NASA Astrophysics Data System (ADS)

Prasertwattana, Kanit; Shimizu, Yoshiaki; Chiadamrong, Navee

This paper studied the material ordering and inventory control of supply chain systems. The effect of controlling policies is analyzed under three different configurations of the supply chain systems, and the formulated problem has been solved by using an evolutional optimization method known as Differential Evolution (DE). The numerical results show that the coordinating policy with the incentive scheme outperforms the other policies and can improve the performance of the overall system as well as all members under the concept of supply chain management.

Give It Up For Baby: outcomes and factors influencing uptake of a pilot smoking cessation incentive scheme for pregnant women

PubMed Central

2013-01-01

Background The use of incentives to promote smoking cessation is a promising technique for increasing the effectiveness of interventions. This study evaluated the smoking cessation outcomes and factors associated with success for pregnant smokers who registered with a pilot incentivised smoking cessation scheme in a Scottish health board area (NHS Tayside). Methods All pregnant smokers who engaged with the scheme between March 2007 and December 2009 were included in the outcome evaluation which used routinely collected data. Data utilised included: the Scottish National Smoking Cessation Dataset; weekly and periodic carbon monoxide (CO) breath tests; status of smoking cessation quit attempts; and amount of incentive paid. Process evaluation incorporated in-depth interviews with a cross-sectional sample of service users, stratified according to level of engagement. Results Quit rates for those registering with Give It Up For Baby were 54% at 4 weeks, 32% at 12 weeks and 17% at 3 months post partum (all data validated by CO breath test). Among the population of women identified as smoking at first booking over a one year period, 20.1% engaged with Give It Up For Baby, with 7.8% of pregnant smokers quit at 4 weeks. Pregnant smokers from more affluent areas were more successful with their quit attempt. The process evaluation indicates financial incentives can encourage attendance at routine advisory sessions where they are seen to form part of a wider reward structure, but work less well with those on lowest incomes who demonstrate high reliance on the financial reward. Conclusions Uptake of Give It Up For Baby by the target population was higher than for all other health board areas offering specialist or equivalent cessation services in Scotland. Quit successes also compared favorably with other specialist interventions, adding to evidence of the benefits of incentives in this setting. The process evaluation helped to explain variations in retention and quit rates achieved by the scheme. This study describes a series of positive outcomes achieved through the use of incentives to promote smoking cessation amongst pregnant smokers. PMID:23587161

Give It Up For Baby: outcomes and factors influencing uptake of a pilot smoking cessation incentive scheme for pregnant women.

PubMed

Radley, Andrew; Ballard, Paul; Eadie, Douglas; MacAskill, Susan; Donnelly, Louise; Tappin, David

2013-04-15

The use of incentives to promote smoking cessation is a promising technique for increasing the effectiveness of interventions. This study evaluated the smoking cessation outcomes and factors associated with success for pregnant smokers who registered with a pilot incentivised smoking cessation scheme in a Scottish health board area (NHS Tayside). All pregnant smokers who engaged with the scheme between March 2007 and December 2009 were included in the outcome evaluation which used routinely collected data. Data utilised included: the Scottish National Smoking Cessation Dataset; weekly and periodic carbon monoxide (CO) breath tests; status of smoking cessation quit attempts; and amount of incentive paid. Process evaluation incorporated in-depth interviews with a cross-sectional sample of service users, stratified according to level of engagement. Quit rates for those registering with Give It Up For Baby were 54% at 4 weeks, 32% at 12 weeks and 17% at 3 months post partum (all data validated by CO breath test). Among the population of women identified as smoking at first booking over a one year period, 20.1% engaged with Give It Up For Baby, with 7.8% of pregnant smokers quit at 4 weeks. Pregnant smokers from more affluent areas were more successful with their quit attempt. The process evaluation indicates financial incentives can encourage attendance at routine advisory sessions where they are seen to form part of a wider reward structure, but work less well with those on lowest incomes who demonstrate high reliance on the financial reward. Uptake of Give It Up For Baby by the target population was higher than for all other health board areas offering specialist or equivalent cessation services in Scotland. Quit successes also compared favorably with other specialist interventions, adding to evidence of the benefits of incentives in this setting. The process evaluation helped to explain variations in retention and quit rates achieved by the scheme.This study describes a series of positive outcomes achieved through the use of incentives to promote smoking cessation amongst pregnant smokers.

Promoting sugar-free medicines: evaluation of a multi-faceted intervention.

PubMed

Weeks, Julie C; Dutt, Amalin; Robinson, Peter G

2003-12-01

To evaluate an intervention to increase the proportion of medicines prescribed as sugar-free formulations by general practitioners. Natural experiment. Interventions were set in Camden and Islington Health Authority with comparator data within that and adjacent health authorities. General medical practices. Two interventions were employed. A prescribing incentive scheme that used the proportion of medicines prescribed as sugar-free formulations as a quality marker for general practitioners and a publicity campaign for health care workers and members of the public. The proportions of amoxycillin mixture and all paracetamol liquid preparations that were prescribed in sugar-free formulations. Sugar-free prescribing in the practices participating in the incentive scheme increased from 27% to 45% whereas non-participating practices showed a decrease from 20% to 14%. The proportion of prescriptions for sugar-free formulations increased by approximately one half across the entire health authority so that after two years Camden and Islington had the highest level of prescribing of sugar-free paracetamol and amoxycillin in London. These data provide compelling evidence of the effectiveness of the prescribing incentive scheme whereas the publicity campaign did not change prescribing behaviour.

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.

When and Why Do University Managers Use Publication Incentive Payments?

ERIC Educational Resources Information Center

Opstrup, Niels

2017-01-01

Pay-for-performance schemes have become a widespread management strategy in the public sector. However, not much is known about the rationales that trigger the adoption of performance-related pay provisions. This article examines managerial and organisational features of university departments in Denmark that use publication incentive payments.…

Bank Size and Small- and Medium-sized Enterprise (SME) Lending: Evidence from China.

PubMed

Shen, Yan; Shen, Minggao; Xu, Zhong; Bai, Ying

2009-04-01

Using panel data collected in 2005, we evaluate how bank size, discretion over credit, incentive schemes, competition, and the institutional environment affect lending to small- and medium-sized enterprises in China. We deal with the endogeneity problem using instrumental variables, and a reduced-form approach is also applied to allow for weak instruments in estimation. We find that total bank asset is an insignificant factor for banks' decision on small- and medium-enterprise (SME) lending, but more local lending authority, more competition, carefully designed incentive schemes, and stronger law enforcement encourage commercial banks to lend to SMEs.

Incentivising effort in governance of public hospitals: Development of a delegation-based alternative to activity-based remuneration.

PubMed

Søgaard, Rikke; Kristensen, Søren Rud; Bech, Mickael

2015-08-01

This paper is a first examination of the development of an alternative to activity-based remuneration in public hospitals, which is currently being tested at nine hospital departments in a Danish region. The objective is to examine the process of delegating the authority of designing new incentive schemes from the principal (the regional government) to the agents (the hospital departments). We adopt a theoretical framework where, when deciding about delegation, the principal should trade off an initiative effect against the potential cost of loss of control. The initiative effect is evaluated by studying the development process and the resulting incentive schemes for each of the departments. Similarly, the potential cost of loss of control is evaluated by assessing the congruence between focus of the new incentive schemes and the principal's objectives. We observe a high impact of the effort incentive in the form of innovative and ambitious selection of projects by the agents, leading to nine very different solutions across departments. However, we also observe some incongruence between the principal's stated objectives and the revealed private interests of the agents. Although this is a baseline study involving high uncertainty about the future, the findings point at some issues with the delegation approach that could lead to inefficient outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Arkansas | Solar Research | NREL

Science.gov Websites

programs. State Incentive Programs There are currently no statewide solar financial incentive programs in Wyoming. Program Administrator Incentive Arkansas Energy Technology Loans for Green Technology Arkansas for the most up-to-date and accurate information on state and utility policies and incentive programs

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.

Alternative Fuels Data Center: Idle Reduction

Science.gov Websites

Cities Annual Petroleum Savings Clean Cities Annual Petroleum Savings Incentive and Law Additions by Fuel /Technology Type Incentive and Law Additions by Fuel/Technology Type Incentive Additions by Policy Type Incentive Additions by Policy Type More Idle Reduction Data | All Maps & Data Case Studies Massachusetts

Creating contiguous forest habitat: An experimental examination on incentives and communication

Treesearch

Travis Warziniack; Jason F. Shogren; Gregory Parkhurst

2007-01-01

Forest fragmentation exists when private landowners break up large forest stands into smaller parts. Fragmentation increases risks to endangered species that find shelter in contiguous forest habitat that falls across several landowners. Policy makers interested in reuniting these forests across fences should consider how to design a voluntary incentive scheme...

Employer contribution and premium growth in health insurance.

PubMed

Liu, Yiyan; Jin, Ginger Zhe

2015-01-01

We study whether employer premium contribution schemes could impact the pricing behavior of health plans and contribute to rising premiums. Using 1991-2011 data before and after a 1999 premium subsidy policy change in the Federal Employees Health Benefits Program (FEHBP), we find that the employer premium contribution scheme has a differential impact on health plan pricing based on two market incentives: 1) consumers are less price sensitive when they only need to pay part of the premium increase, and 2) each health plan has an incentive to increase the employer's premium contribution to that plan. Both incentives are found to contribute to premium growth. Counterfactual simulation shows that average premium would have been 10% less than observed and the federal government would have saved 15% per year on its premium contribution had the subsidy policy change not occurred in the FEHBP. We discuss the potential of similar incentives in other government-subsidized insurance systems such as the Medicare Part D and the Health Insurance Marketplace under the Affordable Care Act. Copyright © 2014 Elsevier B.V. All rights reserved.

Coordination between primary and secondary care: the role of electronic messages and economic incentives.

PubMed

La Rocca, Antonella; Hoholm, Thomas

2017-02-17

In Norway, a government reform has recently been introduced to enhance coordination between primary and secondary care. This paper examines the effects of two newly introduced measures to improve the coordination: an ICT-based communication tool/standard and an economic incentive scheme. This qualitative study is based primarily on 27 open-ended interviews. We interviewed nine employees at a hospital (the focal actor), 17 employees from seven different municipalities, and a representative of a Regional Health Authority. ICT-based communication is perceived to facilitate information exchange between primary and secondary care, thus positively affecting coordination. However, the economic incentive scheme appears to have the opposite effect by creating tensions between the two organizations and accentuating power asymmetry in favor of secondary care. The inter-organizational nature of coordination in health care makes it crucial for policymakers and management of care organizations to conceive incentives and instruments that work jointly across organizations rather than at only one of the health care organizations involved. Such an approach is likely to favor a more symmetrical pattern of collaboration between primary and secondary care.

Firm strategy and consumer behaviour under a complex tobacco tax system: implications for the effectiveness of taxation on tobacco control.

PubMed

Atuk, Oğuz; Özmen, M Utku

2017-05-01

The current tobacco taxation scheme in Turkey, a mix of high ad valorem tax and low specific tax, contains incentives for firms and consumers to change pricing and consumption patterns, respectively. The association between tax structure and price and tax revenue stability has not been studied in detail with micro data containing price segment information. In this study, we analyse whether incentives for firms and consumers undermine the effectiveness of tax policy in reducing consumption. We calculate alternative taxation scheme outcomes using differing ad valorem and specific tax rates through simulation analysis. We also estimate price elasticity of demand using detailed price and volume statistics between segments via regression analysis. A very high ad valorem rate provides strong incentives to firms to reduce prices. Therefore, this sort of tax strategy may induce even more consumption despite its initial aim of discouraging consumption. While higher prices dramatically reduce consumption of economy and medium price segment cigarettes, demand for premium segment cigarettes is found to be highly price-inelastic. The current tax scheme, based on both ad valorem and specific components, introduces various incentives to firms as well as to consumers which reduce the effectiveness of the tax policy. Therefore, on the basis of our theoretical predictions, an appropriate tax scheme should involve a balanced combination of ad valorem and specific rates, away from extreme ( ad valorem or specific dominant) cases to enhance the effectiveness of tax policy for curbing consumption. 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/.

Encouraging breastfeeding: financial incentives.

PubMed

Whitford, Heather; Whelan, Barbara; van Cleemput, Patrice; Thomas, Katharine; Renfrew, Mary; Strong, Mark; Scott, Elaine; Relton, Clare

2015-02-01

The NOSH (Nourishing Start for Health) three-phase research study is testing whether offering financial incentives for breastfeeding improves six-eight-week breastfeeding rates in low-rate areas. This article describes phase one development work, which aimed to explore views about practical aspects of the design of the scheme. Interviews and focus groups were held with women (n = 38) and healthcare providers (n = 53). Overall both preferred shopping vouchers over cash payments, with a total amount of £200-250 being considered a reasonable amount. There was concern that seeking proof of breastfeeding might impact negatively on women and the relationship with their healthcare providers. The most acceptable method to all was that women sign a statement that their baby was receiving breast milk: this was co-signed by a healthcare professional to confirm that they had discussed breastfeeding. These findings have informed the design of the financial incentive scheme being tested in the feasibility phase of the NOSH study.

Impacts of pay for performance on the quality of primary care

PubMed Central

Allen, T; Mason, T; Whittaker, W

2014-01-01

Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers’ payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data. PMID:25061341

Bank Size and Small- and Medium-sized Enterprise (SME) Lending: Evidence from China

PubMed Central

SHEN, YAN; SHEN, MINGGAO; XU, ZHONG; BAI, YING

2014-01-01

Summary Using panel data collected in 2005, we evaluate how bank size, discretion over credit, incentive schemes, competition, and the institutional environment affect lending to small- and medium-sized enterprises in China. We deal with the endogeneity problem using instrumental variables, and a reduced-form approach is also applied to allow for weak instruments in estimation. We find that total bank asset is an insignificant factor for banks’ decision on small- and medium-enterprise (SME) lending, but more local lending authority, more competition, carefully designed incentive schemes, and stronger law enforcement encourage commercial banks to lend to SMEs. PMID:26052179

Research 0n Incentive Mechanism of General Contractor and Subcontractors Dynamic Alliance in Construction Project Based on Team Cooperation

NASA Astrophysics Data System (ADS)

Yin, Honglian; Sun, Aihua; Liu, Quanru; Chen, Zhiyi

2018-03-01

It is the key of motivating sub-contractors working hard and mutual cooperation, ensuring implementation overall goal of the project that to design rational incentive mechanism for general contractor. Based on the principal-agency theory, the subcontractor efforts is divided into two parts, one for individual efforts, another helping other subcontractors, team Cooperation incentive models of multiple subcontractors are set up, incentive schemes and intensities are also given. The results show that the general contractor may provide individual and team motivation incentives when subcontractors working independently, not affecting each other in time and space; otherwise, the general contractor may only provide individual incentive to entice teams collaboration between subcontractors and helping each other. The conclusions can provide a reference for the subcontract design of general and sub-contractor dynamic alliances.

Prototyping the HPDP Chip on STM 65 NM Process

NASA Astrophysics Data System (ADS)

Papadas, C.; Dramitinos, G.; Syed, M.; Helfers, T.; Dedes, G.; Schoellkopf, J.-P.; Dugoujon, L.

2011-08-01

Currently Astrium GmbH is involved in the of the High Performance Data Processor (HPDP) development programme for telecommunication applications under a DLR contract. The HPDP project targets the implementation of the commercially available reconfigurable array processor IP (XPP from the company PACT XPP Technologies) in a radiation hardened technology.In the current complementary development phase funded under the Greek Industry Incentive scheme, it is planned to prototype the HPDP chip in commercial STM 65 nm technology. In addition it is also planned to utilise the preliminary radiation hardened components of this library wherever possible.This abstract gives an overview of the HPDP chip architecture, the basic details of the STM 65 nm process and the design flow foreseen for the prototyping. The paper will discuss the development and integration issues involved in using the STM 65 nm process (also including the available preliminary radiation hardened components) for designs targeted to be used in space applications.

A Review of the Literature on Remote Monitoring Technology in Incentive-Based Interventions for Health-Related Behavior Change.

PubMed

Kurti, Allison N; Davis, Danielle R; Redner, Ryan; Jarvis, Brantley P; Zvorsky, Ivori; Keith, Diana R; Bolivar, Hypatia A; White, Thomas J; Rippberger, Peter; Markesich, Catherine; Atwood, Gary; Higgins, Stephen T

2016-06-01

Use of technology (e.g., Internet, cell phones) to allow remote implementation of incentives interventions for health-related behavior change is growing. To our knowledge, there has yet to be a systematic review of this literature reported. The present report provides a systematic review of the controlled studies where technology was used to remotely implement financial incentive interventions targeting substance use and other health behaviors published between 2004 and 2015. For inclusion in the review, studies had to use technology to remotely accomplish one of the following two aims alone or in combination: (a) monitor the target behavior, or (b) deliver incentives for achieving the target goal. Studies also had to examine financial incentives (e.g., cash, vouchers) for health-related behavior change, be published in peer-reviewed journals, and include a research design that allowed evaluation of the efficacy of the incentive intervention relative to another condition (e.g., non-contingent incentives, treatment as usual). Of the 39 reports that met inclusion criteria, 18 targeted substance use, 10 targeted medication adherence or home-based health monitoring, and 11 targeted diet, exercise, or weight loss. All 39 (100%) studies used technology to facilitate remote monitoring of the target behavior, and 26 (66.7%) studies also incorporated technology in the remote delivery of incentives. Statistically significant intervention effects were reported in 71% of studies reviewed. Overall, the results offer substantial support for the efficacy of remotely implemented incentive interventions for health-related behavior change, which have the potential to increase the cost-effectiveness and reach of this treatment approach.

Parental financial incentives for increasing preschool vaccination uptake: systematic review.

PubMed

Wigham, Sarah; Ternent, Laura; Bryant, Andrew; Robalino, Shannon; Sniehotta, Falko F; Adams, Jean

2014-10-01

Financial incentives have been used to promote vaccination uptake but are not always viewed as acceptable. Quasimandatory policies, such as requiring vaccinations for school enrollment, are widely implemented in some countries. A systematic review was conducted to determine the effectiveness, acceptability, and economic costs and consequences of parental financial incentives and quasimandatory schemes for increasing the uptake of preschool vaccinations in high-income countries. Electronic databases and gray literature were searched for randomized controlled trials, controlled before-and-after studies, and time series analyses examining the effectiveness of parental financial incentives and quasimandatory schemes, as well as any empirical studies exploring acceptability. All included studies were screened for information on economic costs and consequences. Two reviewers independently assessed studies for inclusion, extracted data, and assessed the quality of selected articles by using established instruments. Studies were synthesized in narrative reviews. Four studies on the effectiveness and 6 on the acceptability of parental financial incentives and quasimandatory interventions met the inclusion criteria. Only 1 study reported on costs and consequences. Studies of effectiveness had low risk of bias but displayed substantial heterogeneity in terms of interventions and methods. There was insufficient evidence to conclude whether these interventions were effective. Studies of acceptability suggested a preference, in settings where this already occurs, for incentives linking vaccinations to access to education. There was insufficient evidence to draw conclusions on economic costs and consequences. Copyright © 2014 by the American Academy of Pediatrics.

Evaluating recreational hunting as an incentive for habitat conservation on private land in California

Treesearch

Luke T. Macaulay

2015-01-01

Private land plays a crucial role in the conservation of biodiversity in California, yet these lands are the least protected and most prone to environmental degradation. In 1930, Aldo Leopold recognized the potential to better conserve private land by an incentive scheme where recreational users would pay landowners for access to conserved wildlife habitat. While...

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

Tradeoffs in the Design of Health Plan Payment Systems: Fit, Power and Balance

PubMed Central

Geruso, Michael; McGuire, Thomas G.

2016-01-01

In many markets, including the new U.S. Marketplaces, health insurance plans are paid by risk-adjusted capitation, sometimes combined with reinsurance and other payment mechanisms. This paper proposes a framework for evaluating the de facto insurer incentives embedded in these complex payment systems. We discuss fit, power and balance, each of which addresses a distinct market failure in health insurance. We implement empirical metrics of fit, power, and balance in a study of Marketplace payment systems. Using data similar to that used to develop the Marketplace risk adjustment scheme, we quantify tradeoffs among the three classes of incentives. We show that an essential tradeoff arises between the goals of limiting costs and limiting cream skimming because risk adjustment, which is aimed at discouraging cream-skimming, weakens cost control incentives in practice. A simple reinsurance system scores better on our measures of fit, power and balance than the risk adjustment scheme in use in the Marketplaces. PMID:26922122

Tradeoffs in the design of health plan payment systems: Fit, power and balance.

PubMed

Geruso, Michael; McGuire, Thomas G

2016-05-01

In many markets, including the new U.S. Marketplaces, health insurance plans are paid by risk-adjusted capitation, sometimes combined with reinsurance and other payment mechanisms. This paper proposes a framework for evaluating the de facto insurer incentives embedded in these complex payment systems. We discuss fit, power and balance, each of which addresses a distinct market failure in health insurance. We implement empirical metrics of fit, power, and balance in a study of Marketplace payment systems. Using data similar to that used to develop the Marketplace risk adjustment scheme, we quantify tradeoffs among the three classes of incentives. We show that an essential tradeoff arises between the goals of limiting costs and limiting cream skimming because risk adjustment, which is aimed at discouraging cream-skimming, weakens cost control incentives in practice. A simple reinsurance system scores better on our measures of fit, power and balance than the risk adjustment scheme in use in the Marketplaces. Copyright © 2016 Elsevier B.V. All rights reserved.

Status on Technology Development of Optic Fiber-Coupled Laser Ignition System for Rocket Engine Applications

NASA Technical Reports Server (NTRS)

Trinh, Huu P.; Early, Jim; Osborne, Robin; Thomas, Matthew; Bossard, John

2003-01-01

To pursue technology developments for future launch vehicles, NASA/Marshall Space Flight Center (MSFC) is examining vortex chamber concepts for liquid rocket engine applications. Past studies indicated that the vortex chamber schemes potentially have a number of advantages over conventional chamber methods. Due to the nature of the vortex flow, relatively cooler propellant streams tend to flow along the chamber wall. Hence, the thruster chamber can be operated without the need of any cooling techniques. This vortex flow also creates strong turbulence, which promotes the propellant mixing process. Consequently, the subject chamber concept: not only offer system simplicity, but also enhance the combustion performance. Test results have shown that chamber performance is markedly high even at a low chamber length-to-diameter ratio. This incentive can be translated to a convenience in the thrust chamber packaging.

Modeling regulated water utility investment incentives

NASA Astrophysics Data System (ADS)

Padula, S.; Harou, J. J.

2014-12-01

This work attempts to model the infrastructure investment choices of privatized water utilities subject to rate of return and price cap regulation. The goal is to understand how regulation influences water companies' investment decisions such as their desire to engage in transfers with neighbouring companies. We formulate a profit maximization capacity expansion model that finds the schedule of new supply, demand management and transfer schemes that maintain the annual supply-demand balance and maximize a companies' profit under the 2010-15 price control process in England. Regulatory incentives for costs savings are also represented in the model. These include: the CIS scheme for the capital expenditure (capex) and incentive allowance schemes for the operating expenditure (opex) . The profit-maximizing investment program (what to build, when and what size) is compared with the least cost program (social optimum). We apply this formulation to several water companies in South East England to model performance and sensitivity to water network particulars. Results show that if companies' are able to outperform the regulatory assumption on the cost of capital, a capital bias can be generated, due to the fact that the capital expenditure, contrarily to opex, can be remunerated through the companies' regulatory capital value (RCV). The occurrence of the 'capital bias' or its entity depends on the extent to which a company can finance its investments at a rate below the allowed cost of capital. The bias can be reduced by the regulatory penalties for underperformances on the capital expenditure (CIS scheme); Sensitivity analysis can be applied by varying the CIS penalty to see how and to which extent this impacts the capital bias effect. We show how regulatory changes could potentially be devised to partially remove the 'capital bias' effect. Solutions potentially include allowing for incentives on total expenditure rather than separately for capex and opex and allowing both opex and capex to be remunerated through a return on the company's regulatory capital value.

Additional cash incentive within a conditional cash transfer scheme: a 'controlled before and during' design evaluation study from India.

PubMed

Lahariya, Chandrakant; Mishra, Ashok; Nandan, Deoki; Gautam, Praveen; Gupta, Sanjay

2011-01-01

Conditional Cash Transfer (CCT) schemes have shown largely favorable changes in the health seeking behavior. This evaluation study assesses the process and performance of an Additional Cash Incentive (ACI) scheme within an ongoing CCT scheme in India, and document lessons. A controlled before and during design study was conducted in Madhya Pradesh state of India, from August 2007 to March 2008, with increased in institutional deliveries as a primary outcome. In depth interviews, focus group discussions and household surveys were done for data collection. Lack of awareness about ACI scheme amongst general population and beneficiaries, cumbersome cash disbursement procedure, intricate eligibility criteria, extensive paper work, and insufficient focus on community involvement were the major implementation challenges. There were anecdotal reports of political interference and possible scope for corruption. At the end of implementation period, overall rate of institutional deliveries had increased in both target and control populations; however, the differences were not statistically significant. No cause and effect association could be proven by this study. Poor planning and coordination, and lack of public awareness about the scheme resulted in low utilization. Thus, proper IEC and training, detailed implementation plan, orientation training for implementer, sufficient budgetary allocation, and community participation should be an integral part for successful implementation of any such scheme. The lesson learned this evaluation study may be useful in any developing country setting and may be utilized for planning and implementation of any ACI scheme in future.

[Authorization and reimbursement of orphan drugs in an international comparison].

PubMed

Roll, K; Stargardt, T; Schreyögg, J

2011-08-01

This paper analyses schemes to promote the authorisation of and reimbursement for orphan drugs. 8 countries - Australia, Canada, Germany, Great Britain, France, Netherlands, Switzerland, USA - were studied to compare specific regulations for orphan drugs regarding drug admission, health technology assessment (HTA), decision-making for reimbursement, and off-label and compassionate use. Information was obtained by reviewing published and grey literature. Expert interviews were also conducted. The comparison of orphan drug legislation reveals that the EU and the USA offer the greatest incentives for the development of orphan drugs, whereas there is a tendency for Australia and Switzerland to profit from incentives in other countries. Although not explicitly stated, economic evaluation of orphan drugs takes the special circumstances for orphan drugs into account. In addition to common reimbursement practices, special schemes or programmes for the reimbursement of high-priced orphan drugs exist in all countries that were analysed. Therefore access to orphan drugs seems to be warranted. However, due to co-payments of 5%, the USA may form an exception. On the one hand, the use of special criteria for drug admission, HTA, and reimbursement promotes R&D for orphan drugs. On the other hand, high opportunity costs arise, because huge efforts are made for a minority of patients. A solution for this moral dilemma may be the application of "rule of rescue" or of "no cure, no pay" programmes. © Georg Thieme Verlag KG Stuttgart · New York.

A maternal health voucher scheme: what have we learned from the demand-side financing scheme in Bangladesh?

PubMed

Ahmed, Shakil; Khan, M Mahmud

2011-01-01

It is now more than 2 years since the Ministry of Health and Family Welfare of the Government of Bangladesh implemented the Maternal Health Voucher Scheme, a specialized form of demand-side financing programme. To analyse the early lessons from the scheme, information was obtained through semi-structured interviews with stakeholders at the sub-district level. The analysis identified a number of factors affecting the efficiency and performance of the scheme in the program area: delay in the release of voucher funds, selection criteria used for enrolling pregnant women in the programme, incentives created by the reimbursement system, etc. One of the objectives of the scheme was to encourage market competition among health care providers, but it failed to increase market competitiveness in the area. The resources made available through the scheme did not attract any new providers into the market and public facilities remained the only eligible provider both before and after scheme implementation. However, incentives provided through the voucher system did motivate public providers to offer a higher level of services. The beneficiaries expressed their overall satisfaction with the scheme as well. Since the local facility was not technically ready to provide all types of maternal health care services, providing vouchers may not improve access to care for many pregnant women. To improve the performance of the demand-side strategy, it has become important to adopt some supply-side interventions. In poor developing countries, a demand-side strategy may not be very effective without significant expansion of the service delivery capacity of health facilities at the sub-district level.

Section 4: Evaluation of carbon management requirements

NASA Astrophysics Data System (ADS)

The chapters in this section are perhaps the broadest of the book. They discuss the integrated set of factors that affect carbon management in general. Roed-Larsen and Flach start the section with a detailed summary of current accreditation schemes. Verification of carbon credits is critical for validation of monetary sequestration incentives. Commercial-scale geologic sequestration will likely not advance unless such financial incentives are implemented. The type of incentive also is critical. For example, in the one country where a carbon tax is in place, Norway, commercial geologic sequestration has been underway since 1996. In other countries, where a cap-and-trade system is in place, and of course in countries where no incentives are offered, no commercial carbon sequestration is taking place.

Reducing power usage on demand

NASA Astrophysics Data System (ADS)

Corbett, G.; Dewhurst, A.

2016-10-01

The Science and Technology Facilities Council (STFC) datacentre provides large- scale High Performance Computing facilities for the scientific community. It currently consumes approximately 1.5MW and this has risen by 25% in the past two years. STFC has been investigating leveraging preemption in the Tier 1 batch farm to save power. HEP experiments are increasing using jobs that can be killed to take advantage of opportunistic CPU resources or novel cost models such as Amazon's spot pricing. Additionally, schemes from energy providers are available that offer financial incentives to reduce power consumption at peak times. Under normal operating conditions, 3% of the batch farm capacity is wasted due to draining machines. By using preempt-able jobs, nodes can be rapidly made available to run multicore jobs without this wasted resource. The use of preempt-able jobs has been extended so that at peak times machines can be hibernated quickly to save energy. This paper describes the implementation of the above and demonstrates that STFC could in future take advantage of such energy saving schemes.

48 CFR 215.404-71-2 - Performance risk.

Code of Federal Regulations, 2011 CFR

2011-10-01

... incentive range when contract performance includes the introduction of new, significant technological innovation. Use the technology incentive range only for the most innovative contract efforts. Innovation may... reliability, or reduced costs; or (B) New products or systems that contain significant technological advances...

Designing payments for ecosystem services: Lessons from previous experience with incentive-based mechanisms

PubMed Central

Jack, B. Kelsey; Kousky, Carolyn; Sims, Katharine R. E.

2008-01-01

Payments for ecosystem services (PES) policies compensate individuals or communities for undertaking actions that increase the provision of ecosystem services such as water purification, flood mitigation, or carbon sequestration. PES schemes rely on incentives to induce behavioral change and can thus be considered part of the broader class of incentive- or market-based mechanisms for environmental policy. By recognizing that PES programs are incentive-based, policymakers can draw on insights from the substantial body of accumulated knowledge about this class of instruments. In particular, this article offers a set of lessons about how the environmental, socioeconomic, political, and dynamic context of a PES policy is likely to interact with policy design to produce policy outcomes, including environmental effectiveness, cost-effectiveness, and poverty alleviation. PMID:18621696

Designing payments for ecosystem services: Lessons from previous experience with incentive-based mechanisms.

PubMed

Jack, B Kelsey; Kousky, Carolyn; Sims, Katharine R E

2008-07-15

Payments for ecosystem services (PES) policies compensate individuals or communities for undertaking actions that increase the provision of ecosystem services such as water purification, flood mitigation, or carbon sequestration. PES schemes rely on incentives to induce behavioral change and can thus be considered part of the broader class of incentive- or market-based mechanisms for environmental policy. By recognizing that PES programs are incentive-based, policymakers can draw on insights from the substantial body of accumulated knowledge about this class of instruments. In particular, this article offers a set of lessons about how the environmental, socioeconomic, political, and dynamic context of a PES policy is likely to interact with policy design to produce policy outcomes, including environmental effectiveness, cost-effectiveness, and poverty alleviation.

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

Valuing breastfeeding: a qualitative study of women's experiences of a financial incentive scheme for breastfeeding.

PubMed

Johnson, Maxine; Whelan, Barbara; Relton, Clare; Thomas, Kate; Strong, Mark; Scott, Elaine; Renfrew, Mary J

2018-01-08

A cluster randomised controlled trial of a financial incentive for breastfeeding conducted in areas with low breastfeeding rates in the UK reported a statistically significant increase in breastfeeding at 6-8 weeks. In this paper we report an analysis of interviews with women eligible for the scheme, exploring their experiences and perceptions of the scheme and its impact on breastfeeding to support the interpretation of the results of the trial. Semi-structured interviews were carried out with 35 women eligible for the scheme during the feasibility and trial stages. All interviews were recorded and verbatim transcripts analysed using a Framework Analysis approach. Women reported that their decisions about infant feeding were influenced by the behaviours and beliefs of their family and friends, socio-cultural norms and by health and practical considerations. They were generally positive about the scheme, and felt valued for the effort involved in breastfeeding. The vouchers were frequently described as a reward, a bonus and something to look forward to, and helping women keep going with their breastfeeding. They were often perceived as compensation for the difficulties women encountered during breastfeeding. The scheme was not thought to make a difference to mothers who were strongly against breastfeeding. However, women did believe the scheme would help normalise breastfeeding, influence those who were undecided and help women to keep going with breastfeeding and reach key milestones e.g. 6 weeks or 3 months. The scheme was acceptable to women, who perceived it as rewarding and valuing them for breastfeeding. Women reported that the scheme could raise awareness of breastfeeding and encourage its normalisation. This provides a possible mechanism of action to explain the results of the trial. The trial is registered with the ISRCTN registry, number 44898617 , https://www.isrctn.com.

General practice after-hours incentive funding: a rationale for change.

PubMed

Neil, Amanda L; Nelson, Mark R; Richardson, Tracy; Mann-Leonard, Meghan; Palmer, Andrew J

2015-07-20

After-hours incentive funding for general practice was introduced in 1998 through the introduction of the Practice Incentives Program (PIP). In 2010, a national audit of the PIP identified after-hours incentive funding as having the greatest levels of non-compliance across 12 PIP components. The audit specified the need for secondary data sources to ensure practice compliance. In this article, we examine the drivers of the 1998-2013 PIP mechanism to inform development of a fair, transparent and auditable after-hours incentive funding scheme for Tasmania. The PIP after-hours incentive funding mechanism paid, at diminishing levels, for anticipated burden of care (practice size), claimed method of providing care (stream) and remoteness of practice. Increasing remoteness rather than practice size or stream is the primary determinant of urgent after-hours attendances per practice in Tasmania; after-hours attendances to residential aged care facilities are unrelated to individual practice location or stream but concentrated in urban areas. The PIP after-hours incentive funding mechanism does not preferentially support practices that provide after-hours care and arguably led to perverse incentives. A new after-hours incentive funding mechanism embodying pre-specified objectives - such as support for (unavoidable) burden and/or provision of care to residential aged care facilities - is required. Claimed provision is considered an inappropriate funding determinant.

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

A unifying Bayesian account of contextual effects in value-based choice

PubMed Central

Friston, Karl J.; Dolan, Raymond J.

2017-01-01

Empirical evidence suggests the incentive value of an option is affected by other options available during choice and by options presented in the past. These contextual effects are hard to reconcile with classical theories and have inspired accounts where contextual influences play a crucial role. However, each account only addresses one or the other of the empirical findings and a unifying perspective has been elusive. Here, we offer a unifying theory of context effects on incentive value attribution and choice based on normative Bayesian principles. This formulation assumes that incentive value corresponds to a precision-weighted prediction error, where predictions are based upon expectations about reward. We show that this scheme explains a wide range of contextual effects, such as those elicited by other options available during choice (or within-choice context effects). These include both conditions in which choice requires an integration of multiple attributes and conditions where a multi-attribute integration is not necessary. Moreover, the same scheme explains context effects elicited by options presented in the past or between-choice context effects. Our formulation encompasses a wide range of contextual influences (comprising both within- and between-choice effects) by calling on Bayesian principles, without invoking ad-hoc assumptions. This helps clarify the contextual nature of incentive value and choice behaviour and may offer insights into psychopathologies characterized by dysfunctional decision-making, such as addiction and pathological gambling. PMID:28981514

Corruption in Brazil and the Incentives for Change

DTIC Science & Technology

2017-03-01

money laundering schemes. The intent of this thesis is to identify the key changes that have recently empowered a judiciary that was previously...further implicated in a separate money - laundering scheme with ten members of congress. The 1980s and early 90s were very difficult economically for the...including “misappropriation of public funds, mismanagement, money laundering , inter-party corruption, bribery (active corruption), and tax evasion

Using stated preference methods to design cost-effective subsidy programs to induce technology adoption: an application to a stove program in southern Chile.

PubMed

Gómez, Walter; Salgado, Hugo; Vásquez, Felipe; Chávez, Carlos

2014-01-01

We study the design of an economic incentive based program - a subsidy - to induce adoption of more efficient technology in a pollution reduction program in southern Chile. Stated preferences methods, contingent valuation (CV), and choice experiment (CE) are used to estimate the probability of adoption and the willingness to share the cost of a new technology by a household. The cost-effectiveness property of different subsidy schemes is explored numerically for different regulatory objectives. Our results suggest that households are willing to participate in voluntary programs and to contribute by paying a share of the cost of adopting more efficient technologies. We find that attributes of the existing and the new technology, beyond the price, are relevant determinant factors of the participation decision and payment. Limited access to credit markets for low income families can be a major barrier for an effective implementation of these types of programs. Variations in the design of the subsidy and on the regulator's objective and constraints can have significant impact on the level and the cost of reduction of aggregate emissions achieved. Copyright © 2013 Elsevier Ltd. All rights reserved.

Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?

PubMed Central

Lee, Anne CC; Lawn, Joy E.; Cousens, Simon; Kumar, Vishwajeet; Osrin, David; Bhutta, Zulfiqar A.; Wall, Steven N.; Nandakumar, Allyala K.; Syed, Uzma; Darmstadt, Gary L.

2012-01-01

Background Delays in receiving effective care during labor and at birth may be fatal for the mother and fetus, contributing to 2 million annual intrapartum stillbirths and intrapartum-related neonatal deaths each year. Objective We present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes. Results There is moderate quality evidence that community mobilization with high levels of community engagement can increase institutional births and significantly reduce perinatal and early neonatal mortality. Meta-analysis showed a doubling of skilled birth attendance and a 35% reduction in early neonatal mortality. However, no data are available on intrapartum-specific outcomes. Evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown. Current evidence for maternity waiting homes and risk screening is low quality. Conclusions Empowering communities is an important strategy to reduce the large burden of intrapartum complications. Innovations are needed to bring the poor closer to obstetric care, such as financial incentives and cell phone technology. New questions need to be asked of “old” strategies such as risk screening and maternity waiting homes. The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation. PMID:19815201

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

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.

Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study.

PubMed

O'Donnell, Amy; Haighton, Catherine; Chappel, David; Shevills, Colin; Kaner, Eileen

2016-11-25

Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact. A sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations. Screening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs' beliefs about patient-centred practice. Financial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs that shape how GPs' provide care.

'Just another incentive scheme': a qualitative interview study of a local pay-for-performance scheme for primary care.

PubMed

Hackett, Julia; Glidewell, Liz; West, Robert; Carder, Paul; Doran, Tim; Foy, Robbie

2014-10-25

A range of policy initiatives have addressed inequalities in healthcare and health outcomes. Local pay-for-performance schemes for primary care have been advocated as means of enhancing clinical ownership of the quality agenda and better targeting local need compared with national schemes such as the UK Quality and Outcomes Framework (QOF). We investigated whether professionals' experience of a local scheme in one English National Health Service (NHS) former primary care trust (PCT) differed from that of the national QOF in relation to the goal of reducing inequalities. We conducted retrospective semi-structured interviews with primary care professionals implementing the scheme and those involved in its development. We purposively sampled practices with varying levels of population socio-economic deprivation and achievement. Interviews explored perceptions of the scheme and indicators, likely mechanisms of influence on practice, perceived benefits and harms, and how future schemes could be improved. We used a framework approach to analysis. Thirty-eight professionals from 16 general practices and six professionals involved in developing local indicators participated. Our findings cover four themes: ownership, credibility of the indicators, influences on behaviour, and exacerbated tensions. We found little evidence that the scheme engendered any distinctive sense of ownership or experiences different from the national scheme. Although the indicators and their evidence base were seldom actively questioned, doubts were expressed about their focus on health promotion given that eventual benefits relied upon patient action and availability of local resources. Whilst practices serving more affluent populations reported status and patient benefit as motivators for participating in the scheme, those serving more deprived populations highlighted financial reward. The scheme exacerbated tensions between patient and professional consultation agendas, general practitioners benefitting directly from incentives and nurses who did much of the work, and practices serving more and less affluent populations which faced different challenges in achieving targets. The contentious nature of pay-for-performance was not necessarily reduced by local adaptation. Those developing future schemes should consider differential rewards and supportive resources for practices serving more deprived populations, and employing a wider range of levers to promote professional understanding and ownership of indicators.

Value based pricing, research and development, and patient access schemes. Will the United Kingdom get it right or wrong?

PubMed Central

Towse, Adrian

2010-01-01

The National Health Service (NHS) should reward innovation it values. This will enable the NHS and the United Kingdom (UK) economy to benefit and impact positively on the Research and Development (R&D) decision making of companies. The National Institute for Health and Clinical Excellence (NICE) currently seeks to do this on behalf of the NHS. Yet the Office of Fair Trading proposals for Value Based Pricing add price setting powers – initially for the Department of Health (DH) and then for NICE. This introduces an additional substantial uncertainty that will impact on R&D and, conditional on R&D proceeding, on launch (or not) in the UK. Instead of adding to uncertainty the institutional arrangements for assessing value should seek to be predictable and science based, building on NICE's current arrangements. The real challenge is to increase understanding of the underlying cost-effectiveness of the technology itself by collecting evidence alongside use. The 2009 Pharmaceutical Price Regulation Scheme sought to help do this with Flexible Pricing (FP) and Patient Access Schemes (PASs). The PASs to date have increased access to medicines, but no schemes proposed to date have yet helped to tackle outcomes uncertainty. The 2010 Innovation Pass can also be seen as a form of ‘coverage with evidence development.’ The NHS is understandably concerned about the costs of running such evidence collection schemes. Enabling the NHS to deliver on such schemes will impact favourably on R&D decisions. Increasing the uncertainty in the UK NHS market through government price setting will reduce incentives for R&D and for early UK launch. PMID:20716236

Value based pricing, research and development, and patient access schemes. Will the United Kingdom get it right or wrong?

PubMed

Towse, Adrian

2010-09-01

The National Health Service (NHS) should reward innovation it values. This will enable the NHS and the United Kingdom (UK) economy to benefit and impact positively on the Research and Development (R&D) decision making of companies. The National Institute for Health and Clinical Excellence (NICE) currently seeks to do this on behalf of the NHS. Yet the Office of Fair Trading proposals for Value Based Pricing add price setting powers--initially for the Department of Health (DH) and then for NICE. This introduces an additional substantial uncertainty that will impact on R&D and, conditional on R&D proceeding, on launch (or not) in the UK. Instead of adding to uncertainty the institutional arrangements for assessing value should seek to be predictable and science based, building on NICE's current arrangements. The real challenge is to increase understanding of the underlying cost-effectiveness of the technology itself by collecting evidence alongside use. The 2009 Pharmaceutical Price Regulation Scheme sought to help do this with Flexible Pricing (FP) and Patient Access Schemes (PASs). The PASs to date have increased access to medicines, but no schemes proposed to date have yet helped to tackle outcomes uncertainty. The 2010 Innovation Pass can also be seen as a form of 'coverage with evidence development.' The NHS is understandably concerned about the costs of running such evidence collection schemes. Enabling the NHS to deliver on such schemes will impact favourably on R&D decisions. Increasing the uncertainty in the UK NHS market through government price setting will reduce incentives for R&D and for early UK launch.

Can paying for results help to achieve the Millennium Development Goals? A critical review of selected evaluations of results-based financing.

PubMed

Oxman, Andrew D; Fretheim, Atle

2009-08-01

Results-based financing (RBF) refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. RBF is being promoted for helping to achieve the Millennium Development Goals (MDGs). We undertook a critical appraisal of selected evaluations of RBF schemes in the health sector in low and middle-income countries (LMIC). In addition, key informants were interviewed to identify literature relevant to the use of RBF in the health sector in LMIC, key examples, evaluations, and other key informants. The use of RBF in LMIC has commonly been a part of a package that may include increased funding, technical support, training, changes in management, and new information systems. It is not possible to disentangle the effects of financial incentives as one element of RBF schemes, and there is very limited evidence of RBF per se having an effect. RBF schemes can have unintended effects. When RBF schemes are used, they should be designed carefully, including the level at which they are targeted, the choice of targets and indicators, the type and magnitude of incentives, the proportion of financing that is paid based on results, and the ancillary components of the scheme. For RBF to be effective, it must be part of an appropriate package of interventions, and technical capacity or support must be available. RBF schemes should be monitored for possible unintended effects and evaluated using rigorous study designs. © 2009 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Canada's new national energy program on oil and gas: What are the main provisions? What are the reactions so far?

NASA Astrophysics Data System (ADS)

Burr, K. K.

1981-04-01

The Canadian federal government announced a National Energy Program (NEP) for oil and natural gas to achieve energy self sufficiency. The program deals with two major political and economic influences in Canadian energy: provincial ownership of natural resources and 70% of foreign ownership in the Canadian petroleum industry. The objectives to achieve national energy security, create opportunities for Canadian participation, and share resource benefits among the provinces. The major provisions include: a 80% federal tax on oil and gas production; a natural gas federal excise tax; a pricing scheme which holds conventional oil prices down but gives incentives for oil sands, heavy oil, and tertiary recovery production; a gas pricing scheme which encourages substitution of gas for oil; a 25% carried interest for the government on federal leases; and a Canadianization incentives grant system which replace the depletion allowance system.

Incentive-Based Voltage Regulation in Distribution Networks: Preprint

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

Zhou, Xinyang; Chen, Lijun; Dall'Anese, Emiliano

This paper considers distribution networks fea- turing distributed energy resources, and designs incentive-based mechanisms that allow the network operator and end-customers to pursue given operational and economic objectives, while concurrently ensuring that voltages are within prescribed limits. Two different network-customer coordination mechanisms that require different amounts of information shared between the network operator and end-customers are developed to identify a solution of a well-defined social-welfare maximization prob- lem. Notably, the signals broadcast by the network operator assume the connotation of prices/incentives that induce the end- customers to adjust the generated/consumed powers in order to avoid the violation of the voltagemore » constraints. Stability of the proposed schemes is analytically established and numerically corroborated.« less

Incentive-Based Voltage Regulation in Distribution Networks

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

Dall-Anese, Emiliano; Baker, Kyri A; Zhou, Xinyang

This paper considers distribution networks fea- turing distributed energy resources, and designs incentive-based mechanisms that allow the network operator and end-customers to pursue given operational and economic objectives, while concurrently ensuring that voltages are within prescribed limits. Two different network-customer coordination mechanisms that require different amounts of information shared between the network operator and end-customers are developed to identify a solution of a well-defined social-welfare maximization prob- lem. Notably, the signals broadcast by the network operator assume the connotation of prices/incentives that induce the end- customers to adjust the generated/consumed powers in order to avoid the violation of the voltagemore » constraints. Stability of the proposed schemes is analytically established and numerically corroborated.« less

Automated Demand Response Approaches to Household Energy Management in a Smart Grid Environment

NASA Astrophysics Data System (ADS)

Adika, Christopher Otieno

The advancement of renewable energy technologies and the deregulation of the electricity market have seen the emergence of Demand response (DR) programs. Demand response is a cost-effective load management strategy which enables the electricity suppliers to maintain the integrity of the power grid during high peak periods, when the customers' electrical load is high. DR programs are designed to influence electricity users to alter their normal consumption patterns by offering them financial incentives. A well designed incentive-based DR scheme that offer competitive electricity pricing structure can result in numerous benefits to all the players in the electricity market. Lower power consumption during peak periods will significantly enhance the robustness of constrained networks by reducing the level of power of generation and transmission infrastructure needed to provide electric service. Therefore, this will ease the pressure of building new power networks as we avoiding costly energy procurements thereby translating into huge financial savings for the power suppliers. Peak load reduction will also reduce the inconveniences suffered by end users as a result of brownouts or blackouts. Demand response will also drastically lower the price peaks associated with wholesale markets. This will in turn reduce the electricity costs and risks for all the players in the energy market. Additionally, DR is environmentally friendly since it enhances the flexibility of the power grid through accommodation of renewable energy resources. Despite its many benefits, DR has not been embraced by most electricity networks. This can be attributed to the fact that the existing programs do not provide enough incentives to the end users and, therefore, most electricity users are not willing to participate in them. To overcome these challenges, most utilities are coming up with innovative strategies that will be more attractive to their customers. Thus, this dissertation presents various demand response schemes that can be deployed by electricity providers to manage customer loads. This study also addresses the problem of manual demand response by proposing smart systems that will autonomously execute the DR programs without the direct involvement of the customers.

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.

Incentives for knowledge sharing: impact of organisational culture and information technology

NASA Astrophysics Data System (ADS)

Lyu, Hongbo; Zhang, Zuopeng Justin

2017-10-01

This research presents and examines an analytical model of knowledge management in which organisational culture dynamically improves with knowledge-sharing and learning activities within organisations. We investigate the effects of organisational incentives and the level of information technology on the motivation of knowledge sharing. We derive a linear incentive reward structure for knowledge sharing under both homogeneous and heterogeneous conditions. In addition, we show how the organisational culture and the optimum linear sharing reward change with several crucial factors, and summarise three sets of methods (strong IT support, congruent organisational culture, and effective employee assessment) to complement the best linear incentive. Our research provides valuable insights for practitioners in terms of implementing knowledge-management initiatives.

Managing imperfect competition by pay for performance and reference pricing.

PubMed

Mak, Henry Y

2018-01-01

I study a managed health service market where differentiated providers compete for consumers by choosing multiple service qualities, and where copayments that consumers pay and payments that providers receive for services are set by a payer. The optimal regulation scheme is two-sided. On the demand side, it justifies and clarifies value-based reference pricing. On the supply side, it prescribes pay for performance when consumers misperceive service benefits or providers have intrinsic quality incentives. The optimal bonuses are expressed in terms of demand elasticities, service technology, and provider characteristics. However, pay for performance may not outperform prospective payment when consumers are rational and providers are profit maximizing, or when one of the service qualities is not contractible. Copyright © 2017 Elsevier B.V. All rights reserved.

42 CFR 414.92 - Electronic Prescribing Incentive Program.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Electronic Prescribing Incentive Program. 414.92... Physicians and Other Practitioners § 414.92 Electronic Prescribing Incentive Program. (a) Basis and scope... section, unless otherwise indicated— Certified electronic health record technology means an electronic...

42 CFR 414.92 - Electronic Prescribing Incentive Program.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Electronic Prescribing Incentive Program. 414.92... Physicians and Other Practitioners § 414.92 Electronic Prescribing Incentive Program. (a) Basis and scope... section, unless otherwise indicated— Certified electronic health record technology means an electronic...

42 CFR 414.92 - Electronic Prescribing Incentive Program.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Electronic Prescribing Incentive Program. 414.92... Physicians and Other Practitioners § 414.92 Electronic Prescribing Incentive Program. (a) Basis and scope... section, unless otherwise indicated— Certified electronic health record technology means an electronic...

Alternative Fuels Data Center: Federal Laws and Incentives

Science.gov Websites

and Incentives on AddThis.com... More in this section... Search Federal State Local Examples Summary Payments Advanced Energy Research Project Grants Advanced Technology Vehicle (ATV) and Alternative Fuel Alternative Fuel Tax Exemption Alternative Fuel and Advanced Vehicle Technology Research and Demonstration

Motivation and Incentives for Distance Faculty

ERIC Educational Resources Information Center

Parker, Angie

2003-01-01

Colleges continue to offer growing numbers of courses and programs of study through distance education technologies. Yet despite this growth, relatively little is known about what inspires faculty to teach with a technology-mediated approach. The current study was designed as an exploration into the incentives that faculty perceive as motivating.…

Augmenting the impact of technology adoption with financial incentive to improve radiology report signature times.

PubMed

Andriole, Katherine P; Prevedello, Luciano M; Dufault, Allen; Pezeshk, Parham; Bransfield, Robert; Hanson, Richard; Doubilet, Peter M; Seltzer, Steven E; Khorasani, Ramin

2010-03-01

Radiology report signature time (ST) can be a substantial component of total report turnaround time. Poor turnaround time resulting from lengthy ST can adversely affect patient care. The combination of technology adoption with financial incentive was evaluated to determine if ST improvement can be augmented and sustained. This prospective study was performed at a 751-bed, urban, tertiary care adult teaching hospital. Test-site imaging volume approximated 48,000 examinations per month. The radiology department has 100 trainees and 124 attending radiologists serving multiple institutions. Over a study period of 4 years and 4 months, three interventions focused on radiologist signature performance were implemented: 1) a notification paging application that alerted radiologists when reports were ready for signature, 2) a picture archiving and communications systems (PACS)-integrated speech recognition report generation system, and 3) a departmental financial incentive to reward radiologists semiannually for ST performance. Signature time was compared before and after the interventions. Wilcoxon and linear regression statistical analyses were used to assess the significance of trends. Technology adoption (paging plus speech recognition) reduced median ST from >5 to <1 hour (P < .001) and 80th-percentile ST from >24 to 15 to 18 hours (P < .001). Subsequent addition of a financial incentive further improved 80th-percentile ST to 4 to 8 hours (P < .001). The gains in median and 80th-percentile ST were sustained over the final 31 months of the study period. Technology interventions coupled with financial incentive can result in synergistic and sustainable improvement in radiologist report-signing behavior. The addition of a financial incentive leads to better performance than that achievable through technology alone.

Fraud and fiduciary liability.

PubMed

Hodge, Brian Ray

2003-12-01

All employee benefit plans are potential targets of fraudulent schemes. Smaller plans are targeted by unscrupulous brokers and promoters selling fraudulent policies; plans large enough to be self-insured face greater risks of fraud by providers and participants misrepresenting claims. Plan trustees, administrators and consultants should be alert to the many ways fraudulent schemes manifest themselves and to the legal remedies available; establish investigative programs to detect and discourage fraud; and promote education and plan incentives for participants to report fraud.

What makes British general practitioners take part in a quality improvement scheme?

PubMed

Spooner, A; Chapple, A; Roland, M

2001-07-01

To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.

National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan.

PubMed

Tsai, Yi-Wen; Hu, Teh-Wei

2002-09-01

Taiwan's National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman's choice for primary cesarean delivery. Logistic regressions were used to analyze 11 788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996. After implementation of the NHI's Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P <.0001). Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.

Third Angle of RSBY: Service Providers' Perspective to RSBY-operational Issues in Gujarat.

PubMed

Trivedi, Mayur; Saxena, Deepak B

2013-04-01

Government of India in 2008, launched its flagship health insurance scheme for the poor. The Rashtriya Swasthya Bima Yojana (RSBY) combines cutting edge technology with an unusual reliance on incentives to provide inpatient insurance coverage. The scheme allows for cashless hospitalization services at any of the empaneled hospitals. Stakeholders in RSBY include members of the community, Insurance Company and the service provider. The study manuscript is an attempt to get an insight to understand the bottle necks in faced by the service providers with an overall goal to understand issues in complete roll out of RSBY and its successful implementation across country. It was conducted to undertake the stakeholder analysis and understand the service providers' perspective to RSBY. The present study was conducted in the Patan district of Gujarat state. Qualitative tool mainly in-depth interview of service providers of RSBY in Patan district of Gujarat state was utilized for the data collection. Service providers opined an ineffective IEC around the utility of the RSBY service in the community. In spite of the claim that scheme relies heavily on technology to ensure paperless cashless services, on field, it was observed in the present study that the claim settlements are done through physical documents. The service providers had a perceived threat of being suspended from the list/de-empanelment of the provider by the insurance company. There is an urgent need for improved and effective IEC for the service and possibilities of an arrangement for to settle the case of grievances around suspensions ao that genuine hospitals can have fair deal as well. There definitely remains a greater and more serious role of government, which ranges from ownership to larger issue of governance.

Using financial incentives to improve value in orthopaedics.

PubMed

Lansky, David; Nwachukwu, Benedict U; Bozic, Kevin J

2012-04-01

A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs. We reviewed and discussed physician- and patient-oriented financial incentives being implemented in orthopaedics, key challenges, and prerequisites to payment reform and value-driven payment policy in orthopaedics. We searched the MEDLINE database using as search terms various provider payment and consumer incentive models. We retrieved a total of 169 articles; none of these studies met the inclusion criteria. For incentive models known to the authors to be in use in orthopaedics but for which no peer-reviewed literature was found, we searched Google for further information. Provider financial incentives reviewed include payments for reporting, performance, and patient safety and episode payment. Patient incentives include tiered networks, value-based benefit design, reference pricing, and value-based purchasing. Reform of financial incentives for orthopaedic surgery is challenged by (1) lack of a payment/incentive model that has demonstrated reductions in cost trends and (2) the complex interrelation of current pay schemes in today's fragmented environment. Prerequisites to reform include (1) a reliable and complete data infrastructure; (2) new business structures to support cost sharing; and (3) a retooling of patient expectations. There is insufficient literature reporting the effects of various financial incentive models under implementation in orthopaedics to know whether they increase quality or reduce costs. National concerns about cost will continue to drive experimentation, and all anticipated innovations will require improved collaboration and data collection and reporting.

Policy Studies Series: Japanese Technology Policy: What’s the Secret?

DTIC Science & Technology

1991-02-01

producers, while subsidies , tax incentives and loan programs provide incentives for Japanese industry to invest in and develop technology. These practices...Education [J Science and Technology Agency 0 MITI 234 12 Defense Agency o Ministry of Agric ., For. & Fish - Ministry of HeallhuWelfare 0 Min. of Posts and...34 The primary task of consortia is information exchange and coordination of a research agenda, not actual joint research. They are most effective in

Alternative Fuels Data Center: Technology Bulletins

Science.gov Websites

Alternative Fuel Vehicles and High Occupancy Vehicle Lanes Updated 9/15 Georgia Sets the Pace for Plug-In advanced vehicles. Laws and Incentives State Alternative Fuel and Advanced Vehicle Laws and Incentives Updated 1/18 State Alternative Fuel and Advanced Vehicle Laws and Incentives: 2016 Year in Review Updated

Hospital Characteristics Related to the Intention to Apply for Meaningful Use Incentive Payments

PubMed Central

Diana, Mark L; Kazley, Abby Swanson; Ford, Eric W; Menachemi, Nir

2012-01-01

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides incentives for hospitals to fully adopt and use electronic health records (EHRs). We used data from the 2009 American Hospital Association (AHA) Annual Survey Information Technology Supplement and the Centers for Medicare and Medicaid Services (CMS) 2008 Hospital Cost Reports to examine how various hospital characteristics are associated with the intention to pursue meaningful use incentives. Overall, 86 percent of hospitals indicated an intent to pursue HITECH incentives. However, hospitals that already have an EHR system, are larger, and are located in urban areas are more likely to indicate an intention to pursue incentives. Despite a high interest in HITECH incentives, certain hospital characteristics, including current EHR use, increase the proclivity for some hospitals to pursue meaningful use. Given these differences, there is the potential for the HITECH Act to inadvertently increase the digital divide between hospitals with certain characteristics and their counterparts without those characteristics. Policy makers should consider ways to alleviate barriers, especially for nonusers of EHRs, to realize the maximum benefits of the HITECH Act. PMID:22737100

Financial Incentives to Enable Clean Energy Deployment: Policy Overview and Good Practices

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

Cox, Sadie

Financial incentives have been widely implemented by governments around the world to support scaled up deployment of renewable energy and energy efficiency technologies and practices. As of 2015, at least 48 countries have adopted financial incentives to support renewable energy and energy efficiency deployment. Broader clean energy strategies and plans provide a crucial foundation for financial incentives that often complement regulatory policies such as renewable energy targets, standards, and other mandates. This policy brief provides a primer on key financial incentive design elements, lessons from different country experiences, and curated support resources for more detailed and country-specific financial incentive designmore » information.« less

A TorPath to TorCoin: Proof-of-Bandwidth Altcoins for Compensating Relays

DTIC Science & Technology

2014-07-18

incentive scheme for Tor relying on two novel concepts. We introduce TorCoin, an “altcoin” that uses the Bitcoin protocol to re- ward relays for...or altcoin, based on the Bitcoin protocol [8]. Unlike Bitcoin , its proof-of-work scheme is based on bandwidth rather than computation. To “mine” a...concepts. We introduce TorCoin, an altcoin" that uses the Bitcoin protocol to re- ward relays for contributing bandwidth. Relays mine" TorCoins, then

Physicians' and nurses' attitudes towards performance-based financial incentives in Burundi: a qualitative study in the province of Gitega.

PubMed

Rudasingwa, Martin; Uwizeye, Marie Rose

2017-01-01

Performance-based financing (PBF) was first implemented in Burundi in 2006 as a pilot programme in three provinces and was rolled out nationwide in 2010. PBF is a reform approach to improve the quality, quantity, and equity of health services and aims at achieving universal health coverage. It focuses on how to best motivate health practitioners. To elicit physicians' and nurses' experiences and views on how PBF influenced and helped them in healthcare delivery. A qualitative cross-sectional study was carried out among frontline health workers such as physicians and nurses. The data was gathered through individual face-to-face, in-depth, semi-structured interviews with 6 physicians and 30 nurses from February to March 2011 in three hospitals in Gitega Province. A simple framework approach and thematic analysis using a combination of manual technique and MAXQDA software guided the analysis of the interview data. Overall, the interviewees felt that the PBF scheme had provided positive motivation to improve the quality of care, mainly in the structures and process of care. The utilization of health services and the relationship between health practitioners and patients also improved. The salary top-ups were recognized as the most significant impetus to increase effort in improving the quality of care. The small and sometimes delayed financial incentives paid to physicians and nurses were criticized. The findings of this study also indicate that the positive interaction between performance-based incentive schemes and other health policies is crucial in achieving comprehensive improvement in healthcare delivery. PBF has the potential to motivate medical staff to improve healthcare provision. The views of medical staff and the context of the area of implementation have to be taken into consideration when designing and implementing PBF schemes.

Potential of anaerobic digestion for mitigation of greenhouse gas emissions and production of renewable energy from agriculture: barriers and incentives to widespread adoption in Europe.

PubMed

Banks, C J; Salter, A M; Chesshire, M

2007-01-01

The paper considers the role of anaerobic digestion in promoting good agricultural practice on farms and the contribution this would make to reducing the environmental impacts associated with manure management. There are no regulatory drivers to promote the use of digestion in Europe, and the technology has only been widely adopted where economic drivers and coherent policies have been implemented at a national level. These measures have included direct subsidy on the energy price paid for "green electricity", and exemption of tax when biogas is used as a vehicle fuel. In those countries where financial incentives are not available or where a financial penalty is incurred through the regulatory regime, the uptake of digestion has been poor. Even with subsidies, digestion of animal manures as a single substrate is not common, and countries with successful schemes have achieved this either by permitting the import of wastes onto the farm or offering bonus subsidies for the use of energy crops. Both of these measures improve the energy efficiency of the process by increasing the volumetric methane production, although concerns are expressed that attention could concentrate on energy production at the expense of improving manure management.

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

Dissemination of Technology to Evaluate Healthy Food Incentive Programs.

PubMed

Freedman, Darcy A; Hunt, Alan R; Merritt, Katie; Shon, En-Jung; Pike, Stephanie N

2017-03-01

Federal policy supports increased implementation of monetary incentive interventions for chronic disease prevention among low-income populations. This study describes how a Prevention Research Center, working with a dissemination partner, developed and distributed technology to support nationwide implementation and evaluation of healthy food incentive programming focused on Supplemental Nutrition Assistance Program recipients. FM Tracks, an iOS-based application and website, was developed to standardize evaluation methods for healthy food incentive program implementation at direct-to-consumer markets. This evaluation examined diffusion and adoption of the technology over 9 months (July 2015-March 2016). Data were analyzed in 2016. FM Tracks was disseminated to 273 markets affiliated with 37 regional networks in 18 states and Washington, DC. All markets adopted the sales transaction data collection feature, with nearly all recording at least one Supplemental Nutrition Assistance Program (99.3%) and healthy food incentive (97.1%) transaction. A total of 43,493 sales transactions were recorded. By the ninth month of technology dissemination, markets were entering individual sales transactions using the application (34.5%) and website (29.9%) and aggregated transactions via website (35.6%) at similar rates. Use of optional evaluation features like recording a customer ID with individual transactions increased successively with a low of 22.2% during the first month to a high of 69.2% in the ninth month. Systematic and widely used evaluation technology creates possibilities for pragmatic research embedded within ongoing, real-world implementation of food access interventions. Technology dissemination requires supportive technical assistance and continuous refinement that can be advanced through academic-practitioner partnerships. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Incentives and children's dietary choices: A field experiment in primary schools.

PubMed

Belot, Michèle; James, Jonathan; Nolen, Patrick

2016-12-01

We conduct a field experiment in 31 primary schools in England to test the effectiveness of different temporary incentives on increasing choice and consumption of fruit and vegetables at lunchtime. In each treatment, pupils received a sticker for choosing a fruit or vegetable at lunch. They were eligible for an additional reward at the end of the week depending on the number of stickers accumulated, either individually (individual scheme) or in comparison to others (competition). Overall, we find no significant effect of the individual scheme, but positive effects of competition. For children who had margin to increase their consumption, competition increases choice of fruit and vegetables by 33% and consumption by 48%. These positive effects generally carry over to the week immediately following the treatment, but are not sustained effects six months later. We also find large differences in effectiveness across demographic characteristics such as age and gender. Copyright © 2016 Elsevier B.V. All rights reserved.

Community oncology in an era of payment reform.

PubMed

Cox, John V; Ward, Jeffery C; Hornberger, John C; Temel, Jennifer S; McAneny, Barbara L

2014-01-01

Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

From randomized controlled trials to evidence grading schemes: current state of evidence-based practice in social sciences.

PubMed

Boruch, Robert; Rui, Ning

2008-11-01

With the advance of web search and navigation technology, enormous amount of information, non-information, and misinformation may be obtained in milliseconds in response to questions about 'what works' in social sciences. Today, policy makers in non-medical public service arenas are under increasing pressure to make sound decisions based on scientific evidence. Some of these decisions are a matter of legal requirement. This paper shows how such movements are closely aligned with the evolution of organizations that develop and apply evidence standards and evidence grading schemes within the social science communities. The current state of evidence-based practice in social sciences is examined by reviewing the latest development of randomized trials and evidence grading schemes in the fields of education, criminal justice, and social welfare. Studies conducted under the auspices of the Campbell Collaboration and What Works Clearinghouse are used to illustrate ingredients of evidence grading schemes, graphic display of results of systematic reviews, and discrepancies of evidence derived from randomized trials and non-experimental trials. Furthermore, it is argued that the use of evidence on 'what works' depends on the potential users' awareness, understanding of the evidence, as well as their capacity and willingness to use it. Awareness and understanding depends on the world wide web and its augmentations, while capacity and willingness depends more on incentives to use good evidence and on political and ethical values. Implications for the future development of evidence grading organizations are discussed. © 2008 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

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.

Technology, Incentives, or Both? Factors Related to Level of Hospital Health Information Exchange.

PubMed

Lin, Sunny C; Everson, Jordan; Adler-Milstein, Julia

2018-02-28

To assess whether the level of health information exchange (HIE) in U.S. hospitals is related to technology capabilities, incentives to exchange, or both. A total of 1,812 hospitals attesting to stage 2 of Medicare's Meaningful Use Incentive Program through April 2016. Hospital-level, multivariate OLS regression with state fixed effects was used to analyze the relationship between technology capability and incentives measures, and percent of care transitions with summary of care records (SCRs) sent electronically to subsequent providers. Stage 2 hospitals reported sending SCRs electronically for an average of 41 percent (median = 33 percent) of transitions. HIE level is related to four capability measures, one incentive measure, and one measure that is related to both capability and incentive. Percent of transitions with SCRs sent electronically was 3 percentage points higher (95 percent CI: 0.1-5.1) for hospitals with a third-party HIE vendor, 3 percentage points higher (95 percent CI: 0.5-5.4) for hospitals with an EHR vendor as their HIE vendor, and 3 percentage points higher (95 percent CI: 0.4-5.4) for hospitals that automatically alert primary care providers. The direction and statistical significance of the relationships between specific EHR vendor and electronic SCR transmission level varied by vendor. Nonprofits and government hospitals performed 5 percentage points higher (95 percent CI: 1.5-9.1) and 8 percentage points higher (95 percent CI: 3.4-12.3) than for-profits. Hospitals in systems performed 3 percentage points higher (95 percent CI: 0.8-6.1). The overall level of HIE is low, with hospitals sending an SCR electronically for less than half of patient transitions. Specific hospital characteristics related to both technology capabilities and incentives were associated with higher levels of HIE. © Health Research and Educational Trust.

42 CFR 495.102 - Incentive payments to EPs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... in its place the phrase “Business address, business email address, and” in (a)(3), effective Nov. 5...

In Praise of Monetary Motivation.

ERIC Educational Resources Information Center

Piamonte, John S.

1979-01-01

Although management has built remuneration policies on the belief that money does not motivate personnel, the author states that the best way to encourage high performance is still money if administered correctly. He discusses behavior theories, incentive/contingency principles, the weaknesses of many merit pay schemes, and factors in employee…

Physicians' responses to financial and social incentives: A medically framed real effort experiment.

PubMed

Lagarde, Mylène; Blaauw, Duane

2017-04-01

Because compensation policies have critical implications for the provision of health care, and evidence of their effects is limited and difficult to study in the real world, laboratory experiments may be a valuable methodology to study the behavioural responses of health care providers. With this experiment undertaken in 2013, we add to this new literature by designing a new medically framed real effort task to test the effects of different remuneration schemes in a multi-tasking context. We assess the impact of different incentives on the quantity (productivity) and quality of outputs of 132 participants. We also test whether the existence of benefits to patients influences effort. The results show that salary yields the lowest quantity of output, and fee-for-service the highest. By contrast, we find that the highest quality is achieved when participants are paid by salary, followed by capitation. We also find a lot of heterogeneity in behaviour, with intrinsically motivated individuals hardly sensitive to financial incentives. Finally, we find that when work quality benefits patients directly, subjects improve the quality of their output, while maintaining the same levels of productivity. This paper adds to a nascent literature by providing a new approach to studying remuneration schemes and modelling the medical decision making environment in the lab. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Domestic waste recycling, collective action and economic incentive: the case in Hong Kong.

PubMed

Yau, Yung

2010-12-01

Efficacy of waste recycling is one of the key determinants of environmental sustainability of a city. Like other pro-environmental activities, waste recycling cannot be successfully accomplished by just one or two people, but only by a concerted effort of the community. The collective-action dilemma creates a common underlying difficulty in formulating workable solutions to many environmental problems. With a view to the non-excludability of the outcome, rationality drives people to free-ride efforts of others in waste recycling. To solve this free-rider problem, some scholars suggest the use of economic incentive. This article attempts to study the impacts of reward schemes on waste recycling behaviour of residents in 122 private housing estates in Hong Kong. The study is differentiable from the others as the latter mainly focus on domestic waste recycling in low-rise low-density housing while this one looks into the same in a high-rise high-density residential setting. According to the results of analyses on a set of aggregate data, reward schemes are found to have a significant positive relationship with the per-household weight of recyclables collected, keeping other things constant. The research findings suggest that economic incentives do work in promoting waste recycling in Hong Kong. Practical and policy implications follow. Copyright © 2010 Elsevier Ltd. All rights reserved.

Country Review of Energy-Efficiency Financial Incentives in the Residential Sector

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

Can, Stephane de la Rue du; Shah, Nihar; Phadke, Amol

A large variety of energy-efficiency policy measures exist. Some are mandatory, some are informative, and some use financial incentives to promote diffusion of efficient equipment. From country to country, financial incentives vary considerably in scope and form, the type of framework used to implement them, and the actors that administer them. They range from rebate programs administered by utilities under an Energy-Efficiency Resource Standards (EERS) regulatory framework (California, USA) to the distribution of Eco-points rewarding customers for buying highly efficient appliances (Japan). All have the primary objective of transforming the current market to accelerate the diffusion of efficient technologies bymore » addressing up-front cost barriers faced by consumers; in most instances, efficient technologies require a greater initial investment than conventional technologies. In this paper, we review the different market transformation measures involving the use of financial incentives in the countries belonging to the Major Economies Forum. We characterize the main types of measures, discuss their mechanisms, and provide information on program impacts to the extent that ex-ante or ex-post evaluations have been conducted. Finally, we identify best practices in financial incentive programs and opportunities for coordination between Major Economies Forum countries as envisioned under the Super Efficient Appliance Deployment (SEAD) initiative.« less

"Meaningful use" of EHR in dental school clinics: how to benefit from the U.S. HITECH Act's financial and quality improvement incentives.

PubMed

Kalenderian, Elsbeth; Walji, Muhammad; Ramoni, Rachel B

2013-04-01

Through the 2009 HITECH (Health Information Technology for Economic and Clinical Health) Act, the U.S. government committed $27 billion to incentivize the adoption and "meaningful use" of certified electronic health records (EHRs) by providers, including dentists. Given their patient profiles, dental school clinics are in a position to benefit from this time-delimited commitment to support the adoption and use of certified EHR technology under the Medicaid-based incentive. The benefits are not merely financial: rather, the meaningful use objectives and clinical quality measures can drive quality improvement initiatives within dental practices and help develop a community of medical and dental professionals focused on quality. This article describes how dentists can qualify as eligible providers and the set of activities that must be undertaken and attested to in order to obtain this incentive. Two case studies describe the approaches that can be used to meet the Medicaid threshold necessary to be eligible for the incentive. Dentists can and have successfully applied for meaningful use incentive payments. Given the diverse set of patients who are treated at dental schools, these dental practices are among those most likely to benefit from the incentive programs.

Landfill taxes and Enhanced Waste Management: Combining valuable practices with respect to future waste streams.

PubMed

Hoogmartens, Rob; Eyckmans, Johan; Van Passel, Steven

2016-09-01

Both landfill taxes and Enhanced Waste Management (EWM) practices can mitigate the scarcity issue of landfill capacity by respectively reducing landfilled waste volumes and valorising future waste streams. However, high landfill taxes might erode incentives for EWM, even though EWM creates value by valorising waste. Concentrating on Flanders (Belgium), the paper applies dynamic optimisation modelling techniques to analyse how landfill taxation and EWM can reinforce each other and how taxation schemes can be adjusted in order to foster sustainable and welfare maximising ways of processing future waste streams. Based on the Flemish simulation results, insights are offered that are generally applicable in international waste and resource management policy. As shown, the optimal Flemish landfill tax that optimises welfare in the no EWM scenario is higher than the one in the EWM scenario (93 against €50/ton). This difference should create incentives for applying EWM and is driven by the positive external effects that are generated by EWM practices. In Flanders, as the current landfill tax is slightly lower than these optimal levels, the choice that can be made is to further increase taxation levels or show complete commitment to EWM. A first generally applicable insight that was found points to the fact that it is not necessarily the case that the higher the landfill tax, the more effective waste management improvements can be realised. Other insights are about providing sufficient incentives for applying EMW practices and formulating appropriate pleas in support of technological development. By these insights, this paper should provide relevant information that can assist in triggering the transition towards a resource-efficient, circular economy in Europe. Copyright © 2016 Elsevier Ltd. All rights reserved.

Raising Children Bilingually Is Hard: Why Bother?

ERIC Educational Resources Information Center

Sims, Margaret; Ellis, Elizabeth M.

2014-01-01

This paper presents results from a pilot project that sought to establish parental motivations for raising children bilingually in regional Australia in the absence of a co-located speech community. Cultural and linguistic diversity outside metropolitan areas is increasing as a result of Commonwealth Government incentive schemes, and one effect of…

78 FR 21107 - Circular Welded Carbon Steel Pipes and Tubes from Turkey: Preliminary Results of Countervailing...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-09

...: Allocation of State Land Regional Incentive Scheme: Interest Support OIZ: Waste Water Charges [[Page 21109... customs purposes, the written description of the merchandise is dispositive. Methodology The Department... regarding specificity. For a full description of the methodology underlying our conclusions, please see...

DIFFERENTIATING PASSENGER VEHICLES BY FUEL ECONOMY: STRATEGIC INCENTIVES AND THE COST-EFFECTIVENESS OF TRADABLE CAFE STANDARDS

EPA Science Inventory

The welfare and distributional effects of alternative fuel economy regulations will be compared, including an increase in existing CAFE standards, allowing for tradable credits, and implementing other design options in a trading scheme, such as sliding standards based on ve...

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

Financial incentives and coverage of child health interventions: a systematic review and meta-analysis.

PubMed

Bassani, Diego G; Arora, Paul; Wazny, Kerri; Gaffey, Michelle F; Lenters, Lindsey; Bhutta, Zulfiqar A

2013-01-01

Financial incentives are widely used strategies to alleviate poverty, foster development, and improve health. Cash transfer programs, microcredit, user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America, Sub-Saharan Africa, and more recently in Southeast Asia. Until now, no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted. The objective of this review is to provide estimates on the effect of six types of financial incentive programs: (i) Unconditional cash transfers (CT), (ii) Conditional cash transfers (CCT), (iii) Microcredit (MC), (iv) Conditional Microcredit (CMC), (v) Voucher schemes (VS) and (vi) User fee removal (UFR) on the uptake and coverage of health interventions targeting children under the age of five years. We conducted systematic searches of a series of databases until September 1st, 2012, to identify relevant studies reporting on the impact of financial incentives on coverage of health interventions and behaviors targeting children under 5 years of age. The quality of the studies was assessed using the CHERG criteria. Meta-analyses were undertaken to estimate the effect when multiple studies meeting our inclusion criteria were available. Our searches resulted in 1671 titles identified 25 studies reporting on the impact of financial incentive programs on 5 groups of coverage indicators: breastfeeding practices (breastfeeding incidence, proportion of children receiving colostrum and early initiation of breastfeeding, exclusive breastfeeding for six months and duration of breastfeeding); vaccination (coverage of full immunization, partial immunization and specific antigens); health care use (seeking healthcare when child was ill, visits to health facilities for preventive reasons, visits to health facilities for any reason, visits for health check-up including growth control); management of diarrhoeal disease (ORS use during diarrhea episode, continued feeding during diarrhea, healthcare during diarrhea episode) and other preventive health interventions (iron supplementation, vitamin A, zinc supplementation, preventive deworming). The quality of evidence on the effect of financial incentives on breastfeeding practices was low but seems to indicate a potential positive impact on receiving colostrum, early initiation of breastfeeding, exclusive breastfeeding and mean duration of exclusive breastfeeding. There is no effect of financial incentives on immunization coverage although there was moderate quality evidence of conditional cash transfers leading to a small but non-significant increase in coverage of age-appropriate immunization. There was low quality evidence of impact of CCT on healthcare use by children under age 5 (Risk difference: 0.14 [95%CI: 0.03; 0.26]) as well as low quality evidence of an effect of user fee removal on use of curative health services (RD=0.62 [0.41; 0.82]). Financial incentives may have potential to promote increased coverage of several important child health interventions, but the quality of evidence available is low. The more pronounced effects seem to be achieved by programs that directly removed user fees for access to health services. Some indication of effect were also observed for programs that conditioned financial incentives on participation in health education and attendance to health care visits. This finding suggest that the measured effect may be less a consequence of the financial incentive and more due to conditionalities addressing important informational barriers.

Financial incentives and coverage of child health interventions: a systematic review and meta-analysis

PubMed Central

2013-01-01

Background Financial incentives are widely used strategies to alleviate poverty, foster development, and improve health. Cash transfer programs, microcredit, user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America, Sub-Saharan Africa, and more recently in Southeast Asia. Until now, no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted. The objective of this review is to provide estimates on the effect of six types of financial incentive programs: (i) Unconditional cash transfers (CT), (ii) Conditional cash transfers (CCT), (iii) Microcredit (MC), (iv) Conditional Microcredit (CMC), (v) Voucher schemes (VS) and (vi) User fee removal (UFR) on the uptake and coverage of health interventions targeting children under the age of five years. Methods We conducted systematic searches of a series of databases until September 1st, 2012, to identify relevant studies reporting on the impact of financial incentives on coverage of health interventions and behaviors targeting children under 5 years of age. The quality of the studies was assessed using the CHERG criteria. Meta-analyses were undertaken to estimate the effect when multiple studies meeting our inclusion criteria were available. Results Our searches resulted in 1671 titles identified 25 studies reporting on the impact of financial incentive programs on 5 groups of coverage indicators: breastfeeding practices (breastfeeding incidence, proportion of children receiving colostrum and early initiation of breastfeeding, exclusive breastfeeding for six months and duration of breastfeeding); vaccination (coverage of full immunization, partial immunization and specific antigens); health care use (seeking healthcare when child was ill, visits to health facilities for preventive reasons, visits to health facilities for any reason, visits for health check-up including growth control); management of diarrhoeal disease (ORS use during diarrhea episode, continued feeding during diarrhea, healthcare during diarrhea episode) and other preventive health interventions (iron supplementation, vitamin A, zinc supplementation, preventive deworming). The quality of evidence on the effect of financial incentives on breastfeeding practices was low but seems to indicate a potential positive impact on receiving colostrum, early initiation of breastfeeding, exclusive breastfeeding and mean duration of exclusive breastfeeding. There is no effect of financial incentives on immunization coverage although there was moderate quality evidence of conditional cash transfers leading to a small but non-significant increase in coverage of age-appropriate immunization. There was low quality evidence of impact of CCT on healthcare use by children under age 5 (Risk difference: 0.14 [95%CI: 0.03; 0.26]) as well as low quality evidence of an effect of user fee removal on use of curative health services (RD=0.62 [0.41; 0.82]). Conclusions Financial incentives may have potential to promote increased coverage of several important child health interventions, but the quality of evidence available is low. The more pronounced effects seem to be achieved by programs that directly removed user fees for access to health services. Some indication of effect were also observed for programs that conditioned financial incentives on participation in health education and attendance to health care visits. This finding suggest that the measured effect may be less a consequence of the financial incentive and more due to conditionalities addressing important informational barriers. PMID:24564520

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.

Multiagent cooperation and competition with deep reinforcement learning.

PubMed

Tampuu, Ardi; Matiisen, Tambet; Kodelja, Dorian; Kuzovkin, Ilya; Korjus, Kristjan; Aru, Juhan; Aru, Jaan; Vicente, Raul

2017-01-01

Evolution of cooperation and competition can appear when multiple adaptive agents share a biological, social, or technological niche. In the present work we study how cooperation and competition emerge between autonomous agents that learn by reinforcement while using only their raw visual input as the state representation. In particular, we extend the Deep Q-Learning framework to multiagent environments to investigate the interaction between two learning agents in the well-known video game Pong. By manipulating the classical rewarding scheme of Pong we show how competitive and collaborative behaviors emerge. We also describe the progression from competitive to collaborative behavior when the incentive to cooperate is increased. Finally we show how learning by playing against another adaptive agent, instead of against a hard-wired algorithm, results in more robust strategies. The present work shows that Deep Q-Networks can become a useful tool for studying decentralized learning of multiagent systems coping with high-dimensional environments.

Multiagent cooperation and competition with deep reinforcement learning

PubMed Central

Kodelja, Dorian; Kuzovkin, Ilya; Korjus, Kristjan; Aru, Juhan; Aru, Jaan; Vicente, Raul

2017-01-01

Evolution of cooperation and competition can appear when multiple adaptive agents share a biological, social, or technological niche. In the present work we study how cooperation and competition emerge between autonomous agents that learn by reinforcement while using only their raw visual input as the state representation. In particular, we extend the Deep Q-Learning framework to multiagent environments to investigate the interaction between two learning agents in the well-known video game Pong. By manipulating the classical rewarding scheme of Pong we show how competitive and collaborative behaviors emerge. We also describe the progression from competitive to collaborative behavior when the incentive to cooperate is increased. Finally we show how learning by playing against another adaptive agent, instead of against a hard-wired algorithm, results in more robust strategies. The present work shows that Deep Q-Networks can become a useful tool for studying decentralized learning of multiagent systems coping with high-dimensional environments. PMID:28380078

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.

Incentives to create and sustain healthy behaviors: technology solutions and research needs.

PubMed

Teyhen, Deydre S; Aldag, Matt; Centola, Damon; Edinborough, Elton; Ghannadian, Jason D; Haught, Andrea; Jackson, Theresa; Kinn, Julie; Kunkler, Kevin J; Levine, Betty; Martindale, Valerie E; Neal, David; Snyder, Leslie B; Styn, Mindi A; Thorndike, Frances; Trabosh, Valerie; Parramore, David J

2014-12-01

Health-related technology, its relevance, and its availability are rapidly evolving. Technology offers great potential to minimize and/or mitigate barriers associated with achieving optimal health, performance, and readiness. In support of the U.S. Army Surgeon General's vision for a "System for Health" and its Performance Triad initiative, the U.S. Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled "Incentives to Create and Sustain Change for Health." Members of government and academia participated to identify and define the opportunities, gain clarity in leading practices and research gaps, and articulate the characteristics of future technology solutions to create and sustain real change in the health of individuals, the Army, and the nation. The key factors discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior change intervention, and (5) the role of peer and social networks in change. This report summarizes the recommendations on how technology solutions could be employed to leverage evidence-based best practices and identifies gaps in research where further investigation is needed. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Exogenous and Endogenous Impacts into Teachers' Work Performance Sphere

ERIC Educational Resources Information Center

Nasrun

2016-01-01

By this synopsis research which conveyed of findings to unfold mutual effect between teachers' performance and incentive scheme and teachers' personal competency, and principal leadership, and work motivation, by means of explanatory research in which ex facto method was ad hock model chosen because of classified as non-experiment. The grounds…

Hospital budget increase for information technology during phase 1 meaningful use.

PubMed

Neumeier, Harold; Berner, Eta S; Burke, Darrell E; Azuero, Andres

2015-01-01

Federal policies have a significant effect on how businesses spend money. The 2009 HITECH (Health Information Technology for Economic and Clinical Health Act) authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use certified electronic health records privately and securely to achieve specified improvements in care delivery. Federal incentive payments were offered in 2011 for hospitals that had satisfied "meaningful use" criteria. A longitudinal study of nonfederal hospital information technology (IT) budgets (N = 493) during the years 2009 to 2011 found increases in the percentage of hospital annual operating budgets allocated to IT in the years leading up to these federal incentives. This increase was most pronounced among hospitals receiving high proportions of their reimbursements from Medicaid, followed by hospitals receiving high proportions of their reimbursements from Medicare, possibly indicating a budget shift during this period to more IT spending to achieve meaningful-use policy guidelines.

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.

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.

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.

Health worker recruitment and deployment in remote areas of Indonesia.

PubMed

Efendi, Ferry

2012-01-01

Providing health care in remote and very remote areas has long been a major concern in Indonesia. In order to improve access to quality health care for residents in these areas, various policies on recruitment and deployment of health workers have been implemented, among them compulsory service, contracted staff and the Special Assignment of strategic health workers. Indonesia's difficult geography presents great challenges to health service delivery and most health workers prefer to serve in urban areas, resulting in an uneven distribution of health workers and shortages in remote areas. Great efforts have been made to mobilize health human resources more equitably, including placement schemes for strategic health workers and contracted staff, combined with an incentive scheme. While these have partially addressed the severe shortage of health workers in remote areas, current government policies were reviewed in order to clarify the current situation in Indonesia. The Contracted Staff and Special Assignment of Strategic Health Workers programs show have made a significant contribution to improving the availability of health workers in Indonesia's remote areas. As these two programs used financial incentives as the main intervention, other non-financial interventions should also be trialed. For example, incentives such as the promise of a civil servant appointment or the provision of continuing professional education, as well as the recruitment of rural-background health workers may increase the willingness of health staff to serve in the remote and very remote areas of Indonesia.

Payday, ponchos, and promotions: a qualitative analysis of perspectives from non-governmental organization programme managers on community health worker motivation and incentives.

PubMed

B-Lajoie, Marie-Renée; Hulme, Jennifer; Johnson, Kirsten

2014-12-05

Community health workers (CHWs) have been central to broadening the access and coverage of preventative and curative health services worldwide. Much has been debated about how to best remunerate and incentivize this workforce, varying from volunteers to full time workers. Policy bodies, including the WHO and USAID, now advocate for regular stipends. This qualitative study examines the perspective of health programme managers from 16 international non-governmental organizations (NGOs) who directly oversee programmes in resource-limited settings. It aimed to explore institutional guidelines and approaches to designing CHW incentives, and inquire about how NGO managers are adapting their approaches to working with CHWs in this shifting political and funding climate. Second, it meant to understand the position of stakeholders who design and manage non-governmental organization-run CHW programmes on what they consider priorities to boost CHW motivation. Individuals were recruited using typical case sampling through chain referral at the semi-annual CORE Group meeting in the spring of 2012. Semi-structured interviews were guided by a peer reviewed tool. Two reviewers analyzed the transcripts for thematic saturation. Six key factors influenced programme manager decision-making: National-level government policy, donor practice, implicit organizational approaches, programmatic, cultural, and community contexts, experiences and values of managers, and the nature of the work asked of CHWs. Programme managers strongly relied on national government to provide clear guidance on CHW incentives schemes. Perspectives on remuneration varied greatly, from fears that it is unsustainable, to the view that it is a basic human right, and a mechanism to achieve greater gender equity. Programme managers were interested in exploring career paths and innovative financing schemes for CHWs, such as endowment funds or material sales, to heighten local ownership and sustainability of programmes. Participants also supported the creation of both national-level and global interfaces for sharing practical experience and best practices with other CHW programmes. Prescriptive recommendations for monetary remuneration, aside from those coming from national governments, will likely continue to meet resistance by NGOs, as contexts are nuanced. There is growing consensus that incentives should reflect the nature of the work asked of CHWs, and the potential for motivation through sustainable financial schemes other than regular salaries. Programme managers advocate for greater transparency and information sharing among organizations.

Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study.

PubMed

McGill, Bronwyn; O'Hara, Blythe J; Grunseit, Anne C; Bauman, Adrian; Osborne, Dale; Lawler, Luke; Phongsavan, Philayrath

2018-02-13

Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss. We used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups. Both independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance. If financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire for external supports to motivate and sustain weight loss maintenance.

Physicians’ and nurses’ attitudes towards performance-based financial incentives in Burundi: a qualitative study in the province of Gitega

PubMed Central

Rudasingwa, Martin; Uwizeye, Marie Rose

2017-01-01

ABSTRACT Background: Performance-based financing (PBF) was first implemented in Burundi in 2006 as a pilot programme in three provinces and was rolled out nationwide in 2010. PBF is a reform approach to improve the quality, quantity, and equity of health services and aims at achieving universal health coverage. It focuses on how to best motivate health practitioners. Objective: To elicit physicians’ and nurses’ experiences and views on how PBF influenced and helped them in healthcare delivery. Methods: A qualitative cross-sectional study was carried out among frontline health workers such as physicians and nurses. The data was gathered through individual face-to-face, in-depth, semi-structured interviews with 6 physicians and 30 nurses from February to March 2011 in three hospitals in Gitega Province. A simple framework approach and thematic analysis using a combination of manual technique and MAXQDA software guided the analysis of the interview data. Results: Overall, the interviewees felt that the PBF scheme had provided positive motivation to improve the quality of care, mainly in the structures and process of care. The utilization of health services and the relationship between health practitioners and patients also improved. The salary top-ups were recognized as the most significant impetus to increase effort in improving the quality of care. The small and sometimes delayed financial incentives paid to physicians and nurses were criticized. The findings of this study also indicate that the positive interaction between performance-based incentive schemes and other health policies is crucial in achieving comprehensive improvement in healthcare delivery. Conclusions: PBF has the potential to motivate medical staff to improve healthcare provision. The views of medical staff and the context of the area of implementation have to be taken into consideration when designing and implementing PBF schemes. PMID:28452651

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 effectiveness of Hong Kong's Construction Waste Disposal Charging Scheme.

PubMed

Hao, Jane L; Hills, Martin J; Tam, Vivian W Y

2008-12-01

The Hong Kong Government introduced the Construction Waste Disposal Charging Scheme in December 2005 to ensure that disposal of construction and demolition (C&D) waste is properly priced to reduce such waste. The charging scheme is not only intended to provide an economic incentive for contractors and developers to reduce waste but also to encourage reuse and recycling of waste material thereby slowing down the depletion of limited landfill and public filling capacities. This paper examines the effectiveness of the charging scheme 1 year after implementation. A survey was conducted at Tseung Kwan O Area 137 and Tuen Mun Area 38, and daily C&D waste records were collected from landfills and public filling facilities between January 2006 and December 2006. The results of the survey show that waste has been reduced by approximately 60% in landfills, by approximately 23% in public fills, and by approximately 65% in total waste between 2005 and 2006. Suggestions for improving the scheme are provided.

75 FR 36157 - Establishment of the Temporary Certification Program for Health Information Technology

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

...This final rule establishes a temporary certification program for the purposes of testing and certifying health information technology. This final rule is established under the authority granted to the National Coordinator for Health Information Technology (the National Coordinator) by section 3001(c)(5) of the Public Health Service Act (PHSA), as added by the Health Information Technology for Economic and Clinical Health (HITECH) Act. The National Coordinator will utilize the temporary certification program to authorize organizations to test and certify Complete Electronic Health Records (EHRs) and/or EHR Modules, thereby making Certified EHR Technology available prior to the date on which health care providers seeking incentive payments available under the Medicare and Medicaid EHR Incentive Programs may begin demonstrating meaningful use of Certified EHR Technology.

The use of agrobiodiversity for plant improvement and the intellectual property paradigm: institutional fit and legal tools for mass selection, conventional and molecular plant breeding.

PubMed

Batur, Fulya; Dedeurwaerdere, Tom

2014-12-01

Focused on the impact of stringent intellectual property mechanisms over the uses of plant agricultural biodiversity in crop improvement, the article delves into a systematic analysis of the relationship between institutional paradigms and their technological contexts of application, identified as mass selection, controlled hybridisation, molecular breeding tools and transgenics. While the strong property paradigm has proven effective in the context of major leaps forward in genetic engineering, it faces a systematic breakdown when extended to mass selection, where innovation often displays a collective nature. However, it also creates partial blockages in those innovation schemes rested between on-farm observation and genetic modification, i.e. conventional plant breeding and upstream molecular biology research tools. Neither overly strong intellectual property rights, nor the absence of well delineated protection have proven an optimal fit for these two intermediary socio-technological systems of cumulative incremental innovation. To address these challenges, the authors look at appropriate institutional alternatives which can create effective incentives for in situ agrobiodiversity conservation and the equitable distribution of technologies in plant improvement, using the flexibilities of the TRIPS Agreement, the liability rules set forth in patents or plant variety rights themselves (in the form of farmers', breeders' and research exceptions), and other ad hoc reward regimes.

Evaluation of Impinging Stream Vortex Chamber Concepts for Liquid Rocket Engine Applications

NASA Technical Reports Server (NTRS)

Trinh, Huu P.; Bullard, Brad; Kopicz, Charles; Michaels, Scott; Turner, James (Technical Monitor)

2001-01-01

To pursue technology developments for future launch vehicles, NASA/Marshall Space Flight Center (MSFC) is examining vortex chamber concepts for liquid rocket engine applications. Past studies indicated that the vortex chamber schemes potentially have a number of advantages over conventional chamber methods. Due to the nature of the vortex flow, relatively cooler propellant streams tend to flow along the chamber wall. Hence, the thruster chamber can be operated without the need of any cooling techniques. This vortex flow also creates strong turbulence, which promotes the propellant mixing process. Consequently, the subject chamber concepts not only offer the system simplicity, but they also would enhance the combustion performance. The test results showed that the chamber performance was markedly high even at a low chamber length-to-diameter ratio (L/D). This incentive can be translated to a convenience in the thrust chamber packaging. Variations of the vortex chamber concepts have been introduced in the past few decades. These investigations include an ongoing work at Orbital Technologies Corporation (ORBITEC). By injecting the oxidizer tangentially at the chamber convergence and fuel axially at the chamber head end, Knuth et al. were able to keep the wall relatively cold. A recent investigation of the low L/D vortex chamber concept for gel propellants was conducted by Michaels. He used both triplet (two oxidizer and one fuel orifices) and unlike impinging schemes to inject propellants tangentially along the chamber wall. Michaels called the subject injection scheme as Impinging Stream Vortex Chamber (ISVC). His preliminary tests showed that high performance, with an Isp efficiency of 92%, can be obtained. MSFC and the U.S. Army are jointly investigating an application of the ISVC concept for the cryogenic oxygen/hydrocarbon propellant system. This vortex chamber concept is currently tested with gel propellants at AMCOM at Redstone Arsenal, Alabama. A version of this concept for the liquid oxygen (LOX)/hydrocarbon fuel (RPM) system has been derived from the one for the gel propellant.

Technology transfer needs and experiences: The NASA Research Center perspective

NASA Technical Reports Server (NTRS)

Gross, Anthony R.

1992-01-01

Viewgraphs on technology transfer needs and experiences - the NASA Research Center perspective are provided. Topics covered include: functions of NASA, incentives and benefits, technology transfer mechanisms, economics of technology commercialization, examples, and conclusions.

A constraint satisfaction method applied to the problem of controlling the CO2 emission in the Legal Brazilian Amazon

NASA Astrophysics Data System (ADS)

Caetano, Marco Antonio Leonel; Gherardi, Douglas Francisco Marcolino; Yoneyama, Takashi

2013-11-01

Socioeconomic-driven processes such as deforestation, forest degradation, forest fires, overgrazing, overharvesting of fuelwood and slash-and-burn practices constitute the primary sources of Greenhouse Gases (GHG) emissions in developing countries. Climate policies can induce the development of clean technology and offer incentives to accelerate reforestation. The Brazilian government has already acknowledged the urgency to invest in policies to reduce anthropogenic CO2 emissions in the Legal Brazilian Amazon (BA). In this work, we propose a scheme to estimate the required investments in clean technology and reforestation to achieve a prescribed short term target value for the atmospheric CO2 emission. Initially, a mathematical model is fitted to the available data to allow forecasting the values of the short term emissions of CO2 under a combination of investments in clean technology and reforestation. The investments to reduce the emissions of CO2 below a target value (400 million tons/year, starting at the initial value of 450) in 3 years’ time are proportional to the regional GDP. Using computer simulation it is possible to generate a range of possible investment values in clean technology and reforestation, so that the prescribed emission reduction is achieved without hindering economic growth. This strategy provides the necessary investment flexibility for the implementation of realistic climate policies.

42 CFR 495.304 - Medicaid provider scope and eligibility.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY... incentives program: (1) Medicaid EPs. (2) Acute care hospitals. (3) Children's hospitals. (b) Medicaid EP... patient volume for each year for which the hospital seeks an EHR incentive payment. (2) A children's...

42 CFR 495.304 - Medicaid provider scope and eligibility.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY... incentives program: (1) Medicaid EPs. (2) Acute care hospitals. (3) Children's hospitals. (b) Medicaid EP... patient volume for each year for which the hospital seeks an EHR incentive payment. (2) A children's...

42 CFR 495.304 - Medicaid provider scope and eligibility.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY... incentives program: (1) Medicaid EPs. (2) Acute care hospitals. (3) Children's hospitals. (b) Medicaid EP... patient volume for each year for which the hospital seeks an EHR incentive payment. (2) A children's...

42 CFR 495.304 - Medicaid provider scope and eligibility.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY... incentives program: (1) Medicaid EPs. (2) Acute care hospitals. (3) Children's hospitals. (b) Medicaid EP... each year for which the hospital seeks an EHR incentive payment. (2) A children's hospital is exempt...

42 CFR 495.304 - Medicaid provider scope and eligibility.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY... incentives program: (1) Medicaid EPs. (2) Acute care hospitals. (3) Children's hospitals. (b) Medicaid EP... each year for which the hospital seeks an EHR incentive payment. (2) A children's hospital is exempt...

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.

Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.

PubMed

Berenson, Robert A; Rice, Thomas

2015-12-01

The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. Payment policy should help temper the current "more is better" attitude of physicians and provider organizations. Incentive neutrality would better support health professionals' intrinsic motivation to act in their patients' best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians' intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care. Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes. © Health Research and Educational Trust.

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

The Best Ideas Come from Teachers like You!

ERIC Educational Resources Information Center

Instructor, 2007

2007-01-01

Several teachers share their ideas for classroom activities. These include: (1) combining science and art on Earth Day; (2) implementing an inexpensive incentive scheme to get students to bring their signed papers back to school on time; (3) involving students in a virtual zoo; (4) planting real grass in Easter Bunny baskets; and (5) creating own…

Carbon prices and incentives for technological development.

PubMed

Lundgren, Tommy; Marklund, Per-Olov; Samakovlis, Eva; Zhou, Wenchao

2015-03-01

There is concern that the carbon prices generated through climate policies are too low to create the incentives necessary to stimulate technological development. This paper empirically analyzes how the Swedish carbon dioxide (CO2) tax and the European Union emission trading system (EU ETS) have affected productivity development in the Swedish pulp and paper industry 1998-2008. A Luenberger total factor productivity (TFP) indicator is computed using data envelopment analysis. The results show that climate policy had a modest impact on technological development in the pulp and paper industry, and if significant it was negative. The price of fossil fuels, on the contrary, seems to have created important incentives for technological development. Hence, the results suggest that the carbon prices faced by the industry through EU ETS and the CO2 tax have been too low. Even though the data for this study is specific for Sweden, the models and results are applicable internationally. When designing policy to mitigate CO2 emissions, it is vital that the policy creates a carbon price that is high enough - otherwise the pressure on technological development will not be sufficiently strong. Copyright © 2014 Elsevier Ltd. All rights reserved.

Do rewards reinforce the growth mindset?: Joint effects of the growth mindset and incentive schemes in a field intervention.

PubMed

Chao, Melody Manchi; Visaria, Sujata; Mukhopadhyay, Anirban; Dehejia, Rajeev

2017-10-01

The current study draws on the motivational model of achievement which has been guiding research on the growth mindset intervention (Dweck & Leggett, 1988) and examines how this intervention interacts with incentive systems to differentially influence performance for high- and low-achieving students in Indian schools that serve low-SES communities. Although, as expected, the growth mindset intervention did interact with incentive systems and prior achievement to influence subsequent academic performance, the existing growth mindset framework cannot fully account for the observed effects. Specifically, we found that the growth mindset intervention did facilitate performance through persistence, but only when the incentive system imparted individuals with a sense of autonomy. Such a facilitation effect was only found among those students who had high prior achievement, but not among those who had underperformed. When the incentive did not impart a sense of autonomy, the growth mindset intervention undermined the performance of those who had high initial achievement. To reconcile these discrepancies and to advance understanding of the impacts of psychological interventions on achievement outcomes, we discuss how the existing theory can be extended and integrated with an identity-based motivation framework (Oyserman & Destin, 2010). We also discuss the implications of our work for future research and practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Health-related scientific and technological capabilities and university-industry research collaboration].

PubMed

Britto, Jorge; Vargas, Marco Antônio; Gadelha, Carlos Augusto Grabois; Costa, Laís Silveira

2012-12-01

To examine recent developments in health-related scientific capabilities, the impact of lines of incentives on reducing regional scientific imbalances, and university-industry research collaboration in Brazil. Data were obtained from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazilian National Council for Scientific and Technological Development) databases for the years 2000 to 2010. There were assessed indicators of resource mobilization, research network structuring, and knowledge transfer between science and industry initiatives. Based on the regional distribution map of health-related scientific and technological capabilities there were identified patterns of scientific capabilities and science-industry collaboration. There was relative spatial deconcentration of health research groups and more than 6% of them worked in six areas of knowledge areas: medicine, collective health, dentistry, veterinary medicine, ecology and physical education. Lines of incentives that were adopted from 2000 to 2009 contributed to reducing regional scientific imbalances and improving preexisting capabilities or, alternatively, encouraging spatial decentralization of these capabilities. Health-related scientific and technological capabilities remain highly spatially concentrated in Brazil and incentive policies have contributed to reduce to some extent these imbalances.

42 CFR 495.106 - Incentive payments to CAHs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROGRAM Requirements Specific to the Medicare Program § 495.106 Incentive payments to CAHs. (a... computers and associated hardware and software, necessary to administer certified EHR technology as defined... determining if a CAH is a qualifying CAH under this section; (3) Specification of EHR reporting periods, cost...

42 CFR 495.106 - Incentive payments to CAHs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROGRAM Requirements Specific to the Medicare Program § 495.106 Incentive payments to CAHs. (a... computers and associated hardware and software, necessary to administer certified EHR technology as defined... determining if a CAH is a qualifying CAH under this section; (3) Specification of EHR reporting periods, cost...

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.

42 CFR 495.302 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... thereof by the State agency. Acquisition means to acquire health information technology (HIT) equipment or... technology; (2) Install or commence utilization of certified EHR technology capable of meeting meaningful use...

42 CFR 495.370 - Appeals process for a Medicaid provider receiving electronic health record incentive payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the... provide that the provider (whether individual or entity) is also given any additional appeals rights that...

Effects of government incentives on wind innovation in the United States

NASA Astrophysics Data System (ADS)

Horner, Nathaniel; Azevedo, Inês; Hounshell, David

2013-12-01

In the United States, as elsewhere, state and federal governments have considered or implemented a range of policies to create more sustainable energy generation systems in response to concerns over climate change, security of fuel supply, and environmental impacts. These policies include both regulatory instruments such as renewable portfolio standards (RPSs) and market incentives such as tax credits. While these policies are primarily geared towards increasing renewable generation capacity, they can indirectly affect innovation in associated technologies through a ‘demand-pull’ dynamic. Other policies, such as public research and development (R&D) funding, directly incentivize innovation through ‘technology-push’ means. In this letter, we examine these effects on innovation in the United States wind energy industry. We estimate a set of econometric models relating a set of US federal and state policies to patenting activity in wind technologies over the period 1974-2009. We find that RPS policies have had significant positive effects on wind innovation, whereas tax-based incentives have not been particularly effective. We also find evidence that the effects of RPS incentives differ between states. Finally, we find that public R&D funding can be a significant driver of wind innovation, though its effect in the US has been modest.

Does environmental certification in coffee promote "business as usual"? A case study from the Western Ghats, India.

PubMed

Bose, Arshiya; Vira, Bhaskar; Garcia, Claude

2016-12-01

Conservation initiatives are designed to address threats to forests and biodiversity, often through partnerships with natural-resource users who are incentivized to change their land-use and livelihood practices to avoid further biodiversity loss. In particular, direct incentives programmes that provide monetary benefits are commended for being effective in achieving conservation across short timescales. In biodiversity-rich areas, outside protected areas, such as coffee agroforestry systems, direct incentives, such as certification schemes, are used to motivate coffee producers to maintain native tree species, natural vegetation, restrict wildlife hunting, and conserve soil and water, in addition to encouraging welfare of workers. However, despite these claims, there is a lack of strong evidence of the on-ground impact of such schemes. To assess the conservation importance of certification, we describe a case study in the Western Ghats biodiversity hotspot of India, in which coffee growers are provided price incentives to adopt Rainforest Alliance certification standards. We analyse the conservation and social outcomes of this programme by studying peoples' experiences of participating in certification. Despite high compliance and effective implementation, we find a strong case for the endorsement of 'business as usual' with no changes in farm management as a result of certification. We find that such 'business as usual' participation in certification creates grounds for diminishing credibility and local support for conservation efforts. Working towards locally relevant conservation interventions, rather than implementing global blueprints, may lead to more meaningful biodiversity conservation and increased community support for conservation initiatives in coffee landscapes.

Disease management programmes in Germany: a fundamental fault.

PubMed

Felder, Stefan

2006-12-01

In 2001 Germany introduced disease management programmes (DMPs) in order to give sick funds an incentive to improve the treatment of the chronically ill. By 1 March 2005, a total of 3275 programmes had been approved, 2760 for diabetes, 390 for breast cancer and 125 for coronary heart disease, covering roughly 1 million patients. German DMPs show a major fault regarding financial incentives. Sick funds increase their transfers from the risk adjustment scheme when their clients enroll in DMPs. Since this money is a lump sum, sick funds do not necessarily foster treatment of the chronically ill. Similarly, reimbursement of physicians is also not well targeted to the needs of DMPs. Preliminary evidence points to poor performance of German DMPs.

Pecuniary and Non-Pecuniary Incentives to Increase the Rate of Organ Donations from the Living: A Moral Exploration

PubMed Central

Barilan, Michael Y.

2011-01-01

This paper examines the morality of schemes of payment to live donors/sellers of organs for transplantation. Following empirical and historical evidence, it is argued that consent to sell organs is substantially different from consent to ordinary business transactions and that legalization of exchanges of organs with financial benefits deviates significantly from the scope of liberal toleration and liberal conceptions of human rights. Although altruistic giving is commendable, it is immoral for society to benefit from them without conferring to the donors benefits such as health and nursing insurance for life. Non-alienable and non-fungible benefits of this kind are moral as incentives to organ donation/giving. PMID:23908808

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.

Public Sector Training: A "Blind" Spot in the 1999 South African National Levy-Grant Policy

ERIC Educational Resources Information Center

Paterson, Andrew

2005-01-01

In 2000, South Africa implemented a levy-grant policy (Skills Development Levies Act, 1999) to give an incentive for workplace training across private and public sector workplaces alike, but the impact of the levy-grant scheme in the public sector was restricted by financial and management processes unique to that environment. This article shows…

Higher Education Funding and Incentives: Evidence from the Norwegian Funding Reform

ERIC Educational Resources Information Center

Frolich, Nicoline; Strom, Bjarne

2008-01-01

In this article we examine how the introduction of an output-based funding scheme in Norwegian public higher education in 2003 affects pass requirement standards. Based on a survey of faculty at the institutions concerned, we find that the propensity to expect that the new funding model will affect the failing/non-failing decision in exams is…

When Opportunity Knocks, Who Answers? New Evidence on College Achievement Awards. NBER Working Paper No. 16643

ERIC Educational Resources Information Center

Angrist, Joshua; Oreopoulos, Philip; Williams, Tyler

2010-01-01

We evaluate the effects of academic achievement awards for first and second-year college students on a Canadian commuter campus. The award scheme offered linear cash incentives for course grades above 70. Awards were paid every term. Program participants also had access to peer advising by upperclassmen. Program engagement appears to have been…

Bridging the knowledge-action gap in diabetes: information technologies, physician incentives and consumer incentives converge.

PubMed

Nobel, Jeremy

2006-03-01

The gap between current medical knowledge and its application in chronic disease management is especially apparent in diabetes care. Although research over the last decade has shown that adherence to standards of care can prevent or delay the onset of devastating diabetic complications, little more than one-third of patients achieve adequate glycaemic control. Obstacles to better care include 'system' factors such as inadequate record-keeping and reimbursement policies that reimburse amply for illness but poorly for diabetes education and interventions via telephone and computer. Disparities in healthcare compound the difficulty among vulnerable populations in urban and rural areas. Emerging healthcare delivery systems that encourage payers, providers and consumers to improve diabetes care with the use of information technology and financial incentives are described in different health management settings.

Pricing schemes for new drugs: a welfare analysis.

PubMed

Levaggi, Rosella

2014-02-01

Drug price regulation is acquiring increasing significance in the investment choices of the pharmaceutical sector. The overall objective is to determine an optimal trade-off between the incentives for innovation, consumer protection, and value for money. However, price regulation is itself a source of distortion. In this study, we examine the welfare properties of listing through a bargaining process and value-based pricing schemes. The latter are superior instruments to uncertain listing processes for maximising total welfare, but the distribution of the benefits between consumers and the industry depends on rate of rebate chosen by the regulator. However, through an appropriate choice, it is always possible to define a value-based pricing scheme with risk sharing, which both consumers and the industry prefer to an uncertain bargaining process. Copyright © 2013 Elsevier Ltd. All rights reserved.

Understanding illegality and corruption in forest governance.

PubMed

Sundström, Aksel

2016-10-01

This review synthesizes the literature studying illegality and government corruption in forest management. After discussing the theoretical connections between different types of corruption and illegal forest-related activities it describes the major trends in previous studies, examining cross-national patterns as well as local in-depth studies. Both theory and available empirical findings provide a straightforward suggestion: Bribery is indeed a "door opener" for illegal activities to take place in forest management. It then discusses the implications for conservation, focusing first on international protection schemes such as the REDD+ and second on efforts to reduce illegality and bribery in forest management. Key aspects to consider in the discussion on how to design monitoring institutions of forest regulations is how to involve actors without the incentive to engage in bribery and how to make use of new technologies that may publicize illegal behavior in distant localities. The review concludes by discussing avenues for future research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Alternative approaches to pollution control and waste management: Regulatory and economic instruments. Planteamientos alternos para el control de la contaminacion y el manejo de desechos: instrumentos regulatorios y economicos

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

Bernstein, J.D.

1993-01-01

The paper examines ways in which developed and developing countries control pollution and manage urban wastes. It addresses pollution issues of concern to local, provincial, and national governments, as well as nongovernmental organizations. Two approaches to pollution management are discussed: direct regulation and economic incentives. Direct regulation sets standards and enforces them through permits, licenses, and controls on land or water use. Economic incentives encourage polluters to adopt control measures and are more flexible and cost effective. Such incentives include charging fees to enterprises for pollution discharges or providing government subsidies for pollution control technology. The author tells how economicmore » incentives can supplement direct regulation and why such incentives, when properly used, offer advantages over direct regulation. The author discusses how governments have used economic incentives to deal with specific environmental issues and what factors policymakers must address when they plan pollution controls.« less

42 CFR 495.300 - Basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for adopting, implementing, or upgrading certified EHR technology or for meaningful use of such technology. This subpart also provides enhanced Federal financial participation (FFP) to States to administer...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM...

42 CFR 495.302 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... technology per the ONC EHR certification criteria. Children's hospital means a separately certified children... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... thereof by the State agency. Acquisition means to acquire health information technology (HIT) equipment or...

42 CFR 495.302 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... technology per the ONC EHR certification criteria. Children's hospital means a separately certified children... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... thereof by the State agency. Acquisition means to acquire health information technology (HIT) equipment or...

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.

Commentary on the reimbursement paradox.

PubMed

Reaven, Nancy L; Rosenbloom, Judy

2009-07-01

Reimbursement policies are a critical step in the incorporation of new technologies and therapies into the clinical armamentarium. Reimbursement is an umbrella concept describing the process to manage and pay for healthcare services, including benefit coverage, coding, and payment processes. The technologies and services used in therapeutic temperature management are not directly reimbursed, leading to challenges by hospitals and physicians that the services are too expensive to use. The reimbursement models used in the United States make it increasingly difficult for new technologies and therapies to gain direct reimbursement, part of a strategy by insurers, including Medicare and private insurance companies, to manage access to health care services. Insurers, physicians, hospitals, and other providers face conflicting financial incentives in current reimbursement systems. Aligning the financial incentives underlying reimbursement systems is necessary to adequately support new technologies of merit.

Paying for performance in healthcare organisations

PubMed Central

McDonald, Ruth

2014-01-01

Aligning Financial Incentives (FIs) to health policy goals is becoming increasingly popular. In many cases, such initiatives have failed to deliver anticipated benefits. Attributing this to the actions of self-interested and resistant professionals is not an entirely helpful approach. It is important to avoid simplistic assumptions to build knowledge of how and why schemes are implemented in practice to inform future policy in this area. PMID:24639977

How Building Systems Affect Worker Wellness

DTIC Science & Technology

1994-03-01

spatial configuration must strike a balance between the objective needs of the organization and the more subjective human ingredient. Good building...sense, building design for thermal comfort involves a balance between the building’s orientation, its windowing scheme, the use of thermal mass, and the...stated above. An improved quality of worklife and a humanized work environment are psychological incentives that can increase productivity. Worker specific

Paying for performance in healthcare organisations.

PubMed

McDonald, Ruth

2014-02-01

Aligning Financial Incentives (FIs) to health policy goals is becoming increasingly popular. In many cases, such initiatives have failed to deliver anticipated benefits. Attributing this to the actions of self-interested and resistant professionals is not an entirely helpful approach. It is important to avoid simplistic assumptions to build knowledge of how and why schemes are implemented in practice to inform future policy in this area.

Teacher Incentive Pay and Educational Outcomes: Evidence from the NYC Bonus Program. Program on Education Policy and Governance Working Papers Series. PEPG 10-07

ERIC Educational Resources Information Center

Goodman, Sarena; Turner, Lesley

2010-01-01

Teacher compensation schemes are often criticized for lacking a performance-based component. Proponents of merit pay argue that linking teacher salaries to student achievement will incentivize teachers to focus on raising student achievement and stimulate innovation across the school system as a whole. In this paper, we utilize a policy experiment…

42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Health information technology implementation... CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.338 Health information technology implementation advance planning document...

42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Health information technology implementation... CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.338 Health information technology implementation advance planning document...

42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Health information technology implementation... CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.338 Health information technology implementation advance planning document...

42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Health information technology implementation... CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.338 Health information technology implementation advance planning document...

42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Health information technology implementation... CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.338 Health information technology implementation advance planning document...

42 CFR 495.370 - Appeals process for a Medicaid provider receiving electronic health record incentive payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the... in § 447.253(e) of this chapter for a provider or entity to appeal the following issues related to... entity) has an opportunity to challenge the State's determination under this Part by submitting documents...

SMART Money: Do Financial Incentives Encourage College Students to Study Science?

ERIC Educational Resources Information Center

Evans, Brent

2017-01-01

Increasing the number of science, technology, engineering, and mathematics (STEM) degrees is a major federal education priority. I investigate whether providing a $4,000 financial incentive to low-income students in their junior and senior years of college induces them to major in a STEM field. Using administrative data from Ohio public colleges,…

TECHNOLOGY ASSESSMENT OF AQUACULTURE SYSTEMS FOR MUNICIPAL WASTEWATER TREATMENT

EPA Science Inventory

The innovative and alternative technology provisions of the Clean Water Act of 1977 (PL 95-217) provide financial incentives to communities that use wastewater treatment alternatives to reduce costs or energy consumption over conventional systems. Some of these technologies have ...

Economic Incentives for Cybersecurity: Using Economics to Design Technologies Ready for Deployment

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

Vishik, Claire; Sheldon, Frederick T; Ott, David

Cybersecurity practice lags behind cyber technology achievements. Solutions designed to address many problems may and do exist but frequently cannot be broadly deployed due to economic constraints. Whereas security economics focuses on the cost/benefit analysis and supply/demand, we believe that more sophisticated theoretical approaches, such as economic modeling, rarely utilized, would derive greater societal benefits. Unfortunately, today technologists pursuing interesting and elegant solutions have little knowledge of the feasibility for broad deployment of their results and cannot anticipate the influences of other technologies, existing infrastructure, and technology evolution, nor bring the solutions lifecycle into the equation. Additionally, potentially viable solutionsmore » are not adopted because the risk perceptions by potential providers and users far outweighs the economic incentives to support introduction/adoption of new best practices and technologies that are not well enough defined. In some cases, there is no alignment with redominant and future business models as well as regulatory and policy requirements. This paper provides an overview of the economics of security, reviewing work that helped to define economic models for the Internet economy from the 1990s. We bring forward examples of potential use of theoretical economics in defining metrics for emerging technology areas, positioning infrastructure investment, and building real-time response capability as part of software development. These diverse examples help us understand the gaps in current research. Filling these gaps will be instrumental for defining viable economic incentives, economic policies, regulations as well as early-stage technology development approaches, that can speed up commercialization and deployment of new technologies in cybersecurity.« less

A strategic gaming model for health information exchange markets.

PubMed

Martinez, Diego A; Feijoo, Felipe; Zayas-Castro, Jose L; Levin, Scott; Das, Tapas K

2018-03-01

Current market conditions create incentives for some providers to exercise control over patient data in ways that unreasonably limit its availability and use. Here we develop a game theoretic model for estimating the willingness of healthcare organizations to join a health information exchange (HIE) network and demonstrate its use in HIE policy design. We formulated the model as a bi-level integer program. A quasi-Newton method is proposed to obtain a strategy Nash equilibrium. We applied our modeling and solution technique to 1,093,177 encounters for exchanging information over a 7.5-year period in 9 hospitals located within a three-county region in Florida. Under a set of assumptions, we found that a proposed federal penalty of up to $2,000,000 has a higher impact on increasing HIE adoption than current federal monetary incentives. Medium-sized hospitals were more reticent to adopt HIE than large-sized hospitals. In the presence of collusion among multiple hospitals to not adopt HIE, neither federal incentives nor proposed penalties increase hospitals' willingness to adopt. Hospitals' apathy toward HIE adoption may threaten the value of inter-connectivity even with federal incentives in place. Competition among hospitals, coupled with volume-based payment systems, creates no incentives for smaller hospitals to exchange data with competitors. Medium-sized hospitals need targeted actions (e.g., outside technological assistance, group purchasing arrangements) to mitigate market incentives to not adopt HIE. Strategic game theoretic models help to clarify HIE adoption decisions under market conditions at play in an extremely complex technology environment.

Targeted interventions for improved equity in maternal and child health in low- and middle-income settings: a systematic review and meta-analysis.

PubMed

Målqvist, Mats; Yuan, Beibei; Trygg, Nadja; Selling, Katarina; Thomsen, Sarah

2013-01-01

Targeted interventions to improve maternal and child health is suggested as a feasible and sometimes even necessary strategy to reduce inequity. The objective of this systematic review was to gather the evidence of the effectiveness of targeted interventions to improve equity in MDG 4 and 5 outcomes. We identified primary studies in all languages by searching nine health and social databases, including grey literature and dissertations. Studies evaluating the effect of an intervention tailored to address a structural determinant of inequity in maternal and child health were included. Thus general interventions targeting disadvantaged populations were excluded. Outcome measures were limited to indicators proposed for Millennium Development Goals 4 and 5. We identified 18 articles, whereof 15 evaluated various incentive programs, two evaluated a targeted policy intervention, and only one study evaluated an intervention addressing a cultural custom. Meta-analyses of the effectiveness of incentives programs showed a pooled effect size of RR 1.66 (95% CI 1.43-1.93) for antenatal care attendance (four studies with 2,476 participants) and RR 2.37 (95% CI 1.38-4.07) for health facility delivery (five studies with 25,625 participants). Meta-analyses were not performed for any of the other outcomes due to scarcity of studies. The targeted interventions aiming to improve maternal and child health are mainly limited to addressing economic disparities through various incentive schemes like conditional cash transfers and voucher schemes. This is a feasible strategy to reduce inequity based on income. More innovative action-oriented research is needed to speed up progress in maternal and child survival among the most disadvantaged populations through interventions targeting the underlying structural determinants of inequity.

42 CFR 495.332 - State Medicaid health information technology (HIT) plan requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false State Medicaid health information technology (HIT... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.332 State Medicaid health information technology (HIT) plan requirements. Each State Medicaid HIT plan must include...

42 CFR 495.332 - State Medicaid health information technology (HIT) plan requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false State Medicaid health information technology (HIT... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.332 State Medicaid health information technology (HIT) plan requirements. Each State Medicaid HIT plan must include...

42 CFR 495.332 - State Medicaid health information technology (HIT) plan requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false State Medicaid health information technology (HIT... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.332 State Medicaid health information technology (HIT) plan requirements. Each State Medicaid HIT plan must include...

42 CFR 495.332 - State Medicaid health information technology (HIT) plan requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false State Medicaid health information technology (HIT... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.332 State Medicaid health information technology (HIT) plan requirements. Each State Medicaid HIT plan must include...

42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

42 CFR 495.332 - State Medicaid health information technology (HIT) plan requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false State Medicaid health information technology (HIT... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.332 State Medicaid health information technology (HIT) plan requirements. Each State Medicaid HIT plan must include...

42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

Using provider performance incentives to increase HIV testing and counseling services in Rwanda.

PubMed

de Walque, Damien; Gertler, Paul J; Bautista-Arredondo, Sergio; Kwan, Ada; Vermeersch, Christel; de Dieu Bizimana, Jean; Binagwaho, Agnès; Condo, Jeanine

2015-03-01

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by utilization and quality of care indicators. In 2006, Rwanda began a pay for performance scheme to improve health services delivery, including HIV/AIDS services. Using a prospective quasi-experimental design, this study examines the scheme's impact on individual and couples HIV testing. We find a positive impact of pay for performance on HIV testing among married individuals (10.2 percentage points increase). Paying for performance also increased testing by both partners by 14.7 percentage point among discordant couples in which only one of the partners is an AIDS patient. Copyright © 2014. Published by Elsevier B.V.

The transition of childbirth practices among tribal women in Gujarat, India - a grounded theory approach.

PubMed

Sharma, Bharati; Giri, Gayatri; Christensson, Kyllike; K V, Ramani; Johansson, Eva

2013-10-03

Under the National Rural Health Mission, the current emphasis is on achieving universal institutional births through incentive schemes as part of reforms related to childbirth in India. There has been rapid progress in achieving this goal. To understand the choices made as well as practices and perceptions related to childbirth amongst tribal women in Gujarat and how these have been influenced by modernity in general and modernity brought in through maternal health policies. A model depicting the transition in childbirth practices amongst tribal women was constructed using the grounded theory approach with; 8 focus groups of women, 5 in depth interviews with traditional birth attendants, women, and service providers and field notes on informal discussions and observations. A transition in childbirth practices across generations was noted, i.e. a shift from home births attended by Traditional Birth Attendants (TBAs) to hospital births. The women and their families both adapted to and shaped this transition through a constant 'trade-off between desirable and essential'- the desirable being a traditional homebirth in secure surroundings and the essential being the survival of mother and baby by going to hospital. This transition was shaped by complex multiple factors: 1) Overall economic growth and access to modern medical care influencing women's choices, 2) External context in terms of the international maternal health discourses and national policies, especially incentive schemes for promoting institutional deliveries, 3) Socialisation into medical childbirth practices, through exposure to many years of free outreach services for maternal and child health, 4) Loss of self reliance in the community as a consequence of role redefinition and deskilling of the TBAs and 5) Cultural belief that intervention is necessary during childbirth aiding easy acceptance of medical interventions. In resource poor settings where choices are limited and mortality is high, hospital births are perceived as increasing the choices for women, saving lives of mothers and babies, though there is a need for region specific strategies. Modern obstetric technology is utilised and given meanings based on socio-cultural conceptualisations of birth, which need to be considered while designing policies for maternal health.

The transition of childbirth practices among tribal women in Gujarat, India - a grounded theory approach

PubMed Central

2013-01-01

Background Under the National Rural Health Mission, the current emphasis is on achieving universal institutional births through incentive schemes as part of reforms related to childbirth in India. There has been rapid progress in achieving this goal. To understand the choices made as well as practices and perceptions related to childbirth amongst tribal women in Gujarat and how these have been influenced by modernity in general and modernity brought in through maternal health policies. Method A model depicting the transition in childbirth practices amongst tribal women was constructed using the grounded theory approach with; 8 focus groups of women, 5 in depth interviews with traditional birth attendants, women, and service providers and field notes on informal discussions and observations. Results A transition in childbirth practices across generations was noted, i.e. a shift from home births attended by Traditional Birth Attendants (TBAs) to hospital births. The women and their families both adapted to and shaped this transition through a constant ’trade-off between desirable and essential’- the desirable being a traditional homebirth in secure surroundings and the essential being the survival of mother and baby by going to hospital. This transition was shaped by complex multiple factors: 1) Overall economic growth and access to modern medical care influencing women’s choices, 2) External context in terms of the international maternal health discourses and national policies, especially incentive schemes for promoting institutional deliveries, 3) Socialisation into medical childbirth practices, through exposure to many years of free outreach services for maternal and child health, 4) Loss of self reliance in the community as a consequence of role redefinition and deskilling of the TBAs and 5) Cultural belief that intervention is necessary during childbirth aiding easy acceptance of medical interventions. Conclusion In resource poor settings where choices are limited and mortality is high, hospital births are perceived as increasing the choices for women, saving lives of mothers and babies, though there is a need for region specific strategies. Modern obstetric technology is utilised and given meanings based on socio-cultural conceptualisations of birth, which need to be considered while designing policies for maternal health. PMID:24088383

Privacy and the New Technology

ERIC Educational Resources Information Center

Godwin, William F.; Bode, Katharine Anne

1971-01-01

Technology has been charged with destroying personal privacy. Protection by control of human incentives holds most promise. This article suggests several steps we can take to avoid any individual gain from acquiring information about others. (Author)

Alternative Fuels Data Center: State Alternative Fuel and Advanced Vehicle

Science.gov Websites

reduction (2 laws and regulations, 1 state incentive), and other (1 law/regulation) Figure 1. * Because an incentive, law, or regulation may apply to more than one technology type, adding the totals results in ), acquisition/fuel use (9), air quality/emissions (1), and other (13) Figure 3.* Because a law or regulation may

A Mixed-Methods Randomized Controlled Trial of Financial Incentives and Peer Networks to Promote Walking among Older Adults

ERIC Educational Resources Information Center

Kullgren, Jeffrey T.; Harkins, Kristin A.; Bellamy, Scarlett L.; Gonzales, Amy; Tao, Yuanyuan; Zhu, Jingsan; Volpp, Kevin G.; Asch, David A.; Heisler, Michele; Karlawish, Jason

2014-01-01

Background: Financial incentives and peer networks could be delivered through eHealth technologies to encourage older adults to walk more. Methods: We conducted a 24-week randomized trial in which 92 older adults with a computer and Internet access received a pedometer, daily walking goals, and weekly feedback on goal achievement. Participants…

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.

Nuclear Symbiosis - A Means to Achieve Sustainable Nuclear Growth while Limiting the Spread of Sensititive Nuclear Technology

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

David Shropshire

Global growth of nuclear energy in the 21st century is creating new challenges to limit the spread of nuclear technology without hindering adoption in countries now considering nuclear power. Independent nuclear states desire autonomy over energy choices and seek energy independence. However, this independence comes with high costs for development of new indigenous fuel cycle capabilities. Nuclear supplier states and expert groups have proposed fuel supply assurance mechanisms such as fuel take-back services, international enrichment services and fuel banks in exchange for recipient state concessions on the development of sensitive technologies. Nuclear states are slow to accept any concessions tomore » their rights under the Non-Proliferation Treaty. To date, decisions not to develop indigenous fuel cycle capabilities have been driven primarily by economics. However, additional incentives may be required to offset a nuclear state’s perceived loss of energy independence. This paper proposes alternative economic development incentives that could help countries decide to forgo development of sensitive nuclear technologies. The incentives are created through a nuclear-centered industrial complex with “symbiotic” links to indigenous economic opportunities. This paper also describes a practical tool called the “Nuclear Materials Exchange” for identifying these opportunities.« less

The Effect of Supply Chain Management Processes on Competitive Advantage and Organizational Performance

DTIC Science & Technology

2012-03-22

what constitutes manufacturing flexibility. Sehti and Sehti (1990) point out that there are no fewer than 50 combined flexibility types and...The eight remaining surveys constitute a low 1% response rate. 53 Demographic information concerning the respondent was collected in the survey...Mexican operations under NAFTA , Transportation Journal, Vol. 34, No.3, pp. 25-34. Feldmann, M., & Müller S. (2003) An incentive scheme for true

"It's all about incentive": Social technology as a potential facilitator for self-determined physical activity participation for young people with physical disabilities.

PubMed

Knibbe, Tara Joy; McPherson, Amy C; Gladstone, Brenda; Biddiss, Elaine

2017-09-29

To investigate the perceived role of social technologies in promoting physical activity participation for young people with physical disabilities and to identify design considerations that should be addressed when creating social technologies to promote physical activity. Interactive design workshops for young people with physical disabilities aged 12-18 (n = 8) were held. Data were analyzed using interpretive thematic analysis. Young people perceived significant benefit for social technologies to promote physical activity as they have the potential to overcome many barriers to physical activity participation. Design features recommended by the participants included (1) options for diverse interests and preferences, (2) provision of informational support, (3) support through equitable technology design, (4) incentive through competition and play, and (5) opportunities to develop community. Social technology has potential to provide tailored, equitable opportunities for social engagement and physical activity participation for young people with physical disabilities through needs- and preference-specific design.

77 FR 52105 - Announcement of the Innovation in Arms Control Challenge Under the America Competes...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-28

...,'' with the goal of spurring innovation, and developing scientific and technological options that will... transparency efforts. Processes, incentives, and technologies must, in theory, be practical and implementable...

Summary of: dental practitioners and a digital future: an initial exploration of barriers and incentives to adopting digital technologies.

PubMed

Addy, Liam

2013-12-01

Digital technologies are proliferating into dental practices. While their technical attributes have often been studied, it remains unclear why some dentists adopt and use these technologies more than others. AIM To explore the incentives for and barriers against accepting and using digital dental technologies. Eleven semi-structured qualitative interviews were conducted with experts in dentistry, dental technology and dental education in the Netherlands. Dentists' acceptance and use of digital technologies are to varying degrees driven by the perceived advantages over analogue methods, perceived influence on treatment quality, dentists' personal and professional orientation, and social influence from peers and external groups. These effects are complemented by personal and dental-practice characteristics. The findings suggest that there are large differences in motivation to adopt and use digital technologies between early adopters, late adopters and non-adopters, which should be examined in greater detail. We recommend that educators, dentists, and representatives of the dental industry who deal with the diffusion of these technologies take account of dentists' widely different attitudes to digitalisation.

Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff.

PubMed

McNaughton, Rebekah Jayne; Adams, Jean; Shucksmith, Janet

2016-04-27

Since the 1990 s strenuous attempts have been made to rebuild trust in childhood immunisations. This study aimed to understand if financial incentives (FI) or quasi-mandatory schemes (QMS), e.g. mandating immunisations for entry to universal services such as day care or school, might be acceptable interventions to increase immunisations uptake for preschool children. Parents and carers of preschool children (n=91); health and other professionals (n=18); and those responsible for developing and commissioning immunisation services (n=6) took part in the study. Qualitative methods were employed to explore the acceptability of FI/QMS with stakeholders. Framework analysis was used to develop a coding framework that was applied to the whole dataset. Interpretations of the emergent themes were verified between researchers and presented to the project's Parent Reference Group to ensure coherence and relevance. (1) FI: parents and professionals felt introducing FI was inappropriate. It was acknowledged FI may encourage families living in disadvantage to prioritise immunisation, but unintended consequences could outweigh any advantage. FI essentially changes behaviour into a cash transaction which many equated to bribery that could inadvertently create inequalities. (2) QMS: parents and professionals highlighted the positives of introducing QMS, stating it felt natural, fair and less likely to create inequality. Despite QMS' potential to positively impact on uptake there were concerns about the implementation and workability of such schemes. FI for preschool immunisation may not be acceptable, within a UK context. Introducing FI could have detrimental effects on uptake if it were associated with bribery and coercion. Quasi-mandatory schemes, mandating immunisation for universal service entry, was the most acceptable option and could contribute to the normalising of immunisation. Future work would be needed to assess how this could be successfully implemented and if it did indeed increase uptake. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

A Global Review of Incentive Programs to Accelerate Energy-Efficient Appliances and Equipment

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

de la Rue du Can, Stephane; Phadke, Amol; Leventis, Greg

Incentive programs are an essential policy tool to move the market toward energy-efficient products. They offer a favorable complement to mandatory standards and labeling policies by accelerating the market penetration of energy-efficient products above equipment standard requirements and by preparing the market for increased future mandatory requirements. They sway purchase decisions and in some cases production decisions and retail stocking decisions toward energy-efficient products. Incentive programs are structured according to their regulatory environment, the way they are financed, by how the incentive is targeted, and by who administers them. This report categorizes the main elements of incentive programs, using casemore » studies from the Major Economies Forum to illustrate their characteristics. To inform future policy and program design, it seeks to recognize design advantages and disadvantages through a qualitative overview of the variety of programs in use around the globe. Examples range from rebate programs administered by utilities under an Energy-Efficiency Resource Standards (EERS) regulatory framework (California, USA) to the distribution of Eco-Points that reward customers for buying efficient appliances under a government recovery program (Japan). We found that evaluations have demonstrated that financial incentives programs have greater impact when they target highly efficient technologies that have a small market share. We also found that the benefits and drawbacks of different program design aspects depend on the market barriers addressed, the target equipment, and the local market context and that no program design surpasses the others. The key to successful program design and implementation is a thorough understanding of the market and effective identification of the most important local factors hindering the penetration of energy-efficient technologies.« less

Incentives and Barriers That Influence Clinical Computerization in Hong Kong: A Population-based Physician Survey

PubMed Central

Leung, Gabriel M.; Yu, Philip L. H.; Wong, Irene O. L.; Johnston, Janice M.; Tin, Keith Y. K.

2003-01-01

Objective: Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation. Design and Measurements: A representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They ranked seven incentives or catalysts that may influence computerization. We generated mean rank scores and used multidimensional preference analysis to explore key explanatory dimensions of these variables. A hierarchical cluster analysis was performed to identify homogenous subgroups of respondents. We further determined the relationships between the sets of barriers and incentives/catalysts collectively using canonical correlation. Results: Time costs, lack of technical support and large capital investments were the biggest barriers to computerization, whereas improved office efficiency and better-quality care were ranked highest as potential incentives to computerize. Cost vs. noncost, physician-related vs. patient-related, and monetary vs. nonmonetary factors were the key dimensions explaining the barrier variables. Similarly, within-practice vs external and “push” vs “pull” factors accounted for the incentive variables. Four clusters were identified for barriers and three for incentives/catalysts. Canonical correlation revealed that respondents who were concerned with the costs of computerization also perceived financial incentives and government regulation to be important incentives/catalysts toward computerization. Those who found the potential interference with communication important also believed that the promise of improved care from computerization to be a significant incentive. Conclusion: This study provided evidence regarding common barriers associated with clinical computerization. Our findings also identified possible incentive strategies that may be employed to accelerate uptake of computer systems. PMID:12595409

An Incentive-based Online Optimization Framework for Distribution Grids

DOE PAGES

Zhou, Xinyang; Dall'Anese, Emiliano; Chen, Lijun; ...

2017-10-09

This article formulates a time-varying social-welfare maximization problem for distribution grids with distributed energy resources (DERs) and develops online distributed algorithms to identify (and track) its solutions. In the considered setting, network operator and DER-owners pursue given operational and economic objectives, while concurrently ensuring that voltages are within prescribed limits. The proposed algorithm affords an online implementation to enable tracking of the solutions in the presence of time-varying operational conditions and changing optimization objectives. It involves a strategy where the network operator collects voltage measurements throughout the feeder to build incentive signals for the DER-owners in real time; DERs thenmore » adjust the generated/consumed powers in order to avoid the violation of the voltage constraints while maximizing given objectives. Stability of the proposed schemes is analytically established and numerically corroborated.« less

An Incentive-based Online Optimization Framework for Distribution Grids

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

Zhou, Xinyang; Dall'Anese, Emiliano; Chen, Lijun

This article formulates a time-varying social-welfare maximization problem for distribution grids with distributed energy resources (DERs) and develops online distributed algorithms to identify (and track) its solutions. In the considered setting, network operator and DER-owners pursue given operational and economic objectives, while concurrently ensuring that voltages are within prescribed limits. The proposed algorithm affords an online implementation to enable tracking of the solutions in the presence of time-varying operational conditions and changing optimization objectives. It involves a strategy where the network operator collects voltage measurements throughout the feeder to build incentive signals for the DER-owners in real time; DERs thenmore » adjust the generated/consumed powers in order to avoid the violation of the voltage constraints while maximizing given objectives. Stability of the proposed schemes is analytically established and numerically corroborated.« less

Externalities in a life cycle model with endogenous survival☆

PubMed Central

Kuhn, Michael; Wrzaczek, Stefan; Prskawetz, Alexia; Feichtinger, Gustav

2011-01-01

We study socially vs individually optimal life cycle allocations of consumption and health, when individual health care curbs own mortality but also has a spillover effect on other persons’ survival. Such spillovers arise, for instance, when health care activity at aggregate level triggers improvements in treatment through learning-by-doing (positive externality) or a deterioration in the quality of care through congestion (negative externality). We combine an age-structured optimal control model at population level with a conventional life cycle model to derive the social and private value of life. We then examine how individual incentives deviate from social incentives and how they can be aligned by way of a transfer scheme. The age-patterns of socially and individually optimal health expenditures and the transfer rate are derived. Numerical analysis illustrates the working of our model. PMID:28298810

Enhancing Incentive Programs with Proximal Goals and Immediate Feedback: Engineered Labor Standards and Technology Enhancements in Stocker Replenishment

ERIC Educational Resources Information Center

Goomas, David T.; Ludwig, Timothy D.

2007-01-01

Under baseline conditions warehouse stockers (n = 23) could earn incentives if their team performed above the team quota of 18 cases stocked per hour. They were also subject to disciplinary action if they failed to regularly meet individual stocking quotas. In spite of these contingencies the stockers failed to receive bonus payments most of the…

A systematic review on incentive-driven mobile health technology: As used in diabetes management.

PubMed

de Ridder, Michael; Kim, Jinman; Jing, Yan; Khadra, Mohamed; Nanan, Ralph

2017-01-01

Introduction Mobile health (mHealth) technologies have been shown to improve self-management of chronic diseases, such as diabetes. However, mHealth tools, e.g. apps, often have low rates of retention, eroding their potential benefits. Using incentives is a common mechanism for engaging, empowering and retaining patients that is applied by mHealth tools. We conducted a systematic review aiming to categorize the different types of incentive mechanisms employed in mHealth tools for diabetes management, which we defined as incentive-driven technologies (IDTs). As an auxiliary aim, we also analyzed barriers to adoption of IDTs. Methods Literature published in English between January 2008-August 2014 was identified through searching leading publishers and indexing databases: IEEE, Springer, Science Direct, NCBI, ACM, Wiley and Google Scholar. Results A total of 42 articles were selected. Of these, 34 presented mHealth tools with IDT mechanisms; Education was the most common mechanism ( n = 21), followed by Reminder ( n = 11), Feedback ( n = 10), Social ( n = 8), Alert ( n = 5), Gamification ( n = 3), and Financial ( n = 2). Many of these contained more than one IDT ( n = 19). The remaining eight articles, from which we defined barriers for adoption, were review papers and a qualitative study of focus groups and interviews. Discussion While mHealth technologies have advanced over the last five years, the core IDT mechanisms have remained consistent. Instead, IDT mechanisms have evolved with the advances in technology, such as moving from manual to automatic content delivery and personalization of content. Conclusion We defined the concept of IDT to be core features designed to act as motivating mechanisms for retaining and empowering users. We then identified seven core IDT mechanisms that are used by mHealth tools for diabetes management and classified 34 articles into these categories.

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.

Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?†

PubMed Central

Clemens, Jeffrey; Gottlieb, Joshua D.

2014-01-01

We investigate whether physicians' financial incentives influence health care supply, technology diffusion, and resulting patient outcomes. In 1997, Medicare consolidated the geographic regions across which it adjusts physician payments, generating area-specific price shocks. Areas with higher payment shocks experience significant increases in health care supply. On average, a 2 percent increase in payment rates leads to a 3 percent increase in care provision. Elective procedures such as cataract surgery respond much more strongly than less discretionary services. Non-radiologists expand their provision of MRIs, suggesting effects on technology adoption. We estimate economically small health impacts, albeit with limited precision. PMID:25170174

R&D in the maritime industry : a supplement to an assessment of maritime trade and technology

DOT National Transportation Integrated Search

1985-05-01

Since the publication of "An Assessment of Maritime Trade and Technology" by Office of Technology Assessment (OTA) in October 1983, various proposals have been made to provide incentives for research and development (R&D) in an effort to enhance the ...

76 FR 54953 - Medicare Program; Changes to the Electronic Prescribing (eRx) Incentive Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-06

... That Encourage the Use of Health Information Technology,'' available at http://www.gao.gov/products/GAO... Coordinator for Health Information Technology (at the present time, these bodies are the Office of the National Coordinator for Health Information Technology (ONC)-Authorized Testing and Certification Bodies...

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.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

PubMed

Bärnighausen, Till; Bloom, David E

2009-06-26

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes should prepare participants for the time in an underserved area, stay in close contact with participants throughout the different phases of enrolment and help participants by assigning them mentors, establishing peer support systems or financing education courses relevant to work in underserved areas); enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and evaluation (in order to broaden the evidence on the effectiveness of financial incentives in increasing the health workforce in underserved areas, programmes in developing countries should evaluate their performance; in order to improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible). In comparison to other interventions to increase the supply of health workers to medically underserved areas, financial-incentive programmes have advantages--unlike initiatives using non-financial incentives, they establish legally enforceable commitments to work in underserved areas and, unlike compulsory service policies, they will not be opposed by health workers--as well as disadvantages--unlike initiatives using non-financial incentives, they may not improve the working and living conditions in underserved areas (which are important determinants of health workers' long-term retention) and, unlike compulsory service policies, they cannot guarantee that they will supply health workers to underserved areas who would not have worked in such areas without financial incentives. Financial incentives, non-financial incentives, and compulsory service are not mutually exclusive and may positively affect each other's performance.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

PubMed Central

Bärnighausen, Till; Bloom, David E

2009-01-01

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes should prepare participants for the time in an underserved area, stay in close contact with participants throughout the different phases of enrolment and help participants by assigning them mentors, establishing peer support systems or financing education courses relevant to work in underserved areas); enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and evaluation (in order to broaden the evidence on the effectiveness of financial incentives in increasing the health workforce in underserved areas, programmes in developing countries should evaluate their performance; in order to improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible). In comparison to other interventions to increase the supply of health workers to medically underserved areas, financial-incentive programmes have advantages – unlike initiatives using non-financial incentives, they establish legally enforceable commitments to work in underserved areas and, unlike compulsory service policies, they will not be opposed by health workers – as well as disadvantages – unlike initiatives using non-financial incentives, they may not improve the working and living conditions in underserved areas (which are important determinants of health workers' long-term retention) and, unlike compulsory service policies, they cannot guarantee that they will supply health workers to underserved areas who would not have worked in such areas without financial incentives. Financial incentives, non-financial incentives, and compulsory service are not mutually exclusive and may positively affect each other's performance. PMID:19558682

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.

The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review.

PubMed

Jackson, Tracy; Shields, Michael D; Heaney, Liam G; Kendall, Marilyn; Pearce, Christina J; Hui, Chi Yan; Pinnock, Hilary

2017-01-01

Financial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets. To systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management. We followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017) including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies. We identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7), UK (n = 4) and Canada (n = 1). Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10), written action plans for asthma (n = 1) and hospital/emergency department visits (n = 1). Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving 'perfect care' (including providing a written action plan) increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one. Results for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health outcomes in asthma. Further research is needed to confirm these findings and understand the process by which financial incentives may impact (or not) on care. Protocol registration number: CRD42016027411.

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.

A strategy for the implementation of a quality indicator system in German primary care.

PubMed

van den Heuvel, Henricus

2011-01-01

The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started. To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care. Literature review with a focus on the QOF and German quality indicator literature. There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes. For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.

Recommendation 87/567/EEC on vocational training for women, 24 November 1987.

PubMed

1987-01-01

This document contains the text of a 1987 Recommendation of the Commission of the European Communities on vocational training for women. Article 1 recommends that Member States adopt a policy to encourage participation of women in training schemes, especially those relevant to occupations of the future and in areas where women are under-represented. Article 2 recommends that Member States: 1) integrate training for women within a broad framework of cooperation between all parties involved; 2) staff such services with personnel trained to deal with the specific problems faced by women; 3) promote outreach activities on the part of such services; 4) provide more decentralized and widely distributed educational and training facilities; 5) promote images of women engaged in nontraditional activities; 6) encourage female participation in higher education, especially in technological areas; 7) encourage female participation in nontraditional apprenticeships; 8) encourage female entrepreneurs by offering appropriate training; 9) develop measures to promote participation of women in continuous training activities; 10) provide underprivileged women and women returning to work with specific courses designed to meet their needs; 11) provide flexible child care arrangements and financial incentives for women to participate in training activities; 12) recognize skills acquired in running a household and looking after a family; and 13) monitor the progress of women taking part in training schemes. Member States are to inform the Commission of their activities in these areas within three years to enable the Commission to create a report on such measures.

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.

Incentives, equity and the Able Chooser Problem.

PubMed

Grill, Kalle

2017-03-01

Health incentive schemes aim to produce healthier behaviours in target populations. They may do so both by making incentivised options more salient and by making them less costly. Changes in costs only result in healthier behaviour if the individual rationally assesses the cost change and acts accordingly. Not all people do this well. Those who fail to respond rationally to incentives will typically include those who are least able to make prudent choices more generally. This group will typically include the least advantaged more generally, since disadvantage inhibits one's effective ability to choose well and since poor choices tend to cause or aggravate disadvantage. Therefore, within the target population, health benefits to the better off may come at the cost of aggravated inequity. This is one instance of a problem I name the Able Chooser Problem, previously emphasised by Richard Arneson in relation to coercive paternalism. I describe and discuss this problem by distinguishing between policy options and their effects on the choice situation of individuals. Both positive and negative incentives, as well as mandates that are less than perfectly effective, require some sort of rational deliberation and action and so face the Able Chooser Problem. In contrast, effective restriction of what options are physically available, as well as choice context design that makes some options more salient or appealing, does not demand rational agency. These considerations provide an equity-based argument for preferring smart design of our choice and living environment to incentives and mandates. 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/.

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.

Incentives in Diabetic Eye Assessment by Screening (IDEAS): study protocol of a three-arm randomized controlled trial using financial incentives to increase screening uptake in London.

PubMed

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

2016-03-18

Diabetes is an increasing public health problem in the UK and globally. Diabetic retinopathy is a microvascular complication of diabetes, and is one of the leading causes of blindness in the UK working age population. The diabetic eye screening programme in England aims to invite all people with diabetes aged 12 or over for retinal photography to screen for the presence of diabetic retinopathy. However, attendance rates are only 81 %, leaving many people at risk of preventable sight loss. This is a three arm randomized controlled trial to investigate the impact of different types of financial incentives (based on principles from behavioral economics) on increasing attendance at diabetic eye screening appointments in London. Eligible participants will be aged 16 or over, and are those who have been invited to screening appointments annually, but who have not attended, or telephoned to rearrange an appointment, within the last 24 months. Eligible participants will be randomized to one of three conditions: 1. Control condition (usual invitation letter) 2. Fixed incentive condition (usual invitation letter, including a voucher for £10 if they attend their appointment) 3. Probabilistic incentive condition (invitation letter, including a voucher for a 1 in 100 chance of winning £1000 if they attend their appointment). Participants will be sent invitation letters, and the primary outcome will be whether or not they attend their appointment. One thousand participants will be included in total, randomized with a ratio of 1.4:1:1. In order to test whether the incentive scheme has a differential impact on patients from different demographic or socio-economic groups, information will be recorded on age, gender, distance from screening center, socio-economic status and length of time since they were last screened. A cost-effectiveness analysis will also be performed. This study will be the first trial of financial incentives for improving uptake of diabetic eye screening. If effective, the intervention may suggest a cost-effective way to increase screening rates, thus reducing unnecessary blindness. ISRCTN14896403, 25 February 2016.

Alternative Fuels Data Center

Science.gov Websites

Advanced Technology Vehicle (ATV) and Alternative Fuel Infrastructure Manufacturing Incentives Through the Advanced Technology Vehicles Manufacturing Loan Program, manufacturers may be eligible for direct loans for up to 30% of the cost of re-equipping, expanding, or establishing manufacturing

42 CFR 495.302 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... of “Certified EHR Technology” for FY and CY 2015 and subsequent years). Children's hospital means a... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... thereof by the State agency. Acquisition means to acquire health information technology (HIT) equipment or...

The role of business incentives in the development of renewable energy technologies

NASA Astrophysics Data System (ADS)

A 15% business energy tax credit for renewable energy systems is examined. Witnesses from photovoltaics, solar thermal, wind, and OTEC industries testified about the importance of the credits to their ability to develop and demonstrate new technologies.

42 CFR 495.6 - Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General Provisions § 495.6 Meaningful use objectives and... their first payment year. For Medicaid EPs who adopt, implement, or upgrade certified EHR technology in... certified EHR technology in their first payment year, the meaningful use objectives and associated measures...

42 CFR 495.6 - Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General Provisions § 495.6 Meaningful use objectives and... their first payment year. For Medicaid EPs who adopt, implement, or upgrade certified EHR technology in... first payment year. (4) Flexible options for using certified EHR technology in 2014. For an EHR...

42 CFR 495.6 - Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General Provisions § 495.6 Meaningful use objectives and... year. For Medicaid EPs who adopt, implement, or upgrade certified EHR technology in their first payment... technology in their first payment year, the meaningful use objectives and associated measures of the Stage 1...

42 CFR 495.6 - Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General Provisions § 495.6 Meaningful use objectives and... year. For Medicaid EPs who adopt, implement, or upgrade certified EHR technology in their first payment... technology in their first payment year, the meaningful use objectives and associated measures of the Stage 1...

42 CFR 495.6 - Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General Provisions § 495.6 Meaningful use objectives and... year. For Medicaid EPs who adopt, implement, or upgrade certified EHR technology in their first payment... technology in their first payment year, the meaningful use objectives and associated measures of the Stage 1...

Exploring Faculty Incentives and Barriers to Participation in Web-Based Instruction

ERIC Educational Resources Information Center

Kinuthia, Wanjira

2006-01-01

The area of integration of technology in education is a continuous effort that revolves around looking for factors and practices that can be applied to encourage faculty to integrate technology into their areas of teaching. Web-based instruction (WBI) is one of the technologies affecting higher education, and historically Black colleges and…

Are Green Vehicles Worth the Extra Cost? The Case of Diesel-Electric Hybrid Technology for Urban Delivery Vehicles

ERIC Educational Resources Information Center

Krutilla, Kerry; Graham, John D.

2012-01-01

A central question for environmental policy is whether the long-term benefits of energy-saving technologies are sufficient to justify their short-term costs, and if so, whether financial incentives are needed to stimulate adoption. The fiscal effects of incentivizing new technologies, and the revenue effects of using the technology, are also…

The Integration of Technology into School Curriculum in Saudi Arabia: Factors Affecting Technology Implementation in the Classroom

ERIC Educational Resources Information Center

Barri, Moatasim A.

2013-01-01

There are a number of factors that influence technology implementation in the classroom including teachers' concerns; barriers; and intrinsic incentives. These factors give classroom teachers a chance to make a shift in their thinking and practice to help them properly integrate technology across the curriculum. This study was designed to assess:…

Are people who claim compensation "cured by a verdict"? A longitudinal study of health outcomes after whiplash.

PubMed

Spearing, Natalie M; Gyrd-Hansen, Dorte; Pobereskin, Louis H; Rowell, David S; Connelly, Luke B

2012-09-01

This study examines whether the lure of injury compensation prompts whiplash claimants to overstate their symptoms. Claim settlement is the intervention of interest, as it represents the point at which there is no further incentive to exaggerate symptoms, and neck pain at 24 months is the outcome of interest. Longitudinal data on neck pain scores and timing of claim settlement were regressed, controlling for the effect of time on recovery, to compare outcomes in claimants who had and had not settled their compensation claims. The results show clearly that removing the financial incentive to over-report symptoms has no effect on self-reported neck pain in a fault-based compensation scheme, and this finding concurs with other studies on this topic. Policy decisions to limit compensation in the belief that claimants systematically misrepresent their health status are not supported empirically Claimants do not appear to be "cured by a verdict".

The 'donations for decreased ALT (D4D)' prosocial behavior incentive scheme for NAFLD patients.

PubMed

Sumida, Yoshio; Yoshikawa, Toshikazu; Tanaka, Saiyu; Taketani, Hiroyoshi; Kanemasa, Kazuyuki; Nishimura, Tekeshi; Yamaguchi, Kanji; Mitsuyoshi, Hironori; Yasui, Kohichiroh; Minami, Masahito; Naito, Yuji; Itoh, Yoshito

2014-12-01

Physicians often experience difficulties in motivating patients with non-alcoholic fatty liver disease (NAFLD) to undergo lifestyle changes. The aim of this study is to examine whether 'Donations for Decreased alanine aminotransferase (ALT)' (D4D) prosocial behavior incentive can serve as an effective intrinsic motivational factor in comparison with conventional dietary and exercise intervention alone for NAFLD patients. Twenty-five NAFLD patients with elevated ALT were randomly assigned to a control group that received conventional dietary and exercise intervention alone, or a donation group whereby, as an incentive, we would make a monetary donation to the United Nations World Food Programme (WFP) based on the decrease in their ALT levels achieved over 12 weeks, in addition to receiving control intervention. In a donation group, we would donate US$1 to the WFP for every 1 IU/l of decrease in their ALT levels. There were no differences of pre-treatment clinical characteristics between the two groups. Significant reductions of ALT levels were achieved only in a donation group, although post-treatment ALT levels were not different between the two groups. These patients raised a total of $316 for the WFP. Promoting patients' intrinsic motivation by incorporating 'D4D' prosocial behavior incentive into conventional dietary and exercise intervention may provide a means to improve NAFLD. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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.

Public policy for solar heating and cooling

NASA Technical Reports Server (NTRS)

Hirshberg, A. S.

1976-01-01

Recent analyses indicated that solar heating and cooling systems for residential buildings are nearly economically competitive with conventional fossil fuel or electric systems, the former having higher initial cost but a lower operating cost than the latter. The paper examines obstacles to the widespread acceptance and use of solar space conditioning systems and explores some general policies which could help to overcome them. The discussion covers such institutional barriers limiting the adoption of solar technologies as existing building codes, financing constraints, and organizational structure of the building industry. The potential impact of financial incentives is analyzed. It is noted that a tax incentive of 25% could speed the use of solar energy by 7 to 8 years and produce an 8% reduction in fossil fuel use by 1990. A preliminary incentive package which could be helpful in promoting solar energy both at federal and state levels is proposed, and the necessary incentive level is analysed.

A Secure and Privacy-Preserving Targeted Ad-System

NASA Astrophysics Data System (ADS)

Androulaki, Elli; Bellovin, Steven M.

Thanks to its low product-promotion cost and its efficiency, targeted online advertising has become very popular. Unfortunately, being profile-based, online advertising methods violate consumers' privacy, which has engendered resistance to the ads. However, protecting privacy through anonymity seems to encourage click-fraud. In this paper, we define consumer's privacy and present a privacy-preserving, targeted ad system (PPOAd) which is resistant towards click fraud. Our scheme is structured to provide financial incentives to all entities involved.

A Peer-Assisted Teaching Scheme to Improve Units with Critically Low Student Satisfaction: Opportunities and Challenges

ERIC Educational Resources Information Center

Carbone, Angela

2014-01-01

This paper outlines a peer-assisted teaching scheme (PATS) which was piloted in the Faculty of Information Technology at Monash University, Australia to address the low student satisfaction with the quality of information and communication technology units. Positive results from the pilot scheme led to a trial of the scheme in other disciplines.…

Why do Economic Instruments Fail? The role of Water trading and Pricing at a River Basin Scale

NASA Astrophysics Data System (ADS)

Pérez-Blanco, C. D.; Gomez, C.; Loch, A. J.; Adamson, D. C.

2016-12-01

Water management problems stem from the mismatch between a multitude of individual decisions, on the one hand, and the current and projected status of water resources, on the other. Economics provides valuable information on the incentives that drive individual decisions and can be used to design instruments that address the problem. Yet, proposals from economists regarding instruments like water pricing or trading are mostly based upon basic and general principles of welfare economics that are not straightaway applicable to assets as complex as water. For example, while water markets clearly serve to the parts directly involved in the transaction, the unique characteristics of water often leads to Pareto inefficient allocations that affect the environment and related economic uses. The flaw in this approach lies in the understanding that water prices and water trading schemes may be good or bad on their own (e.g. finding the "right" price). This vision changes radically when we focus on the problem, instead of the instrument. In this case addressing water management challenges is equivalent to making the multitude of decisions people do about water compatible with collective water governance goals such as curbing degradation trends or building water security for the future. These ideas provide both the basis for assessing existing incentives such as pricing and trading schemes and reshaping economic instruments to serve the objectives of an integrated water resources management.

Instructional and Performance Technology in Brazil.

ERIC Educational Resources Information Center

Stone, John H.; Romiszowski, Alexander J.

1982-01-01

Describes the status and trends, achievements, and problems in the development of educational technology (ET) in Brazil. Areas examined include tax incentives for training programs, graduate programs in ET, teleducation and correspondence teaching, and government support of ET programs. Five references are listed. (MER)

Impact of risk aversion and disease outbreak characteristics on the incentives of producers as a group to participate in animal disease insurance-A simulation.

PubMed

Niemi, Jarkko K; Heikkilä, Jaakko

2011-06-01

The participation of agricultural producers in financing losses caused by livestock epidemics has been debated in many countries. One of the issues raised is how reluctant producers are to participate voluntarily in the financing of disease losses before an outbreak occurs. This study contributes to the literature by examining whether disease losses should be financed through pre- or post-outbreak premiums or their combination. A Monte Carlo simulation was employed to illustrate the costs of financing two diseases of different profiles. The profiles differed in the probability in which the damage occurs and in the average damage per event. Three hypothetical financing schemes were compared based on their ability to reduce utility losses in the case of risk-neutral and risk-averse producer groups. The schemes were examined in a dynamic setting where premiums depended on the compensation history of the sector. If producers choose the preferred financing scheme based on utility losses, results suggest that the timing of the premiums, the transaction costs of the scheme, the degree of risk aversion of the producer, and the level and the volatility of premiums affect the choice of the financing scheme. Copyright © 2011 Elsevier B.V. All rights reserved.

Financial incentives, quality improvement programs, and the adoption of clinical information technology.

PubMed

Robinson, James C; Casalino, Lawrence P; Gillies, Robin R; Rittenhouse, Diane R; Shortell, Stephen S; Fernandes-Taylor, Sara

2009-04-01

Physician use of clinical information technology (CIT) is important for the management of chronic illness, but has lagged behind expectations. We studied the role of health insurers' financial incentives (including pay-for-performance) and quality improvement initiatives in accelerating adoption of CIT in large physician practices. National survey of all medical groups and independent practice association (IPA) physician organizations with 20 or more physicians in the United States in 2006 to 2007. The response rate was 60.3%. Use of 19 CIT capabilities was measured. Multivariate statistical analysis of financial and organizational factors associated with adoption and use of CIT. Use of information technology varied across physician organizations, including electronic access to laboratory test results (medical groups, 49.3%; IPAs, 19.6%), alerts for potential drug interactions (medical groups, 33.9%; IPAs, 9.5%), electronic drug prescribing (medical groups, 41.9%; IPAs, 25.1%), and physician use of e-mail with patients (medical groups, 34.2%; IPAs, 29.1%). Adoption of CIT was stronger for physician organizations evaluated by external entities for pay-for-performance and public reporting purposes (P = 0.042) and for those participating in quality improvement initiatives (P < 0.001). External incentives and participation in quality improvement initiatives are associated with greater use of CIT by large physician practices.

Casemix and rehabilitation: evaluation of an early discharge scheme.

PubMed

Brandis, S

2000-01-01

This paper presents a case study of an early discharge scheme funded by casemix incentives and discusses limitations of a casemix model of funding whereby hospital inpatient care is funded separately from care in other settings. The POSITIVE Rehabilitation program received 151 patients discharged early from hospital in a twelve-month period. Program evaluation demonstrates a 40.9% drop in the average length of stay of rehabilitation patients and a 42.6% drop in average length of stay for patients with stroke. Other benefits of the program include a high level of patient satisfaction, improved carer support and increased continuity of care. The challenge under the Australian interpretation of a casemix model of funding is ensuring the viability of services that extend across acute hospital, non-acute care, and community and home settings.

Competition and the Reference Pricing Scheme for pharmaceuticals.

PubMed

Ghislandi, Simone

2011-12-01

By introducing n (>1) firms with infinite cross-price elasticity (i.e. generic drugs), we explore the effects of competition on the optimal pricing strategies under a Reference Pricing Scheme (RPS). A two-stage model repeated infinite number of times is presented. When stage 1 is competitive, the equilibrium in pure strategies exists and is efficient only if the reference price (R) does not depend on the price of the branded product. When generics collude, the way R is designed is crucial for both the stability of the cartel among generics and the collusive prices in equilibrium. An optimally designed RPS must set R as a function only of the infinitely elastic side of the market and should provide the right incentives for competition. Copyright © 2011 Elsevier B.V. All rights reserved.

Using farmers' attitude and social pressures to design voluntary Bluetongue vaccination strategies.

PubMed

Sok, J; Hogeveen, H; Elbers, A R W; Oude Lansink, A G J M

2016-10-01

Understanding the context and drivers of farmers' decision-making is critical to designing successful voluntary disease control interventions. This study uses a questionnaire based on the Reasoned Action Approach framework to assess the determinants of farmers' intention to participate in a hypothetical reactive vaccination scheme against Bluetongue. Results suggest that farmers' attitude and social pressures best explained intention. A mix of policy instruments can be used in a complementary way to motivate voluntary vaccination based on the finding that participation is influenced by both internal and external motivation. Next to informational and incentive-based instruments, social pressures, which stem from different type of perceived norms, can spur farmers' vaccination behaviour and serve as catalysts in voluntary vaccination schemes. Copyright © 2016 Elsevier B.V. All rights reserved.

Defence Technology Strategy for the Demands of the 21st Century

DTIC Science & Technology

2006-10-01

understanding of human capability in the CBM role. Ownership of the intellectual property behind algorithms may be sovereign10, but implementation will...synchronisation schemes. · coding schemes. · modulation techniques. · access schemes. · smart spectrum usage . · low probability of intercept. · implementation...modulation techniques; access schemes; smart spectrum usage ; low probability of intercept Spectrum and bandwidth management · cross layer technologies to

The High-Technology Connection: Academic/Industrial Cooperation for Economic Growth. ASHE-ERIC Higher Education Research Report No. 6.

ERIC Educational Resources Information Center

Johnson, Lynn G.

Cooperative arrangements between academic institutions and industry are examined, with attention to linkages in high technology research and development (R&D), the commercial application of R&D (technology transfer), and the preparation and continuing development of scientific and engineering personnel. Incentives and barriers to campus/corporate…

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

An economic analysis of private incentives to adopt DNA barcoding technology for fish species authentication in Canada.

PubMed

Ugochukwu, Albert I; Hobbs, Jill E; Phillips, Peter W B; Gray, Richard

2015-12-01

The increasing spate of species substitution and mislabelling in fish markets has become a concern to the public and a challenge to both the food industry and regulators. Species substitution and mislabelling within fish supply chains occurs because of price incentives to misrepresent products for economic gain. Emerging authenticity technologies, such as the DNA barcoding technology that has been used to identify plants and animal (particularly fish) species through DNA sequencing, offer a potential technological solution to this information problem. However, the adoption of these authenticity technologies depends also on economic factors. The present study uses economic welfare analysis to examine the effects of species substitution and mislabelling in fish markets, and examines the feasibility of the technology for a typical retail store in Canada. It is assumed that increased accuracy of the technology in detecting fraud and enforcement of legal penalties and other associated costs would be likely to discourage cheating. Empirical results suggest that DNA barcoding technology would be feasible presently for a typical retail store only if authentication is done in a third party laboratory, as it may not be feasible on an individual retail store level once fixed and other associated costs of the technology are considered.

Some hospitals are falling behind in meeting 'meaningful use' criteria and could be vulnerable to penalties in 2015.

PubMed

DesRoches, Catherine M; Worzala, Chantal; Bates, Scott

2013-08-01

With nearly $30 billion in incentives available, it is critical to know to what extent US hospitals have been able to respond to those incentives by adopting electronic health record (EHR) systems that meet Medicare's criteria for their "meaningful use." Medicare has provided aggregate incentive payment data, but still missing is an understanding of how these payments are distributed across hospital types and years. Our analysis of Medicare data found a substantial increase in the percentage of hospitals receiving EHR incentive payments between 2011 (17.4 percent) and 2012 (36.8 percent). However, this increase was not uniform across all hospitals, and the overall proportion of hospitals receiving a payment for meaningful use was low. Critical-access, smaller, and publicly owned or nonprofit hospitals appeared to be at particular risk for failing to meet Medicare's meaningful-use criteria, and the overall proportion of hospitals receiving a payment for meaningful use was low. Starting in 2015, hospitals that fail to meet the criteria will be subject to financial penalties. To address the needs of institutions in danger of incurring these penalties, policy makers could implement targeted grant programs and provide additional information technology workforce support. In addition, the capacity of EHR system vendors should be carefully monitored to ensure that these institutions have access to the technology they need.

Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology.

PubMed

Spring, Bonnie; Schneider, Kristin; McFadden, H Gene; Vaughn, Jocelyn; Kozak, Andrea T; Smith, Malaina; Moller, Arlen C; Epstein, Leonard H; Demott, Andrew; Hedeker, Donald; Siddique, Juned; Lloyd-Jones, Donald M

2012-05-28

Many patients exhibit multiple chronic disease risk behaviors. Research provides little information about advice that can maximize simultaneous health behavior changes. To test which combination of diet and activity advice maximizes healthy change, we randomized 204 adults with elevated saturated fat and low fruit and vegetable intake, high sedentary leisure time, and low physical activity to 1 of 4 treatments: increase fruit/vegetable intake and physical activity, decrease fat and sedentary leisure, decrease fat and increase physical activity, and increase fruit/vegetable intake and decrease sedentary leisure. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. During treatment, incentives were contingent on using the mobile device to self-monitor and attain behavioral targets; during follow-up, incentives were contingent only on recording. The outcome was standardized, composite improvement on the 4 diet and activity behaviors at the end of treatment and at 5-month follow-up. Of the 204 individuals randomized, 200 (98.0%) completed follow-up. The increase fruits/vegetables and decrease sedentary leisure treatments improved more than the other 3 treatments (P < .001). Specifically, daily fruit/vegetable intake increased from 1.2 servings to 5.5 servings, sedentary leisure decreased from 219.2 minutes to 89.3 minutes, and saturated fat decreased from 12.0% to 9.5% of calories consumed. Differences between treatment groups were maintained through follow-up. Traditional dieting (decrease fat and increase physical activity) improved less than the other 3 treatments (P < .001). Remote coaching supported by mobile technology and financial incentives holds promise to improve diet and activity. Targeting fruits/vegetables and sedentary leisure together maximizes overall adoption and maintenance of multiple healthy behavior changes.

“Meaningful use” of electronic health records and its relevance to laboratories and pathologists

PubMed Central

Henricks, Walter H.

2011-01-01

Electronic health records (EHRs) have emerged as a major topic in health care and are central to the federal government’s strategy for transforming healthcare delivery in the United States. Recent federal actions that aim to promote the use of EHRs promise to have significant implications for laboratories and for pathology practices. Under the HITECH (Health Information Technology Economic and Clinical Health) Act, an EHR incentive program has been established through which individual physicians and hospitals can qualify to receive incentive payments if they achieve “meaningful use” of “certified” EHR technology. The rule also establishes payment penalties in future years for eligible providers who have not met the requirements for meaningful use of EHRs. Meaningful use must be achieved using EHR technology that has been certified in accordance with functional and technical criteria that are set forth a regulation that parallels the meaningful use criteria in the incentive program. These actions and regulations are important to laboratories and pathologists for a number of reasons. Several of the criteria and requirements in the meaningful use rules and EHR certification criteria relate directly or indirectly to laboratory testing and laboratory information management, and future stage requirements are expected to impact the laboratory as well. Furthermore, as EHR uptake expands, there will be greater expectations for electronic interchange of laboratory information and laboratory information system (LIS)-EHR interfaces. Laboratories will need to be aware of the technical, operational, and business challenges that they may face as expectations for LIS-EHR increase. This paper reviews the important recent federal efforts aimed at accelerating EHR use, including the incentive program for EHR meaningful use, provider eligibility, and EHR certification criteria, from a perspective of their relevance for laboratories and pathology practices. PMID:21383931

Incentive-Based Conservation Programs in Developing Countries: A Review of Some Key Issues and Suggestions for Improvements

NASA Astrophysics Data System (ADS)

Spiteri, Arian; Nepalz, Sanjay K.

2006-01-01

Biodiversity conservation in developing countries has been a challenge because of the combination of rising human populations, rapid technological advances, severe social hardships, and extreme poverty. To address the social, economic, and ecological limitations of people-free parks and reserves, incentives have been incorporated into conservation programs in the hopes of making conservation meaningful to local people. However, such incentive-based programs have been implemented with little consideration for their ability to fulfill promises of greater protection of biodiversity. Evaluations of incentive-based conservation programs indicate that the approach continually falls short of the rhetoric. This article provides an overview of the problems associated with incentive-based conservation approaches in developing countries. It argues that existing incentive-based programs (IBPs) have yet to realize that benefits vary greatly at different “community” scales and that a holistic conceptualization of a community is essential to incorporate the complexities of a heterogeneous community when designing and implementing the IBPs. The spatial complexities involved in correctly identifying the beneficiaries in a community and the short-term focus of IBPs are two major challenges for sustaining conservation efforts. The article suggests improvements in three key areas: accurate identification of “target” beneficiaries, greater inclusion of marginal communities, and efforts to enhance community aptitudes.

Health information technology impact on productivity.

PubMed

Eastaugh, Steven R

2012-01-01

Managers work to achieve the greatest output for the least input effort, better balancing all factors of delivery to achieve the most with the smallest resource effort. Documentation of actual health information technology (HIT) cost savings has been elusive. Information technology and linear programming help to control hospital costs without harming service quality or staff morale. This study presents production function results from a study of hospital output during the period 2008-2011. The results suggest that productivity varies widely among the 58 hospitals as a function of staffing patterns, methods of organization, and the degree of reliance on information support systems. Financial incentives help to enhance productivity. Incentive pay for staff based on actual productivity gains is associated with improved productivity. HIT can enhance the marginal value product of nurses and staff, so that they concentrate their workday around patient care activities. The implementation of electronic health records (EHR) was associated with a 1.6 percent improvement in productivity.

An Examination of Forest Certification Status among Logging Companies in Cameroon

PubMed Central

Nukpezah, Daniel; Alemagi, Dieudonne; Duguma, Lalisa; Minang, Peter; Mbosso, Charlie; Tchoundjeu, Zac

2014-01-01

This paper assesses the level of interest, awareness, and adoption of ISO 14001 and Forest Stewardship Council (FSC) certification schemes among logging companies in Cameroon. Eleven logging companies located in Douala in the Littoral Region of Cameroon were assessed through a structured interview using an administered questionnaire which was mostly analyzed qualitatively thereafter. The findings indicated that none of the companies was certified for ISO 14001; however 63.64% of them were already FSC-certified. Four companies (36.36%) were neither FSC- nor ISO 14001 EMS-certified. Among the factors found to influence the adoption rate was the level of awareness about ISO 14001 and FSC certification schemes. The main drivers for pursuing FSC certification were easy penetration into international markets, tax holiday benefits, and enhancement of corporate image of the logging companies through corporate social responsibility fulfillments. Poor domestic market for certified products was found to be the major impediment to get certified. To make logging activities more environmentally friendly and socially acceptable, logging companies should be encouraged to get certified through the ISO 14001 EMS scheme which is almost nonexistent so far. This requires awareness creation about the scheme, encouraging domestic markets for certified products and creating policy incentives. PMID:27355041

An Examination of Forest Certification Status among Logging Companies in Cameroon.

PubMed

Nukpezah, Daniel; Alemagi, Dieudonne; Duguma, Lalisa; Minang, Peter; Mbosso, Charlie; Tchoundjeu, Zac

2014-01-01

This paper assesses the level of interest, awareness, and adoption of ISO 14001 and Forest Stewardship Council (FSC) certification schemes among logging companies in Cameroon. Eleven logging companies located in Douala in the Littoral Region of Cameroon were assessed through a structured interview using an administered questionnaire which was mostly analyzed qualitatively thereafter. The findings indicated that none of the companies was certified for ISO 14001; however 63.64% of them were already FSC-certified. Four companies (36.36%) were neither FSC- nor ISO 14001 EMS-certified. Among the factors found to influence the adoption rate was the level of awareness about ISO 14001 and FSC certification schemes. The main drivers for pursuing FSC certification were easy penetration into international markets, tax holiday benefits, and enhancement of corporate image of the logging companies through corporate social responsibility fulfillments. Poor domestic market for certified products was found to be the major impediment to get certified. To make logging activities more environmentally friendly and socially acceptable, logging companies should be encouraged to get certified through the ISO 14001 EMS scheme which is almost nonexistent so far. This requires awareness creation about the scheme, encouraging domestic markets for certified products and creating policy incentives.

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.

On Proportionate and Truthful International Alliance Contributions: An Analysis of IncentiveCompatible Cost Sharing Mechanisms to Burden Sharing

DTIC Science & Technology

2017-03-23

Therefore, the mecha- nism induces a stable cost sharing scheme wherein a subset of colluding players will not all benefit . In a subset of colluding...goods are not divisible and are not excludable. Cost sharing mechanisms specific to public goods have been researched extensively in the literature...Jackson & Moulin [1992] consider the sharing of cost for an indivisible public project among many players, and their work was extended by Bag [1997] to

42 CFR 495.4 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... technology has the same definition as this term is defined at 45 CFR 170.102. Critical access hospital (CAH) means a facility that has been certified as a critical access hospital under section 1820(e) of the Act... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General...

42 CFR 495.4 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... technology has the same definition as this term is defined at 45 CFR 170.102. Critical access hospital (CAH) means a facility that has been certified as a critical access hospital under section 1820(e) of the Act... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General...

42 CFR 495.342 - Annual HIT IAPD requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... delays in meeting target dates in the approved HIT technology PAPD/IAPD and approved changes to it. (c) A... products. (d) A project activity schedule for the remainder of the project. (e) A project expenditure...

42 CFR 495.342 - Annual HIT IAPD requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... delays in meeting target dates in the approved HIT technology PAPD/IAPD and approved changes to it. (c) A... products. (d) A project activity schedule for the remainder of the project. (e) A project expenditure...

The Long and Winding Path (from Instructional Design to Performance Technology).

ERIC Educational Resources Information Center

Carr, Clay; Totzke, Larry

1995-01-01

Presents a case study based on experiences at Amway Corporation that explains how the Human Resources Development Department progressed from providing training to providing a broader range of human performance technology interventions. Strategic planning is described, including identifying incentives and required competencies, providing for…

75 FR 1843 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-13

... Information Technology for Economic and Clinical Health Act HMO Health Maintenance Organization HOS Health... Sponsored Organization RHC Rural Health Clinic RPPO Regional Preferred Provider Organization SMHP State... proposed rulemaking on the process for organizations to conduct the certification of EHR technology. DATES...

42 CFR 495.352 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... activities performed during the quarter, including progress in implementing the State's approved Medicaid HIT...

Health information technology adoption in U.S. acute care hospitals.

PubMed

Zhang, Ning Jackie; Seblega, Binyam; Wan, Thomas; Unruh, Lynn; Agiro, Abiy; Miao, Li

2013-04-01

Previous studies show that the healthcare industry lags behind many other economic sectors in the adoption of information technology. The purpose of this study is to understand differences in structural characteristics between providers that do and that do not adopt Health Information Technology (HIT) applications. Publicly available secondary data were used from three sources: American Hospital Association (AHA) annual survey, Healthcare Information and Management Systems Society (HIMSS) analytics annual survey, and Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) databases. Fifty-two information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. Negative binomial regression was applied with adoption of technology as the dependent variables and eight organizational and contextual factors as the independent variables. Hospitals adopt a relatively larger proportion of administrative information technology as compared to clinical and strategic IT. Large size, urban location and HMO penetration were found to be the most influential hospital characteristics that positively affect information technology adoption. There are still considerable variations in the adoption of information technology across hospitals and in the type of technology adopted. Organizational factors appear to be more influential than market factors when it comes to information technology adoption. The future research may examine whether the Electronic Health Record (EHR) Incentive Program in 2011 would increase the information technology uses in hospitals as it provides financial incentives for HER adoptions and uses among providers.

Federal incentives for industrial modernization: Historical review and future opportunities

NASA Technical Reports Server (NTRS)

Coleman, Sandra C.; Batson, Robert G.

1987-01-01

Concerns over the aging of the U.S. aerospace industrial base led DOD to introduce first its Technology Modernization (Tech Mod) Program, and more recently the Industrial Modernization Incentive Program (IMIP). These incentives include productivity shared savings rewards, contractor investment protection to allow for amortization of plant and equipment, and subcontractor/vendor participation. The purpose here is to review DOD IMIP and to evaluate whether a similar program is feasible for NASA and other non-DOD agencies. The IMIP methodology is of interest to industrial engineers because it provides a structured, disciplined approach to identifying productivity improvement opportunities and documenting their expected benefit. However, it is shown that more research on predicting and validating cost avoidance is needed.

Leveraging technology: creating and sustaining changes for health.

PubMed

Teyhen, Deydre S; Aldag, Matt; Edinborough, Elton; Ghannadian, Jason D; Haught, Andrea; Kinn, Julie; Kunkler, Kevin J; Levine, Betty; McClain, James; Neal, David; Stewart, Tiffany; Thorndike, Frances P; Trabosh, Valerie; Wesensten, Nancy; Parramore, David J

2014-09-01

The rapid growth and evolution of health-related technology capabilities are driving an established presence in the marketplace and are opening up tremendous potential to minimize and/or mitigate barriers associated with achieving optimal health, performance, and readiness. This article summarizes technology-based strategies that promote healthy habits related to physical activity, nutrition, and sleep. The Telemedicine and Advanced Technology Research Center convened a workshop titled "Leveraging Technology: Creating & Sustaining Changes for Health" (May 29-30, 2013, Fort Detrick, MD). Participants included experts from academia (n=3), government (n=33), and industry (n=16). A modified Delphi method was used to establish expert consensus in six topic areas: (1) physical activity, (2) nutrition, (3) sleep, (4) incentives for behavior change, (5) usability/interoperability, and (6) mobile health/open platform. Overall, 162 technology features, constructs, and best practices were reviewed and prioritized for physical activity monitors (n=29), nutrition monitors (n=35), sleep monitors (n=24), incentives for change (n=36), usability and interoperability (n=25), and open data (n=13). Leading practices, gaps, and research needs for technology-based strategies were identified and prioritized. This information can be used to provide a research and development road map for (1) leveraging technology to minimize barriers to enhancing health and (2) facilitating evidence-based techniques to create and sustain healthy behaviors.

The impact of pecuniary and non-pecuniary incentives for attracting young doctors to rural general practice.

PubMed

Holte, Jon Helgheim; Kjaer, Trine; Abelsen, Birgit; Olsen, Jan Abel

2015-03-01

Shortages of GPs in rural areas constitute a profound health policy issue worldwide. The evidence for the effectiveness of various incentives schemes, which can be specifically implemented to boost recruitment to rural general practice, is generally considered to be poor. This paper investigates young doctors' preferences for key job attributes in general practice (GP), particularly concerning location and income, using a discrete choice experiment (DCE). The subjects were all final year medical students and interns in Norway (N = 1562), of which 831 (53%) agreed to participate in the DCE. Data was collected in November-December 2010. Policy simulations were conducted to assess the potential impact of various initiatives that can be used to attract young doctors to rural areas. Most interestingly, the simulations highlight the need to consider joint policy programs containing several incentives if the policies are to have a sufficient impact on the motivation and likelihood to work in rural areas. Furthermore, we find that increased income seem to have less impact as compared to improvements in the non-pecuniary attributes. Our results should be of interest to policy makers in countries with publicly financed GP systems that may struggle with the recruitment of GPs in rural areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Paradigm of Viral Communication.

ERIC Educational Resources Information Center

Welker, Carl B.

2002-01-01

Introduces the concepts of idea viruses and viral communication, a technology-based communication that spreads ideas quickly. Explains its applicability in the area of direct marketing and discusses a technology platform that provides the opportunity of sending a message to a large number of people and emotional or pecuniary incentives to…

Societal Incentives for Work: Lessons from Tanzania.

ERIC Educational Resources Information Center

Bjorkquist, David C.

1993-01-01

A study of work and economics, technology, and culture in Tanzania reveals that (1) material returns to rural workers were barely life sustaining; (2) people live dignified lives without consuming much; (3) simpler technological solutions were better; (4) tension exists between competitiveness and humaneness; and (5) tribal traditions contribute…

Surface reconstruction and deformation monitoring of stratospheric airship based on laser scanning technology

NASA Astrophysics Data System (ADS)

Guo, Kai; Xie, Yongjie; Ye, Hu; Zhang, Song; Li, Yunfei

2018-04-01

Due to the uncertainty of stratospheric airship's shape and the security problem caused by the uncertainty, surface reconstruction and surface deformation monitoring of airship was conducted based on laser scanning technology and a √3-subdivision scheme based on Shepard interpolation was developed. Then, comparison was conducted between our subdivision scheme and the original √3-subdivision scheme. The result shows our subdivision scheme could reduce the shrinkage of surface and the number of narrow triangles. In addition, our subdivision scheme could keep the sharp features. So, surface reconstruction and surface deformation monitoring of airship could be conducted precisely by our subdivision scheme.

An Improvement of Robust and Efficient Biometrics Based Password Authentication Scheme for Telecare Medicine Information Systems Using Extended Chaotic Maps.

PubMed

Moon, Jongho; Choi, Younsung; Kim, Jiye; Won, Dongho

2016-03-01

Recently, numerous extended chaotic map-based password authentication schemes that employ smart card technology were proposed for Telecare Medical Information Systems (TMISs). In 2015, Lu et al. used Li et al.'s scheme as a basis to propose a password authentication scheme for TMISs that is based on biometrics and smart card technology and employs extended chaotic maps. Lu et al. demonstrated that Li et al.'s scheme comprises some weaknesses such as those regarding a violation of the session-key security, a vulnerability to the user impersonation attack, and a lack of local verification. In this paper, however, we show that Lu et al.'s scheme is still insecure with respect to issues such as a violation of the session-key security, and that it is vulnerable to both the outsider attack and the impersonation attack. To overcome these drawbacks, we retain the useful properties of Lu et al.'s scheme to propose a new password authentication scheme that is based on smart card technology and requires the use of chaotic maps. Then, we show that our proposed scheme is more secure and efficient and supports security properties.

Linking payment to health outcomes: a taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers.

PubMed

Carlson, Josh J; Sullivan, Sean D; Garrison, Louis P; Neumann, Peter J; Veenstra, David L

2010-08-01

To identify, categorize and examine performance-based health outcomes reimbursement schemes for medical technology. We performed a review of performance-based health outcomes reimbursement schemes over the past 10 years (7/98-010/09) using publicly available databases, web and grey literature searches, and input from healthcare reimbursement experts. We developed a taxonomy of scheme types by inductively organizing the schemes identified according to the timing, execution, and health outcomes measured in the schemes. Our search yielded 34 coverage with evidence development schemes, 10 conditional treatment continuation schemes, and 14 performance-linked reimbursement schemes. The majority of schemes are in Europe and Australia, with an increasing number in Canada and the U.S. These schemes have the potential to alter the reimbursement and pricing landscape for medical technology, but significant challenges, including high transaction costs and insufficient information systems, may limit their long-term impact. Future studies regarding experiences and outcomes of implemented schemes are necessary. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

78 FR 25013 - Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-29

...This proposed rule would revise the Incentive Reward Program provisions in Sec. 420.405 and certain provider enrollment requirements in part 424, subpart P. The most significant of these revisions include: changing the Incentive Reward Program potential reward amount for information on individuals and entities who are or have engaged in acts or omissions which resulted in the imposition of a sanction from 10 percent of the overpayments recovered in the case or $1,000, whichever is less, to 15 percent of the final amount collected applied to the first $66,000,000 for the sanctionable conduct; expanding the instances in which a felony conviction can serve as a basis for denial or revocation of a provider or supplier's enrollment; if certain criteria are met, enabling us to deny enrollment if the enrolling provider, supplier, or owner thereof had an ownership relationship with a previously enrolled provider or supplier that had a Medicare debt; enabling us to revoke Medicare billing privileges if we determine that the provider or supplier has a pattern or practice of submitting claims for services that fail to meet Medicare requirements; and limiting the ability of ambulance suppliers to ``backbill'' for services performed prior to enrollment. We believe this proposed rule would--increase the incentive for individuals to report information on individuals and entities that have or are engaged in sanctionable conduct; improve our ability to detect new fraud schemes; and help us ensure that fraudulent entities and individuals do not enroll in or maintain their enrollment in the Medicare program.

Hybrid coconut seedlings, scholarships, and discount cards for family planning acceptors.

PubMed

Sumarsono

1989-10-01

Having learned from failed family planning (FP) incentive schemes in other countries, Indonesia implemented a reward system designed to popularize FP in the community. In order to overcome cultural opposition to FP, many countries in the 1970s opted to give incentives--money, materials, etc.--to new contraceptive acceptors and the FP workers who successfully recruited them. These countries, which oftentimes spent up to 1/4 of their program budget on incentives, saw rapid increases in the number of new acceptors. The results, however, only reflected a superficial acceptance of FP. When the incentives stopped, the number of acceptors dropped considerably. Recognizing this, the Indonesian government set out to increase FP acceptance by making the small family the norm in the community. And one of the approaches for doing so was a reward system. The goals of the reward program were: 1) to raise awareness of the recognition given to individuals or groups that have accepted FP; 2) to create pride among FP workers and new acceptors; and 3) to generate leadership in the community. Villages with high FP acceptance receive rewards such as deep-wells that provide clean water or income generating projects. Individuals also receive rewards that sometimes include hybrid coconut seedlings which, after 3 years, can yield up to 700 coconuts, which can provide a family with a significant supplemental income. The government also gives scholarships to children of FP acceptors. Also, the president of Indonesia publicly recognized family planning acceptors. In 1989, over 800,000 couples received awards for practicing contraception over the past 5-16 years.

Chapter 15: Using System Dynamics to Model Industry's Developmental Response to Energy Policy

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

Bush, Brian; Inman, Daniel; Newes, Emily

In this chapter we explore the potential development of the biofuels industry using the Biomass Scenario Model (BSM), a system dynamics model developed at the National Renewable Energy Laboratory through the support of the U.S. Department of Energy. The BSM is designed to analyze the implications of policy on the development of the supply chain for biofuels in the United States. It explicitly represents the behavior of decision makers such as farmers, investors, fueling station owners, and consumers. We analyze several illustrative case studies that explore a range of policies and discuss how incentives interact with individual parts of themore » supply chain as well as the industry as a whole. The BSM represents specific incentives that are intended to approximate policy in the form of selected laws and regulations. Through characterizing the decision making behaviors of economic actors within the supply chain that critically influence the adoption rate of new biofuels production technologies and demonstrating synergies among policies, we find that incentives with coordinated impacts on each major element of the supply chain catalyze net effects of decision maker behavior such that the combined incentives are greater than the summed effects of individual incentives in isolation.« less

Can economic incentives enhance adoption and use of a household energy technology? Evidence from a pilot study in Cambodia

NASA Astrophysics Data System (ADS)

Usmani, Faraz; Steele, Jason; Jeuland, Marc

2017-03-01

While much work has examined approaches to increase uptake of a variety of household environmental, health and energy technologies, researchers and policymakers alike have struggled to ensure long-term use. Drawing on a pilot-scale experiment conducted in rural Cambodia, this study evaluates whether economic incentives enhance continued use of—and fuel savings from—improved cookstoves (ICS). Capital-cost subsidies that have been traditionally employed to enhance ICS adoption were augmented with rebates linked to stated and objectively measured use in order to investigate impacts on both initial and sustained adoption in the treatment group. Results show that households do respond to these rebates by adopting the intervention ICS at significantly higher rates, and by using it more frequently and for longer periods. Consistent with these stove-use patterns, solid-fuel use and time spent collecting or preparing fuels also decline. However, this effect appears to diminish over time. Thus, while economic inducements may significantly increase adoption and use of new environmental health technologies, corresponding reductions in environmental or livelihood burdens are not guaranteed. Additional research on the design and implementation of incentive-based interventions targeting households directly—such as carbon financing or other forms of results-based financing (RBF) for improved cookstoves—therefore seems warranted prior to wider implementation of such solutions.

Medicare and Medicaid programs; modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and other changes to EHR Incentive Program; and health information technology: revision to the certified EHR technology definition and EHR certification changes related to standards. Final rule.

PubMed

2014-09-04

This final rule changes the meaningful use stage timeline and the definition of certified electronic health record technology (CEHRT) to allow options in the use of CEHRT for the EHR reporting period in 2014. It also sets the requirements for reporting on meaningful use objectives and measures as well as clinical quality measure (CQM) reporting in 2014 for providers who use one of the CEHRT options finalized in this rule for their EHR reporting period in 2014. In addition, it finalizes revisions to the Medicare and Medicaid EHR Incentive Programs to adopt an alternate measure for the Stage 2 meaningful use objective for hospitals to provide structured electronic laboratory results to ambulatory providers; to correct the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission; and to set a case number threshold exemption for CQM reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013. Finally, this rule finalizes the provisionally adopted replacement of the Data Element Catalog (DEC) and the Quality Reporting Document Architecture (QRDA) Category III standards with updated versions of these standards.

The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review

PubMed Central

Shields, Michael D.; Heaney, Liam G.; Kendall, Marilyn; Pearce, Christina J.; Hui, Chi Yan; Pinnock, Hilary

2017-01-01

Introduction Financial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets. Objectives To systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management. Methods We followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017) including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies. Results We identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7), UK (n = 4) and Canada (n = 1). Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10), written action plans for asthma (n = 1) and hospital/emergency department visits (n = 1). Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving ‘perfect care’ (including providing a written action plan) increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one. Conclusions Results for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health outcomes in asthma. Further research is needed to confirm these findings and understand the process by which financial incentives may impact (or not) on care. Trial registration Protocol registration number: CRD42016027411 PMID:29107955

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to...

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to...

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to...

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to...

42 CFR 495.358 - Cost allocation plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... acquire HIT equipment and services under this subpart are subject to cost allocation plan requirements in...

Colour correct: the interactive effects of food label nutrition colouring schemes and food category healthiness on health perceptions.

PubMed

Nyilasy, Gergely; Lei, Jing; Nagpal, Anish; Tan, Joseph

2016-08-01

The purpose of the present study was to examine the effects of food label nutrition colouring schemes in interaction with food category healthiness on consumers' perceptions of food healthiness. Three streams of colour theory (colour attention, colour association and colour approach-avoidance) in interaction with heuristic processing theory provide consonant predictions and explanations for the underlying psychological processes. A 2 (food category healthiness: healthy v. unhealthy)×3 (food label nutrient colouring schemes: healthy=green, unhealthy=red (HGUR) v. healthy=red, unhealthy=green (HRUG) v. no colour (control)) between-subjects design was used. The research setting was a randomised-controlled experiment using varying formats of food packages and nutritional information colouring. Respondents (n 196) sourced from a national consumer panel, USA. The findings suggest that, for healthy foods, the nutritional colouring schemes reduced perceived healthiness, irrespective of which nutrients were coloured red or green (healthinesscontrol=4·86; healthinessHGUR=4·10; healthinessHRUG=3·70). In contrast, for unhealthy foods, there was no significant difference in perceptions of food healthiness when comparing different colouring schemes against the control. The results make an important qualification to the common belief that colour coding can enhance the correct interpretation of nutrition information and suggest that this incentive may not necessarily support healthier food choices in all situations.

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

Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes.

PubMed

Millett, Christopher; Gray, Jeremy; Saxena, Sonia; Netuveli, Gopalakrishnan; Majeed, Azeem

2007-06-05

Many people with diabetes continue to smoke despite being at high risk of cardiovascular disease. We examined the impact of a pay-for-performance incentive in the United Kingdom introduced in 2004 as part of the new general practitioner contract to improve support for smoking cessation and to reduce the prevalence of smoking among people with chronic diseases such as diabetes. We performed a population-based longitudinal study of the recorded delivery of cessation advice and the prevalence of smoking using electronic records of patients with diabetes obtained from participating general practices. The survey was carried out in an ethnically diverse part of southwest London before (June-October 2003) and after (November 2005-January 2006) the introduction of a pay-for-performance incentive. Significantly more patients with diabetes had their smoking status ever recorded in 2005 than in 2003 (98.8% v. 90.0%, p <0.001). The proportion of patients with documented smoking cessation advice also increased significantly over this period, from 48.0% to 83.5% (p < 0.001). The prevalence of smoking decreased significantly from 20.0% to 16.2% (p < 0.001). The reduction over the study period was lower among women (adjusted odds ratio 0.71, 95% confidence interval 0.53-0.95) but was not significantly different in the most and least affluent groups. In 2005, smoking rates continued to differ significantly with age (10.6%-25.1%), sex (women, 11.5%; men, 20.6%) and ethnic background (4.9%-24.9%). The introduction of a pay-for-performance incentive in the United Kingdom increased the provision of support for smoking cessation and was associated with a reduction in smoking prevalence among patients with diabetes in primary health care settings. Health care planners in other countries may wish to consider introducing similar incentive schemes for primary care physicians.

A Trial of Financial and Social Incentives to Increase Older Adults' Walking.

PubMed

Harkins, Kristin A; Kullgren, Jeffrey T; Bellamy, Scarlett L; Karlawish, Jason; Glanz, Karen

2017-05-01

Despite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults' motivation to become active. This study tested the effects of financial incentives, donations to charity, and the combined effects of both interventions on older adults' uptake and retention of increased levels of walking. RCT comparing three interventions to control. Data collection occurred from 2012 to 2013. Analyses were conducted in 2013-2016. Ninety-four adults aged ≥65 years from Philadelphia-area retirement communities. All participants received digital pedometers, walking goals of a 50% increase in daily steps, and weekly feedback on goal attainment. Participants were randomized to one of four groups: (1) Control: received weekly feedback only; (2) Financial Incentives: received payment of $20 each week walking goals were met; (3) Social Goals: received donation of $20 to a charity of choice each week walking goals were met; and (4) Combined: received $20 each week walking goals were met that could be received by participant, donated to a charity of choice, or divided between the participant and charity. Mean proportion of days walking goals were met during the 16-week intervention and 4-week follow-up period. After adjusting for baseline walking, the proportion of days step goals were met during the 16-week intervention period was higher in all intervention groups versus controls (relative risk, 3.71; 95% CI=1.37, 10.01). During the 4-week follow up period, the proportion of days step goals were met did not differ in intervention groups compared to control (relative risk, 2.91; 95% CI=0.62, 13.64). Incentive schemes that use donations to a charity of choice, personal financial incentives, or a combination of the two can each increase older adults' initial uptake of increased levels of walking. This study is registered at www.clinicaltrials.gov NCT01643538. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

76 FR 6496 - Special Flight Rules Area in the Vicinity of Grand Canyon National Park, Draft Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-04

... being considered include: Alternative A Current Condition: Key elements are corridors open year round, annual allocation cap of 93,971, and no quiet technology incentive. Current tours for helicopters and... to quiet technology aircraft. Alternative F Modified Current Condition: Key elements are similar to...

The Long Term Educational Needs of a High-Technology Society.

ERIC Educational Resources Information Center

Button, Kenneth; Cox, Kenneth; Stough, Roger; Taylor, Samantha

2002-01-01

Discusses information technology (IT) labor issues in the U.S. and elsewhere, including demand for IT workers, skills and education needed to pursue IT jobs, and methods to increase supply of IT workers. Examines legislative attempts to increase supply, including use of tax incentives. Discusses IT needs and training programs in six other…

Supporting Technology Integration within a Teacher Education System

ERIC Educational Resources Information Center

Schaffer, Scott P.; Richardson, Jennifer C.

2004-01-01

The purpose of this case study was to examine a teacher education system relative to the degree of performance support for the use of technology to support learning. Performance support was measured by the presence of factors such as clear expectations, feedback, tools, rewards, incentives, motivation, capacity, skills, and knowledge within the…

76 FR 31547 - Medicare Program; Proposed Changes to the Electronic Prescribing (eRx) Incentive Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-01

... unless we specify otherwise. For more information on which professionals are eligible to participate in... Information Technology,'' available at http://www.gao.gov/products/GAO-11-159 ). As a result of the above... certification body authorized by the National Coordinator for Health Information Technology (at the present time...

Meaningful Use of Health Information Technology by Rural Hospitals

ERIC Educational Resources Information Center

McCullough, Jeffrey; Casey, Michelle; Moscovice, Ira; Burlew, Michele

2011-01-01

Purpose: This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. Methods: Data…

Creating value: unifying silos into public health business intelligence.

PubMed

Davidson, Arthur J

2014-01-01

Through September 2014, federal investments in health information technology have been unprecedented, with more than 25 billion dollars in incentive funds distributed to eligible hospitals and providers. Over 85 percent of eligible United States hospitals and 60 percent of eligible providers have used certified electronic health record (EHR) technology and received Meaningful Use incentive funds (HITECH Act1). Certified EHR technology could create new public health (PH) value through novel and rapidly evolving data-use opportunities, never before experienced by PH. The long-standing "silo" approach to funding has fragmented PH programs and departments,2 but the components for integrated business intelligence (i.e., tools and applications to help users make informed decisions) and maximally reuse data are available now. Challenges faced by PH agencies on the road to integration are plentiful, but an emphasis on PH systems and services research (PHSSR) may identify gaps and solutions for the PH community to address. Technology and system approaches to leverage this information explosion to support a transformed health care system and population health are proposed. By optimizing this information opportunity, PH can play a greater role in the learning health system.

Innovation and The Welfare Effects of Public Drug Insurance*

PubMed Central

Lakdawalla, Darius; Sood, Neeraj

2010-01-01

Rewarding inventors with inefficient monopoly power has long been regarded as the price of encouraging innovation. Prescription drug insurance escapes that trade-off and achieves an elusive goal: lowering static deadweight loss, without reducing incentives for innovation. As a result of this feature, the public provision of drug insurance can be welfare-improving, even for risk-neutral and purely self-interested consumers. The design of insurers’ cost-sharing schedules can either reinforce or mitigate this result. Schedules that impose higher consumer cost-sharing requirements on more expensive drugs help ensure that insurance subsidies translate into higher utilization, rather than pure increases in manufacturer profits. Moreover, some degree of price-negotiation with manufacturers is likely to be welfare-improving, but the optimal degree depends on the size of such transactions costs, as well as the social cost of weakening innovation incentives by lowering innovator profits. These results have practical implications for the evaluation of public drug insurance programs like the US Medicaid and Medicare Part D programs, along with European insurance schemes. PMID:20454467

Persons with Multiple Disabilities Exercise Adaptive Response Schemes with the Help of Technology-Based Programs: Three Single-Case Studies

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Lang, Russell

2012-01-01

The present three single-case studies assessed the effectiveness of technology-based programs to help three persons with multiple disabilities exercise adaptive response schemes independently. The response schemes included (a) left and right head movements for a man who kept his head increasingly static on his wheelchair's headrest (Study I), (b)…

Natural remedies in Scandinavia-authorization and sales.

PubMed

Waaseth, Marit; Eggen, Anne Elise; Grimsgaard, Sameline

2007-06-01

to quantify sales of authorized natural remedies (ANRs) in Norway, to compare the Norwegian authorization scheme with similar schemes in Sweden, Denmark and the EU, and to identify factors influencing the number of marketed ANRs. descriptive statistics are used to present sales of ANRs in Norway. The ANRs are classified by indication group and assigned a recommended daily dose (RDD) according to the posology section in the Summary of Product Characteristics (SPC). Document analysis of regulation and general information concerning natural remedies is used to compare the authorization schemes for ANRs in Scandinavia and for traditional herbal medicinal products (THMs) in the EU. Four cases of herbs are described to illustrate the consequences of this regulation and identify possible influencing factors. sales, in terms of both mean consumer prices and number of RDDs, and the factors found to influence the number of marketed ANRs. total sales of ANRs in Norway in 2003 were 1.5 per capita (3% of the food supplement market), or 5.5 RDD/1,000/day, and the sales have tended to decline. Norway has very few ANRs compared with Sweden and Denmark. Changes in Norwegian ANR regulation in 2004 have harmonized application requirements in Scandinavia, but results have yet to be seen. THMs are subject to the same quality requirements as ANRs, and will replace the ANRs over the next 7 years. Several factors have influenced the manufacturers' application incentive, e.g., application costs, differentiated VAT rates, consumer knowledge and surveillance by health authorities. sales of authorized compared to unauthorized natural remedies in Norway are very low and the ANRs are in a weak position compared to Denmark and Sweden. Surveillance by health authorities and increased consumer knowledge of ANRs is probably more stimulating with respect to application incentive than lower application costs. Introducing THMs will hopefully increase the number of quality-controlled products on the Scandinavian market.

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... identified as an overpayment regardless of recoupment from such providers, within 60 days of discovery of the...

Creating Value: Unifying Silos into Public Health Business Intelligence

PubMed Central

Davidson, Arthur J.

2014-01-01

Introduction: Through September 2014, federal investments in health information technology have been unprecedented, with more than 25 billion dollars in incentive funds distributed to eligible hospitals and providers. Over 85 percent of eligible United States hospitals and 60 percent of eligible providers have used certified electronic health record (EHR) technology and received Meaningful Use incentive funds (HITECH Act1). Technology: Certified EHR technology could create new public health (PH) value through novel and rapidly evolving data-use opportunities, never before experienced by PH. The long-standing “silo” approach to funding has fragmented PH programs and departments,2 but the components for integrated business intelligence (i.e., tools and applications to help users make informed decisions) and maximally reuse data are available now. Systems: Challenges faced by PH agencies on the road to integration are plentiful, but an emphasis on PH systems and services research (PHSSR) may identify gaps and solutions for the PH community to address. Conclusion: Technology and system approaches to leverage this information explosion to support a transformed health care system and population health are proposed. By optimizing this information opportunity, PH can play a greater role in the learning health system. PMID:25995989

Development of sanitation technologies in African context : how could we make it more sustainable?

NASA Astrophysics Data System (ADS)

Dakouré, M. S.; Traoré, M. B.; Sossou, S. K.; Maïga, A. H.

2017-03-01

Access to sanitation technologies remains one of the biggest challenges in sub-Saharan Africa. To overcome this gap, a sanitation project called “Ameli-EAUR” translated from French as improvement of water and sanitation in urban and rural areas, was implemented in Burkina Faso for 5 years (2010-2016). The technologies from the project were designed on the basis of agro-sanitation concept, leading to package containing a composting toilet, a grey water treatment facility and a set of urine collection and treatment. The study aimed to evaluate of Ameli-EAUR project, one year after the end, and identify some key factors of sustainability of technologies. As methodology, a survey and a technical diagnostic of implemented technologies were done. The results showed that, the pilot families stopped using all the technologies one year after the end of the project. However, two main lessons can be learnt: (1) in term of efficiency and effectiveness of the project the technology of composting toilet was not robust enough, leading to a rapid abandonment after the project (2) in term of impact and sustainability, the economic incentive of the resource oriented sanitation concept was very weak compared to the needed workload. The technologies development in this kind of project should be carried on and associated with a more inclusive system driven by economic incentive.

American Power Act (Discussion of Draft)

EPA Pesticide Factsheets

To secure the energy future of the United States, to provide incentives for the domestic production of clean energy technology, to achieve meaningful pollution reductions, to create jobs, and for other purposes.

Evaluation of Vortex Chamber Concepts for Liquid Rocket Engine Applications

NASA Technical Reports Server (NTRS)

Trinh, Huu Phuoc; Knuth, Williams; Michaels, Scott; Turner, James E. (Technical Monitor)

2000-01-01

Rocket-based combined-cycle engines (RBBC) being considered at NASA for future generation launch vehicles feature clusters of small rocket thrusters as part of the engine components. Depending on specific RBBC concepts, these thrusters may be operated at various operating conditions including power level and/or propellant mixture ratio variations. To pursue technology developments for future launch vehicles, NASA/Marshall Space Flight Center (MSFC) is examining vortex chamber concepts for the subject cycle engine application. Past studies indicated that the vortex chamber schemes potentially have a number of advantages over conventional chamber methods. Due to the nature of the vortex flow, relatively cooler propellant streams tend to flow along the chamber wall. Hence, the thruster chamber can be operated without the need of any cooling techniques. This vortex flow also creates strong turbulence, which promotes the propellant mixing process. Consequently, the subject chamber concepts not only offer the system simplicity but they also would enhance the combustion performance. The test results showed that the chamber performance was markedly high even at a low chamber length-to- diameter ratio (L/D). This incentive can be translated to a convenience in the thrust chamber packaging.

Impacts of the type of social health insurance on health service utilisation and expenditures: implications for a unified system in China.

PubMed

Tan, Si Ying; Wu, Xun; Yang, Wei

2018-05-08

While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model. Our results show that Urban Employee Medical Insurance, which offers the most generous benefits, incurs the highest total costs prior to reimbursement when compared to other SHI schemes. Our analysis also shows that utilisation of SHI did not show significant reduction in out-of-pocket payments for outpatients. We argue that, unless effective measures are introduced to deal with perverse provider payment incentives, the move towards a unified system with more generous benefits may usher in a new wave of cost escalation for health care systems in China.

Developing a TPCK-SRL Assessment Scheme for Conceptually Advancing Technology in Education

ERIC Educational Resources Information Center

Kohen, Zehavit; Kramarski, Bracha

2012-01-01

The present study aimed to: (a) develop a conceptual TPCK-SRL scheme for assessing teachers' integration of self-regulated learning (SRL) considerations while infusing technology into a TPCK classroom context (blending K = knowledge about T = technology, P = pedagogy, and C = content), which reflects all three knowledge components' dynamic…

Developing Medicare Competitive Bidding: A Study of Clinical Laboratories

PubMed Central

Hoerger, Thomas J.; Meadow, Ann

1997-01-01

Competitive bidding to derive Medicare fees promises several advantages over administered fee systems. The authors show how incentives for cost savings, quality, and access can be incorporated into bidding schemes, and they report on a study of the clinical laboratory industry conducted in preparation for a bidding demonstration. The laboratory industry is marked by variable concentration across geographic markets and, among firms themselves, by social and economic heterogeneity. The authors conclude that these conditions can be accommodated by available bidding design options and by careful selection of bidding markets. PMID:10180003

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.

Advancing the Growth of the U.S. Wind Industry: Federal Incentives, Funding, and Partnership Opportunities

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

The U.S. Department of Energy's (DOE's) Wind Energy Technologies Office (WETO) works to accelerate the development and deployment of wind power. The office provides information for researchers, developers, businesses, manufacturers, communities, and others seeking various types of federal assistance available for advancing wind projects. This fact sheet outlines the primary federal incentives for developing and investing in wind power, resources for funding wind power, and opportunities to partner with DOE and other federal agencies on efforts to move the U.S. wind industry forward.

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.

A qualitative study of stakeholder views regarding participation in locally commissioned enhanced optometric services.

PubMed

Konstantakopoulou, E; Harper, R A; Edgar, D F; Lawrenson, J G

2014-05-29

To explore the views of optometrists, general practitioners (GPs) and ophthalmologists regarding the development and organisation of community-based enhanced optometric services. Qualitative study using free-text questionnaires and telephone interviews. A minor eye conditions scheme (MECS) and a glaucoma referral refinement scheme (GRRS) are based on accredited community optometry practices. 41 optometrists, 6 ophthalmologists and 25 GPs. The most common reason given by optometrists for participation in enhanced schemes was to further their professional development; however, as providers of 'for-profit' healthcare, it was clear that participants had also considered the impact of the schemes on their business. Lack of fit with the 'retail' business model of optometry was a frequently given reason for non-participation. The methods used for training and accreditation were generally thought to be appropriate, and participating optometrists welcomed the opportunities for ongoing training. The ophthalmologists involved in the MECS and GRRS expressed very positive views regarding the schemes and widely acknowledged that the new care pathways would reduce unnecessary referrals and shorten patient waiting times. GPs involved in the MECS were also very supportive. They felt that the scheme provided an 'expert' local opinion that could potentially reduce the number of secondary care referrals. The results of this study demonstrated strong stakeholder support for the development of community-based enhanced optometric services. Although optometrists welcomed the opportunity to develop their professional skills and knowledge, enhanced schemes must also provide a sufficient financial incentive so as not to compromise the profitability of their business. 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 fundholding fandango.

PubMed Central

Bowie, C; Harris, T

1994-01-01

General practitioner fundholding allows flexible use of resources at the coal-face, provides incentives to alter practice such as prescribing within cash limits and forces hospitals to be more responsive to general practitioner demands. However, the additional administrative costs both in time and money, the fragmentation of purchasing power compounded by a lack of expertise and experience in contracting, and the poor information and financial systems which exist in the National Health Service are severe constraints. A suggested way forward is to delegate responsibility for running the scheme, including the contracting and billing, to district health authorities offering more flexible budgets to all practices and extending the scheme as local information systems allow. This will reduce fragmentation of purchasing power and administrative costs and re-establish local accountability. It will also give the general practitioner more time to see and treat patients, who will see the system as being fairer. PMID:8312038

Eco-certification of farmed seafood: will it make a difference?

PubMed

Jonell, Malin; Phillips, Michael; Rönnbäck, Patrik; Troell, Max

2013-10-01

Eco-certification is widely considered a tool for reducing environmental impacts of aquaculture, but what are the likely environmental outcomes for the world's fastest growing animal-food production sector? This article analyzes a number of eco-certification schemes based on species choice, anticipated share of the global seafood market, size of eligible producers, and targeted environmental impacts. The potential of eco-certification to reduce the negative environmental impacts of aquaculture at scale presently appears uncertain as: (a) certification schemes currently focus on species predominantly consumed in the EU and US, with limited coverage of Asian markets; (b) the share of certified products in the market as currently projected is too low; (c) there is an inequitable and non-uniform applicability of certification across the sector; (d) mechanisms or incentives for improvement among the worst performers are lacking; and (e) there is incomplete coverage of environmental impacts, with biophysical sustainability and ecosystem perspectives generally lacking.

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.

New Authentication Scheme for Wireless Body Area Networks Using the Bilinear Pairing.

PubMed

Wang, Chunzhi; Zhang, Yanmei

2015-11-01

Due to the development of information technologies and network technologies, healthcare systems have been employed in many countries. As an important part of healthcare systems, the wireless body area network (WBAN) could bring convenience to both patients and physicians because it could help physicians to monitor patients' physiological values remotely. It is essential to ensure secure communication in WBANs because patients' physiological values are very sensitive. Recently, Liu et al. proposed an efficient authentication scheme for WBANs. Unfortunately, Zhao pointed out that their scheme suffered from the stolen verifier-table attack. To improve security and efficiency, Zhao proposed an anonymous authentication scheme for WBANs. However, Zhao's scheme cannot provide real anonymity because the users' pseudo identities are constant value and the attack could tract the users. In this paper, we propose a new anonymous authentication scheme for WBANs. Security analysis shows that the proposed scheme could overcome weaknesses in previous scheme. We also use the BAN logic to demonstrate the security of the proposed scheme.

The Information Revolution and International Stability: A Multi-Article Exploration of Computing, Cyber, and Incentives for Conflict

ERIC Educational Resources Information Center

Schneider, Jacquelyn

2017-01-01

Over the last twenty years, the digital technologies of the information revolution have fundamentally impacted the nature of modern warfare and introduced significant uncertainty about capabilities, intentions, and the limits of conflict. How do these digital advances and the explosion of cyber technologies on and off the battlefield impact…

Did state renewable portfolio standards induce technical change in methane mitigation in the U.S. landfill sector?

NASA Astrophysics Data System (ADS)

Delhotal, Katherine Casey

Landfill gas (LFG) projects use the gas created from decomposing waste, which is approximately 49% methane, and substitute it for natural gas in engines, boilers, turbines, and other technologies to produce energy or heat. The projects are beneficial in terms of increased safety at the landfill, production of a cost-effective source of energy or heat, reduced odor, reduced air pollution emissions, and reduced greenhouse gas emissions. However, landfills sometimes face conflicting policy incentives. The theory of technical change shows that the diffusion of a technology or groups of technologies increases slowly in the beginning and then picks up speed as knowledge and better understanding of using the technology diffuses among potential users. Using duration analysis, data on energy prices, State and Federal policies related to landfill gas, renewable energy, and air pollution, as well as control data on landfill characteristics, I estimate the influence and direction of influence of renewable portfolio standards (RPS). The analysis found that RPS positively influences the diffusion of landfill gas technologies, encouraging landfills to consider electricity generation projects over direct sales of LFG to another facility. Energy price increases or increased revenues for a project are also critical. Barriers to diffusion include air emission permits in non-attainment areas and policies, such as net metering, which promote other renewables over LFG projects. Using the estimates from the diffusion equations, I analyze the potential influence of a Federal RPS as well as the potential interaction with a Federal, market based climate change policy, which will increase the revenue of a project through higher energy sale prices. My analysis shows that a market based climate change policy such as a cap-and-trade or carbon tax scheme would increase the number of landfill gas projects significantly more than a Federal RPS.

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.

Agricultural intensification escalates future conservation costs.

PubMed

Phelps, Jacob; Carrasco, Luis Roman; Webb, Edward L; Koh, Lian Pin; Pascual, Unai

2013-05-07

The supposition that agricultural intensification results in land sparing for conservation has become central to policy formulations across the tropics. However, underlying assumptions remain uncertain and have been little explored in the context of conservation incentive schemes such as policies for Reducing Emissions from Deforestation and forest Degradation, conservation, sustainable management, and enhancement of carbon stocks (REDD+). Incipient REDD+ forest carbon policies in a number of countries propose agricultural intensification measures to replace extensive "slash-and-burn" farming systems. These may result in conservation in some contexts, but will also increase future agricultural land rents as productivity increases, creating new incentives for agricultural expansion and deforestation. While robust governance can help to ensure land sparing, we propose that conservation incentives will also have to increase over time, tracking future agricultural land rents, which might lead to runaway conservation costs. We present a conceptual framework that depicts these relationships, supported by an illustrative model of the intensification of key crops in the Democratic Republic of Congo, a leading REDD+ country. A von Thünen land rent model is combined with geographic information systems mapping to demonstrate how agricultural intensification could influence future conservation costs. Once postintensification agricultural land rents are considered, the cost of reducing forest sector emissions could significantly exceed current and projected carbon credit prices. Our analysis highlights the importance of considering escalating conservation costs from agricultural intensification when designing conservation initiatives.

Agricultural intensification escalates future conservation costs

PubMed Central

Phelps, Jacob; Carrasco, Luis Roman; Webb, Edward L.; Koh, Lian Pin; Pascual, Unai

2013-01-01

The supposition that agricultural intensification results in land sparing for conservation has become central to policy formulations across the tropics. However, underlying assumptions remain uncertain and have been little explored in the context of conservation incentive schemes such as policies for Reducing Emissions from Deforestation and forest Degradation, conservation, sustainable management, and enhancement of carbon stocks (REDD+). Incipient REDD+ forest carbon policies in a number of countries propose agricultural intensification measures to replace extensive “slash-and-burn” farming systems. These may result in conservation in some contexts, but will also increase future agricultural land rents as productivity increases, creating new incentives for agricultural expansion and deforestation. While robust governance can help to ensure land sparing, we propose that conservation incentives will also have to increase over time, tracking future agricultural land rents, which might lead to runaway conservation costs. We present a conceptual framework that depicts these relationships, supported by an illustrative model of the intensification of key crops in the Democratic Republic of Congo, a leading REDD+ country. A von Thünen land rent model is combined with geographic information systems mapping to demonstrate how agricultural intensification could influence future conservation costs. Once postintensification agricultural land rents are considered, the cost of reducing forest sector emissions could significantly exceed current and projected carbon credit prices. Our analysis highlights the importance of considering escalating conservation costs from agricultural intensification when designing conservation initiatives. PMID:23589860

A real options approach to biotechnology investment policy-the case of developing a Campylobacter vaccine to poultry.

PubMed

Lund, Mogens; Jensen, Jørgen Dejgård

2016-06-01

The aim of the article is to identify and analyse public-private incentives for the development and marketing of new animal vaccines within a real options methodological framework, and to investigate how real options methodology can be utilized to support economic incentives for vaccine development in a cost-effective way. The development of a vaccine against Campylobacter jejuni in poultry is applied as a case study. Employing the real options methodology, the net present value of the vaccine R&D project becomes larger than a purely probabilistic expected present value throughout the different stages of the project - and the net present value becomes larger, when more types of real options are taken into consideration. The insight from the real options analysis reveals opportunities for new policies to promote the development of animal vaccines. One such approach might be to develop schemes combining stage-by-stage optimized subsidies in the individual development stages, with proper account taken of investors'/developers' economic incentives to proceed, sell or cancel the project in the respective stages. Another way of using the real options approach to support the development of desirable animal vaccines could be to issue put options for the vaccine candidate, enabling vaccine developers to hedge against the economic risk from market volatility. Copyright © 2016 Elsevier B.V. All rights reserved.

78 FR 40084 - Proposed Requirement-Migrant Education Program Consortium Incentive Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-03

... techniques may include ``identifying changing future compliance costs that might result from technological innovation or anticipated behavioral changes.'' We are issuing this proposed requirement only on a reasoned...

42 CFR 495.328 - Request for reconsideration of adverse determination.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.328 Request for... planning document or State Medicaid HIT Plan under this subpart, or determines that requirements are met...

Application of advanced technology to space automation

NASA Technical Reports Server (NTRS)

Schappell, R. T.; Polhemus, J. T.; Lowrie, J. W.; Hughes, C. A.; Stephens, J. R.; Chang, C. Y.

1979-01-01

Automated operations in space provide the key to optimized mission design and data acquisition at minimum cost for the future. The results of this study strongly accentuate this statement and should provide further incentive for immediate development of specific automtion technology as defined herein. Essential automation technology requirements were identified for future programs. The study was undertaken to address the future role of automation in the space program, the potential benefits to be derived, and the technology efforts that should be directed toward obtaining these benefits.

Opportunities and Challenges for Solar Minigrid Development in Rural India

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

Thirumurthy, N.; Harrington, L.; Martin, D.

2012-09-01

The goal of this report is to inform investors about the potential of solar minigrid technologies to serve India's rural market. Under the US-India Energy Dialogue, the US Department of Energy's (DOE) National Renewable Energy Laboratory (NREL) is supporting the Indian Ministry of New and Renewable Energy (MNRE)'s Jawaharlal Nehru National Solar Mission (JNNSM) in performing a business-case and policy-oriented analysis on the deployment of solar minigrids in India. The JNNSM scheme targets the development of 2GW of off-grid solar power by 2022 and provides large subsidies to meet this target. NREL worked with electricity capacity and demand data suppliedmore » by the Ladakh Renewable Energy Development Agency (LREDA) from Leh District, to develop a technical approach for solar minigrid development. Based on the NREL-developed, simulated solar insolation data for the city of Leh, a 250-kW solar photovoltaic (PV) system can produce 427,737 kWh over a 12-month period. The business case analysis, based on several different scenarios and JNNSM incentives shows the cost of power ranges from Rs. 6.3/kWh (US$0.126) to Rs. 9/kWh (US$0.18). At these rates, solar power is a cheaper alternative to diesel. An assessment of the macro-environment elements--including political, economic, environmental, social, and technological--was also performed to identify factors that may impact India?s energy development initiatives.« less

Effects of Deployment Investment on the Growth of the Biofuels Industry. 2016 Update

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

Vimmerstedt, Laura J.; Warner, Ethan S.; Stright, Dana

This report updates the 2013 report of the same title. Some text originally published in that report is retained and indicated in gray. In support of the national goals for biofuel use in the United States, numerous technologies have been developed that convert biomass to biofuels. Some of these biomass to biofuel conversion technology pathways are operating at commercial scales, while others are in earlier stages of development. The advancement of a new pathway toward commercialization involves various types of progress, including yield improvements, process engineering, and financial performance. Actions of private investors and public programs can accelerate the demonstrationmore » and deployment of new conversion technology pathways. These investors (both private and public) will pursue a range of pilot, demonstration, and pioneer scale biorefinery investments; the most cost-effective set of investments for advancing the maturity of any given biomass to biofuel conversion technology pathway is unknown. In some cases, whether or not the pathway itself will ultimately be technically and financially successful is also unknown. This report presents results from the Biomass Scenario Model--a system dynamics model of the biomass to biofuels system--that estimate effects of investments in biorefineries at different maturity levels and operational scales. The report discusses challenges in estimating effects of such investments and explores the interaction between this deployment investment and a volumetric production incentive. Model results show that investments in demonstration and deployment have a substantial growth impact on the development of the biofuels industry. Results also show that other conditions, such as accompanying incentives, have major impacts on the effectiveness of such investments. Results from the 2013 report are compared to new results. This report does not advocate for or against investments, incentives, or policies, but analyzes simulations of their hypothetical effects.« less

Analysis of agency relationships in the design and implementation process of the equity fund in Madagascar.

PubMed

Honda, Ayako

2015-02-04

There are large gaps in the literature relating to the implementation of user fee policy and fee exemption measures for the poor, particularly on how such schemes are implemented and why many have not produced expected outcomes. In October 2003, Madagascar instituted a user fee exemption policy which established "equity funds" at public health centres, and used medicine sales revenue to subsidise the cost of medicine for the poor. This study examines the policy design and implementation process of the equity fund in Madagascar in an attempt to explore factors influencing the poor equity outcomes of the scheme. This study applied an agency-incentive framework to investigate the equity fund policy design and implementation practices. It analysed agency relationships established during implementation; examined incentive structures given to the agency relationships in the policy design; and considered how incentive structures were shaped and how agents responded in practice. The study employed a case-study approach with in-depth analysis of three equity fund cases in Madagascar's Boeny region. Policy design problems, triggering implementation problems, caused poor equity performance. These problems were compounded by the re-direction of policy objectives by health administrators and strong involvement of the administrators in the implementation of policy. The source of the policy design and implementation failure was identified as a set of principal-agent problems concerning: monitoring mechanisms; facility-based fund management; and the nature and level of community participation. These factors all contributed to the financial performance of the fund receiving greater attention than its ability to financially protect the poor. The ability of exemption policies to protect the poor from user fees can be found in the details of the policy design and implementation; and implications of the policy design and implementation in a specific context determine whether a policy can realise its objectives. The equity fund experience in Madagascar, which illustrates the challenges of beneficiary identification, casts doubts on the application of the 'targeting' approach in health financing and raises issues to be considered in universal health policy formulation. The agency framework provides a useful lens through which to examine policy process issues.

Design and baseline characteristics of participants in the Enhancing Physical Activity and Reducing Obesity through Smartcare and Financial Incentives (EPAROSFI): A pilot randomized controlled trial.

PubMed

Shin, Dong Wook; Joh, Hee-Kyung; Yun, Jae Moon; Kwon, Hyuk Tae; Lee, Hyejin; Min, Hyeyeon; Shin, Jung-Hyun; Chung, Won Joo; Park, Jin Ho; Cho, BeLong

2016-03-01

An activity tracker combined with a smartphone application (smartcare) may help people track and receive feedback on their own activities. However, activity trackers themselves generally fail to drive long-term sustained engagement for a majority of users. One potential strategy for increasing the effectiveness of smartcare is through the use of incentives. The purpose of this pilot randomized trial is to test the feasibility of our intervention and to assess the extent to which smartcare with or without financial incentives can increase physical activity levels and reduce weight over a 12-week period. This study employs a three-arm, open-label randomized controlled trial design: control (standard basic education), smartcare, and smartcare plus financial incentives. Male university students with body mass index ≥ 27 are enrolled. Our primary and secondary endpoints are the amount of weight loss and the level of physical activity respectively. The weight loss goal is 3% of baseline at week 4, 5% at week 8, and 7% at week 12. The daily physical activity goal was individualized according to the participants' weight. Process incentives are accumulated when participants met daily physical activity goals, and outcome incentives are provided when they met weight reduction goals. Given the global increase in physical inactivity and obesity, there is a growing need for effective, scalable, and affordable health promotion strategies. Our proof-of-concept study will provide the evidence for the combination of rising health promotion technology of activity trackers and smartphone applications with the modern concept of behavioral economics using financial incentives. Copyright © 2015. Published by Elsevier Inc.

The Use of Enhanced Appointment Access Strategies by Medical Practices.

PubMed

Rodriguez, Hector P; Knox, Margae; Hurley, Vanessa; Rittenhouse, Diane R; Shortell, Stephen M

2016-06-01

Strategies to enhance appointment access are being adopted by medical practices as part of patient-centered medical home (PCMH) implementation, but little is known about the use of these strategies nationally. We examine practice use of open access scheduling and after-hours care. Data were analyzed from the Third National Study of Physician Organizations (NSPO3) to examine which enhanced appointment access strategies are more likely to be used by practices with more robust PCMH capabilities and with greater external incentives. Logistic regression estimated the effect of PCMH capabilities and external incentives on practice use of open access scheduling and after-hours care. Physician organizations with >20% primary care physicians (n=1106). PCMH capabilities included team-based care, health information technology capabilities, quality improvement orientation, and patient experience orientation. External incentives included public reporting, pay-for-performance (P4P), and accountable care organization participation. A low percentage of practices (19.8%) used same-day open access scheduling, while after-hours care (56.1%) was more common. In adjusted analyses, system-owned practices and practices with greater use of team-based care, health information technology capabilities, and public reporting were more likely to use open access scheduling. Accountable care organization-affiliated practices and practices with greater use of public reporting and P4P were more likely to provide after-hours care. Open access scheduling may be most effectively implemented by practices with robust PCMH capabilities. External incentives appear to influence practice adoption of after-hours care. Expanding open access scheduling and after-hours care will require distinct policies and supports.

Life Cycle Assessment of Residential Heating and Cooling Systems in Minnesota A comprehensive analysis on life cycle greenhouse gas (GHG) emissions and cost-effectiveness of ground source heat pump (GSHP) systems compared to the conventional gas furnace and air conditioner system

NASA Astrophysics Data System (ADS)

Li, Mo

Ground Source Heat Pump (GSHP) technologies for residential heating and cooling are often suggested as an effective means to curb energy consumption, reduce greenhouse gas (GHG) emissions and lower homeowners' heating and cooling costs. As such, numerous federal, state and utility-based incentives, most often in the forms of financial incentives, installation rebates, and loan programs, have been made available for these technologies. While GSHP technology for space heating and cooling is well understood, with widespread implementation across the U.S., research specific to the environmental and economic performance of these systems in cold climates, such as Minnesota, is limited. In this study, a comparative environmental life cycle assessment (LCA) is conducted of typical residential HVAC (Heating, Ventilation, and Air Conditioning) systems in Minnesota to investigate greenhouse gas (GHG) emissions for delivering 20 years of residential heating and cooling—maintaining indoor temperatures of 68°F (20°C) and 75°F (24°C) in Minnesota-specific heating and cooling seasons, respectively. Eight residential GSHP design scenarios (i.e. horizontal loop field, vertical loop field, high coefficient of performance, low coefficient of performance, hybrid natural gas heat back-up) and one conventional natural gas furnace and air conditioner system are assessed for GHG and life cycle economic costs. Life cycle GHG emissions were found to range between 1.09 × 105 kg CO2 eq. and 1.86 × 10 5 kg CO2 eq. Six of the eight GSHP technology scenarios had fewer carbon impacts than the conventional system. Only in cases of horizontal low-efficiency GSHP and hybrid, do results suggest increased GHGs. Life cycle costs and present value analyses suggest GSHP technologies can be cost competitive over their 20-year life, but that policy incentives may be required to reduce the high up-front capital costs of GSHPs and relatively long payback periods of more than 20 years. In addition, results suggest that the regional electricity fuel mix and volatile energy prices significantly influence the benefits of employing GSHP technologies in Minnesota from both environmental and economic perspectives. It is worthy noting that with the historically low natural gas price in 2012, the conventional system's energy bill reduction would be large enough to bring its life-cycle cost below those of the GSHPs. As a result, the environmentally favorable GSHP technologies would become economically unfavorable, unless they are additionally subsidized. Improved understanding these effects, along with design and performance characteristics of GSGP technologies specific to Minnesota's cold climate, allows better decision making among homeowners considering these technologies and policy makers providing incentives for alternative energy solutions.

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.

42 CFR 413.70 - Payment for services of a CAH.

Code of Federal Regulations, 2010 CFR

2010-10-01

... receives an incentive payment for the reasonable costs of purchasing certified EHR technology in a cost..., nurse practitioner, or clinical nurse specialist who is on call” means a doctor of medicine or...

42 CFR 413.70 - Payment for services of a CAH.

Code of Federal Regulations, 2014 CFR

2014-10-01

... receives an incentive payment for the reasonable costs of purchasing certified EHR technology in a cost..., nurse practitioner, or clinical nurse specialist who is on call” means a doctor of medicine or...

42 CFR 413.70 - Payment for services of a CAH.

Code of Federal Regulations, 2011 CFR

2011-10-01

... receives an incentive payment for the reasonable costs of purchasing certified EHR technology in a cost... call” means a doctor of medicine or osteopathy, a physician assistant, a nurse practitioner, or a...

42 CFR 413.70 - Payment for services of a CAH.

Code of Federal Regulations, 2013 CFR

2013-10-01

... receives an incentive payment for the reasonable costs of purchasing certified EHR technology in a cost... call” means a doctor of medicine or osteopathy, a physician assistant, a nurse practitioner, or a...

Use of incentives to encourage ITS deployment.

DOT National Transportation Integrated Search

2014-07-01

Moving Ahead for Progress in the 21st Century Act (MAP-21) identifies Intelligent Transportation Systems (ITS) as part of the solution to the Nations transportation needs and provides mechanisms for accelerating deployment of innovative technology...

42 CFR 495.330 - Termination of FFP for failure to provide access to information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.330 Termination... HIT planning and implementation efforts, and the systems used to interoperate with electronic HIT...

Electricity distribution networks: Changing regulatory approaches

NASA Astrophysics Data System (ADS)

Cambini, Carlo

2016-09-01

Increasing the penetration of distributed generation and smart grid technologies requires substantial investments. A study proposes an innovative approach that combines four regulatory tools to provide economic incentives for distribution system operators to facilitate these innovative practices.

A prospective view on European pharmaceutical research and development. Policy options to reduce fragmentation and increase competitiveness.

PubMed

Kanavos, P

1998-02-01

This article analyses 3 areas of policy that could reduce the fragmentation and improve the competitiveness of the European pharmaceutical sector. It argues that a potential solution to the issue of fragmentation of pharmaceutical research, development and innovation may be the development of policies at the European level, in those areas that European institutions have a competence. These areas may not necessarily rely exclusively on solving the issue of pricing and reimbursing pharmaceuticals as European Union (EU) Member States invoke the subsidiarity principle to claim policy exclusivity in this area. By contrast, policy areas where European institutions have a competence may include: i) a more intensified collaboration in science and technology policy (supporting the science base, identifying education needs for the future, collaborating in the development of new technologies and fostering university-industry collaboration); ii) support of research and development (R&D) by means of directly channelling funds into basic pharmaceutical research, avoiding duplication of the research effort, developing a set of research priorities, tackling the issue of technology transfer, promoting university-industry and cross-border collaborations or providing incentives that would induce private R&D activities in areas with large socioeconomic impact; and iii) an improvement in the environment for the financing of innovation in the EU, by means of selective use of tax policy at the national level (and where applicable, at the EU level), institutional reform in order to widen the pool of available funds for private investment, and the introduction of schemes that would encourage individuals and institutions to hold equity in innovative companies. The article identifies specific research, regulatory, medical and financing needs that require policy intervention, evaluates the possible dynamic implications of such interventions and highlights the benefits that may accrue from their implementation.

Education Offered Via Telecommunications: Trends, Issues, and State-Level Problems in Instructional Technology for Colleges and Universities. Report 87-49.

ERIC Educational Resources Information Center

California State Postsecondary Education Commission, Sacramento.

Issues concerning telecommunications courses offered by California universities and colleges are reviewed with a focus on the progress made over the past 6 years regarding the lack of incentives for faculty to use instructional technology in their teaching, lack of coordination among interested institutions and agencies, and high initial costs for…

Nineteen Patents Issued in 2012 for Inventions by Frederick Researchers | Poster

Cancer.gov

By Karen Surabian, Contributing Writer Patents provide a period of exclusivity and are a way to exclude others from making, using, or selling an inventor’s novel technology. For the National Institutes of Health (NIH), patents are an incentive for an outside party to license, develop, and commercialize NIH technologies that will benefit public health, especially those that

Fuel Cell Electric Vehicles: Drivers and Impacts of Adoption.

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

Levinson, Rebecca Sobel; West, Todd H.; Manley, Dawn K.

We present scenario and parametric analyses of the US light duty vehicle (LDV) stock, sim- ulating the evolution of the stock in order to assess the potential role and impacts of fuel cell electric vehicles (FCEVs). The analysis probes the competition of FCEVs with other LDVs and the effects of FCEV adoption on LDV fuel use and emissions. We parameterize commodity and technology prices in order to explore the sensitivities of FCEV sales and emissions to oil, natural gas, battery technology, fuel cell technology, and hydrogen produc- tion prices. We additionally explore the effects of vehicle purchasing incentives for FCEVs,more » identifying potential impacts and tipping points. Our analyses lead to the following conclu- sions: (1) In the business as usual scenario, FCEVs comprise 7% of all new LDV sales by 2050. (2) FCEV adoption will not substantially impact green house gas emissions without either policy intervention, significant increases in natural gas prices, or technology improve- ments that motivate low carbon hydrogen production. (3) FCEV technology cost reductions have a much greater potential for impact on FCEV sales than hydrogen fuel cost reductions. (4) FCEV purchasing incentives must be both substantial and sustained in order to motivate lasting changes to FCEV adoption.« less

[Medical doctors driving technological innovation: questions about and innovation management approaches to incentive structures for lead users].

PubMed

Bohnet-Joschko, Sabine; Kientzler, Fionn

2010-01-01

Management science defines user-generated innovations as open innovation and lead user innovation. The medical technology industry finds user-generated innovations profitable and even indispensable. Innovative medical doctors as lead users need medical technology innovations in order to improve patient care. Their motivation to innovate is mostly intrinsic. But innovations may also involve extrinsic motivators such as gain in reputation or monetary incentives. Medical doctors' innovative activities often take place in hospitals and are thus embedded into the hospital's organisational setting. Hospitals find it difficult to gain short-term profits from in-house generated innovations and sometimes hesitate to support them. Strategic investment in medical doctors' innovative activities may be profitable for hospitals in the long run if innovations provide first-mover competitive advantages. Industry co-operations with innovative medical doctors offer chances but also bear potential risks. Innovative ideas generated by expert users may result in even higher complexity of medical devices; this could cause mistakes when applied by less specialised users and thus affect patient safety. Innovations that yield benefits for patients, medical doctors, hospitals and the medical technology industry can be advanced by offering adequate support for knowledge transfer and co-operation models.

Lean systems approaches to health technology assessment: a patient-focused alternative to cost-effectiveness analysis.

PubMed

Bridges, John F P

2006-12-01

Many countries now use health technology assessment (HTA) to review new and emerging technologies, especially with regard to reimbursement, pricing and/or clinical guidelines. One of the common, but not universal, features of these systems is the use of economic evaluation, normally cost-effectiveness analysis (CEA), to confirm that new technologies offer value for money. Many have criticised these systems as primarily being concerned with cost containment, rather than advancing the interests of patients or innovators. This paper calls into question the underlying principles of CEA by arguing that value in the healthcare system may in fact be unconstrained. It is suggested that 'lean management principles' can be used not only to trim waste from the health system, but as a method of creating real incentives for innovation and value creation. Following the lean paradigm, this value must be defined purely from the patients' perspective, and the entire health system needs to work towards the creation of such value. This paper offers as a practical example a lean approach to HTA, arguing that such an approach would lead to better incentives for innovation in health, as well as more patient-friendly outcomes in the long run.

75 FR 30268 - Airworthiness Directives; AeroSpace Technologies of Australia Pty Ltd Models N22B, N22S, and N24A...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-01

... FAA-approved repair scheme/modification and incorporate the repair scheme/ modification. Due to FAA policy, the repair scheme/modification for crack damage must include an immediate repair of the crack. The repair scheme cannot be by repetitive inspection only. The repair scheme/modification may...

75 FR 10694 - Airworthiness Directives; AeroSpace Technologies of Australia Pty Ltd Models N22B, N22S, and N24A...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-09

... FAA-approved repair scheme/modification and incorporate the repair scheme/ modification. Due to FAA policy, the repair scheme/modification for crack damage must include an immediate repair of the crack. The repair scheme cannot be by repetitive inspection only. The repair scheme/modification may...

Predicting the deforestation-trend under different carbon-prices

PubMed Central

Kindermann, Georg E; Obersteiner, Michael; Rametsteiner, Ewald; McCallum, Ian

2006-01-01

Background Global carbon stocks in forest biomass are decreasing by 1.1 Gt of carbon annually, owing to continued deforestation and forest degradation. Deforestation emissions are partly offset by forest expansion and increases in growing stock primarily in the extra-tropical north. Innovative financial mechanisms would be required to help reducing deforestation. Using a spatially explicit integrated biophysical and socio-economic land use model we estimated the impact of carbon price incentive schemes and payment modalities on deforestation. One payment modality is adding costs for carbon emission, the other is to pay incentives for keeping the forest carbon stock intact. Results Baseline scenario calculations show that close to 200 mil ha or around 5% of todays forest area will be lost between 2006 and 2025, resulting in a release of additional 17.5 GtC. Today's forest cover will shrink by around 500 million hectares, which is 1/8 of the current forest cover, within the next 100 years. The accumulated carbon release during the next 100 years amounts to 45 GtC, which is 15% of the total carbon stored in forests today. Incentives of 6 US$/tC for vulnerable standing biomass payed every 5 year will bring deforestation down by 50%. This will cause costs of 34 billion US$/year. On the other hand a carbon tax of 12 $/tC harvested forest biomass will also cut deforestation by half. The tax income will, if enforced, decrease from 6 billion US$ in 2005 to 4.3 billion US$ in 2025 and 0.7 billion US$ in 2100 due to decreasing deforestation speed. Conclusion Avoiding deforestation requires financial mechanisms that make retention of forests economically competitive with the currently often preferred option to seek profits from other land uses. Incentive payments need to be at a very high level to be effective against deforestation. Taxes on the other hand will extract budgetary revenues from the regions which are already poor. A combination of incentives and taxes could turn out to be a viable solution for this problem. Increasing the value of forest land and thereby make it less easily prone to deforestation would act as a strong incentive to increase productivity of agricultural and fuelwood production, which could be supported by revenues generated by the deforestation tax. PMID:17150095

Predicting the deforestation-trend under different carbon-prices.

PubMed

Kindermann, Georg E; Obersteiner, Michael; Rametsteiner, Ewald; McCallum, Ian

2006-12-06

Global carbon stocks in forest biomass are decreasing by 1.1 Gt of carbon annually, owing to continued deforestation and forest degradation. Deforestation emissions are partly offset by forest expansion and increases in growing stock primarily in the extra-tropical north. Innovative financial mechanisms would be required to help reducing deforestation. Using a spatially explicit integrated biophysical and socio-economic land use model we estimated the impact of carbon price incentive schemes and payment modalities on deforestation. One payment modality is adding costs for carbon emission, the other is to pay incentives for keeping the forest carbon stock intact. Baseline scenario calculations show that close to 200 mil ha or around 5% of today's forest area will be lost between 2006 and 2025, resulting in a release of additional 17.5 GtC. Today's forest cover will shrink by around 500 million hectares, which is 1/8 of the current forest cover, within the next 100 years. The accumulated carbon release during the next 100 years amounts to 45 GtC, which is 15% of the total carbon stored in forests today. Incentives of 6 US$/tC for vulnerable standing biomass payed every 5 year will bring deforestation down by 50%. This will cause costs of 34 billion US$/year. On the other hand a carbon tax of 12 $/tC harvested forest biomass will also cut deforestation by half. The tax income will, if enforced, decrease from 6 billion US$ in 2005 to 4.3 billion US$ in 2025 and 0.7 billion US$ in 2100 due to decreasing deforestation speed. Avoiding deforestation requires financial mechanisms that make retention of forests economically competitive with the currently often preferred option to seek profits from other land uses. Incentive payments need to be at a very high level to be effective against deforestation. Taxes on the other hand will extract budgetary revenues from the regions which are already poor. A combination of incentives and taxes could turn out to be a viable solution for this problem. Increasing the value of forest land and thereby make it less easily prone to deforestation would act as a strong incentive to increase productivity of agricultural and fuelwood production, which could be supported by revenues generated by the deforestation tax.

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.

A Secure ECC-based RFID Mutual Authentication Protocol to Enhance Patient Medication Safety.

PubMed

Jin, Chunhua; Xu, Chunxiang; Zhang, Xiaojun; Li, Fagen

2016-01-01

Patient medication safety is an important issue in patient medication systems. In order to prevent medication errors, integrating Radio Frequency Identification (RFID) technology into automated patient medication systems is required in hospitals. Based on RFID technology, such systems can provide medical evidence for patients' prescriptions and medicine doses, etc. Due to the mutual authentication between the medication server and the tag, RFID authentication scheme is the best choice for automated patient medication systems. In this paper, we present a RFID mutual authentication scheme based on elliptic curve cryptography (ECC) to enhance patient medication safety. Our scheme can achieve security requirements and overcome various attacks existing in other schemes. In addition, our scheme has better performance in terms of computational cost and communication overhead. Therefore, the proposed scheme is well suitable for patient medication systems.

California Publicly-Owned Utilities (POUs) – LBNL ‘Beyond Widgets’ Project. Task: ambient lighting and occupancy-based plug load control. System Program Manual

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

Robinson, Alastair; Mathew, Paul A.; Regnier, Cynthia

This program manual contains detailed technical information for implementing an incentive program for task-ambient lighting and occupancy-based plug load control. This manual was developed by Lawrence Berkeley National Laboratory, in collaboration with the California Publicly-Owned Utilities (CA POUs) as a partner in the ‘Beyond Widgets’ program funded by the U.S. Department of Energy Building Technologies Office. The primary audience for this manual is the program staff of the various CA POUs. It may also be used by other utility incentive programs to help develop similar programs. It is anticipated that the content of this manual be utilized by the CAmore » POU staff for developing related documents such as the Technical Resource Manual and other filings pertaining to the rollout of an energy systems-based rebate incentive program.« less

Identifying organizational capacities and incentives for clinical data-sharing: the case of a regional perinatal information system.

PubMed

Korst, Lisa M; Signer, Jordana M K; Aydin, Carolyn E; Fink, Arlene

2008-01-01

The development of regional data-sharing among healthcare organizations is viewed as an important step in the development of health information technology (HIT), but little is known about this complex task. This is a case study of a regional perinatal data system that involved four hospitals, together responsible for over 10,000 births annually. Using standard qualitative methods, we chronicled project milestones, and identified 31 "critical incidents" that delayed or prevented their achievement. We then used these critical incidents to articulate six organizational capacity domains associated with the achievement of project milestones, and a seventh domain consisting of organizational incentives. Finally, we analyzed the relationship of milestone achievement to the presence of these capacities and incentives. This data center case suggests four requirements for sharing data across organizations: 1) a readiness assessment; 2) a perceived mandate; 3) a formal governance structure; and 4) a third party IT component.

A new scheme for grading the quality of scientific reports that evaluate imaging modalities for cerebrovascular diseases.

PubMed

Qureshi, Adnan I

2007-10-01

Imaging of head and neck vasculature continues to improve with the application of new technology. To judge the value of new technologies reported in the literature, it is imperative to develop objective standards optimized against bias and favoring statistical power and clinical relevance. A review of the existing literature identified the following items as lending scientific value to a report on imaging technology: prospective design, comparison with an accepted modality, unbiased patient selection, standardized image acquisition, blinded interpretation, and measurement of reliability. These were incorporated into a new grading scheme. Two physicians tested the new scheme and an established scheme to grade reports published in the medical literature. Inter-observer reliability for both methods was calculated using the kappa coefficient. A total of 22 reports evaluating imaging modalities for cervical internal carotid artery stenosis were identified from a literature search and graded by both schemes. Agreement between the two physicians in grading the level of scientific evidence using the new scheme was excellent (kappa coefficient: 0.93, p<0.0001). Agreement using the established scheme was less rigorous (kappa coefficient: 0.39, p<0.0001). The weighted kappa coefficients were 0.95 and 0.38 for the new and established schemes, respectively. Overall agreement was higher for the newer scheme (95% versus 64%). The new grading scheme can be used reliably to categorize the strength of scientific knowledge provided by individual studies of vascular imaging. The new method could assist clinicians and researchers in determining appropriate clinical applications of newly reported technical advances.

DSM Electricity Savings Potential in the Buildings Sector in APP Countries

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

McNeil, MIchael; Letschert, Virginie; Shen, Bo

2011-01-12

The global economy has grown rapidly over the past decade with a commensurate growth in the demand for electricity services that has increased a country's vulnerability to energy supply disruptions. Increasing need of reliable and affordable electricity supply is a challenge which is before every Asia Pacific Partnership (APP) country. Collaboration between APP members has been extremely fruitful in identifying potential efficiency upgrades and implementing clean technology in the supply side of the power sector as well established the beginnings of collaboration. However, significantly more effort needs to be focused on demand side potential in each country. Demand side managementmore » or DSM in this case is a policy measure that promotes energy efficiency as an alternative to increasing electricity supply. It uses financial or other incentives to slow demand growth on condition that the incremental cost needed is less than the cost of increasing supply. Such DSM measures provide an alternative to building power supply capacity The type of financial incentives comprise of rebates (subsidies), tax exemptions, reduced interest loans, etc. Other approaches include the utilization of a cap and trade scheme to foster energy efficiency projects by creating a market where savings are valued. Under this scheme, greenhouse gas (GHG) emissions associated with the production of electricity are capped and electricity retailers are required to meet the target partially or entirely through energy efficiency activities. Implementation of DSM projects is very much in the early stages in several of the APP countries or localized to a regional part of the country. The purpose of this project is to review the different types of DSM programs experienced by APP countries and to estimate the overall future potential for cost-effective demand-side efficiency improvements in buildings sectors in the 7 APP countries through the year 2030. Overall, the savings potential is estimated to be 1.7 thousand TWh or 21percent of the 2030 projected base case electricity demand. Electricity savings potential ranges from a high of 38percent in India to a low of 9percent in Korea for the two sectors. Lighting, fans, and TV sets and lighting and refrigeration are the largest contributors to residential and commercial electricity savings respectively. This work presents a first estimates of the savings potential of DSM programs in APP countries. While the resulting estimates are based on detailed end-use data, it is worth keeping in mind that more work is needed to overcome limitation in data at this time of the project.« less

Ridesharing options analysis and practitioners' toolkit

DOT National Transportation Integrated Search

2010-12-01

The purpose of this toolkit is to elaborate upon the recent changes in ridesharing, introduce the wide variety that exists in ridesharing programs today, and the developments in technology and funding availability that create greater incentives for p...

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.

7 CFR 1466.23 - Payment rates.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) Residue management; (B) Nutrient management; (C) Air quality management; (D) Invasive species management; (E) Pollinator habitat development or improvement; (F) Animal carcass management technology; or (G... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS ENVIRONMENTAL QUALITY INCENTIVES PROGRAM Contracts and...

Hybrid Storage Market Assessment: A JISEA White Paper

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

Ericson, Sean J.; Rose, Eric; Jayaswal, Harshit

This white paper evaluates which markets are best suited for battery storage and storage hybrids and reviews regulations and incentives that support or impede the implementation of standalone storage and battery hybrids. The costs of battery storage technologies have dropped in recent years, resulting in a seven-fold increase in installed capacity over the last decade (1). These technologies offer an attractive rate of return in some locations; however, cost and regulatory barriers still limit the market for storage. Hybridizing a battery (combining the battery with a generator) can in some instances reduce total system costs and increase value compared tomore » separate installations. The fast ramping and dispatchability of a battery can complement the generator to provide services that neither battery nor generator could provide alone. Battery hybrids also benefit from some policy incentives and may be better able to meet market and regulatory requirements.« less

Wind power for the electric-utility industry: Policy incentives for fuel conservation

NASA Astrophysics Data System (ADS)

March, F.; Dlott, E. H.; Korn, D. H.; Madio, F. R.; McArthur, R. C.; Vachon, W. A.

1982-06-01

A systematic method for evaluating the economics of solar-electric/conservation technologies as fuel-savings investments for electric utilities in the presence of changing federal incentive policies is presented. The focus is on wind energy conversion systems (WECS) as the solar technology closest to near-term large scale implementation. Commercially available large WECS are described, along with computer models to calculate the economic impact of the inclusion of WECS as 10% of the base-load generating capacity on a grid. A guide to legal structures and relationships which impinge on large-scale WECS utilization is developed, together with a quantitative examination of the installation of 1000 MWe of WECS capacity by a utility in the northeast states. Engineering and financial analyses were performed, with results indicating government policy changes necessary to encourage the entrance of utilities into the field of windpower utilization.

2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Final rule.

PubMed

2015-10-16

This final rule finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria or "2015 Edition'') and a new 2015 Edition Base Electronic Health Record (EHR) definition, while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings. The 2015 Edition establishes the capabilities and specifies the related standards and implementation specifications that Certified Electronic Health Record Technology (CEHRT) would need to include to, at a minimum, support the achievement of meaningful use by eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) under the Medicare and Medicaid EHR Incentive Programs (EHR Incentive Programs) when such edition is required for use under these programs.

Computerized Detection of Lung Nodules by Means of “Virtual Dual-Energy” Radiography

PubMed Central

Chen, Sheng; Suzuki, Kenji

2014-01-01

Major challenges in current computer-aided detection (CADe) schemes for nodule detection in chest radiographs (CXRs) are to detect nodules that overlap with ribs and/or clavicles and to reduce the frequent false positives (FPs) caused by ribs. Detection of such nodules by a CADe scheme is very important, because radiologists are likely to miss such subtle nodules. Our purpose in this study was to develop a CADe scheme with improved sensitivity and specificity by use of “virtual dual-energy” (VDE) CXRs where ribs and clavicles are suppressed with massive-training artificial neural networks (MTANNs). To reduce rib-induced FPs and detect nodules overlapping with ribs, we incorporated the VDE technology in our CADe scheme. The VDE technology suppressed rib and clavicle opacities in CXRs while maintaining soft-tissue opacity by use of the MTANN technique that had been trained with real dual-energy imaging. Our scheme detected nodule candidates on VDE images by use of a morphologic filtering technique. Sixty morphologic and gray-level-based features were extracted from each candidate from both original and VDE CXRs. A nonlinear support vector classifier was employed for classification of the nodule candidates. A publicly available database containing 140 nodules in 140 CXRs and 93 normal CXRs was used for testing our CADe scheme. All nodules were confirmed by computed tomography examinations, and the average size of the nodules was 17.8 mm. Thirty percent (42/140) of the nodules were rated “extremely subtle” or “very subtle” by a radiologist. The original scheme without VDE technology achieved a sensitivity of 78.6% (110/140) with 5 (1165/233) FPs per image. By use of the VDE technology, more nodules overlapping with ribs or clavicles were detected and the sensitivity was improved substantially to 85.0% (119/140) at the same FP rate in a leave-one-out cross-validation test, whereas the FP rate was reduced to 2.5 (583/233) per image at the same sensitivity level as the original CADe scheme obtained (Difference between the specificities of the original and the VDE-based CADe schemes was statistically significant). In particular, the sensitivity of our VDE-based CADe scheme for subtle nodules (66.7% = 28/42) was statistically significantly higher than that of the original CADe scheme (57.1% = 24/42). Therefore, by use of VDE technology, the sensitivity and specificity of our CADe scheme for detection of nodules, especially subtle nodules, in CXRs were improved substantially. PMID:23193306

Computerized detection of lung nodules by means of "virtual dual-energy" radiography.

PubMed

Chen, Sheng; Suzuki, Kenji

2013-02-01

Major challenges in current computer-aided detection (CADe) schemes for nodule detection in chest radiographs (CXRs) are to detect nodules that overlap with ribs and/or clavicles and to reduce the frequent false positives (FPs) caused by ribs. Detection of such nodules by a CADe scheme is very important, because radiologists are likely to miss such subtle nodules. Our purpose in this study was to develop a CADe scheme with improved sensitivity and specificity by use of "virtual dual-energy" (VDE) CXRs where ribs and clavicles are suppressed with massive-training artificial neural networks (MTANNs). To reduce rib-induced FPs and detect nodules overlapping with ribs, we incorporated the VDE technology in our CADe scheme. The VDE technology suppressed rib and clavicle opacities in CXRs while maintaining soft-tissue opacity by use of the MTANN technique that had been trained with real dual-energy imaging. Our scheme detected nodule candidates on VDE images by use of a morphologic filtering technique. Sixty morphologic and gray-level-based features were extracted from each candidate from both original and VDE CXRs. A nonlinear support vector classifier was employed for classification of the nodule candidates. A publicly available database containing 140 nodules in 140 CXRs and 93 normal CXRs was used for testing our CADe scheme. All nodules were confirmed by computed tomography examinations, and the average size of the nodules was 17.8 mm. Thirty percent (42/140) of the nodules were rated "extremely subtle" or "very subtle" by a radiologist. The original scheme without VDE technology achieved a sensitivity of 78.6% (110/140) with 5 (1165/233) FPs per image. By use of the VDE technology, more nodules overlapping with ribs or clavicles were detected and the sensitivity was improved substantially to 85.0% (119/140) at the same FP rate in a leave-one-out cross-validation test, whereas the FP rate was reduced to 2.5 (583/233) per image at the same sensitivity level as the original CADe scheme obtained (Difference between the specificities of the original and the VDE-based CADe schemes was statistically significant). In particular, the sensitivity of our VDE-based CADe scheme for subtle nodules (66.7% = 28/42) was statistically significantly higher than that of the original CADe scheme (57.1% = 24/42). Therefore, by use of VDE technology, the sensitivity and specificity of our CADe scheme for detection of nodules, especially subtle nodules, in CXRs were improved substantially.

The public role in promoting child health information technology.

PubMed

Conway, Patrick H; White, P Jonathan; Clancy, Carolyn

2009-01-01

The public sector plays an important role in promoting child health information technology. Public sector support is essential in 5 main aspects of child health information technology, namely, data standards, pediatric functions in health information systems, privacy policies, research and implementation funding, and incentives for technology adoption. Some innovations in health information technology for adult populations can be transferred to or adapted for children, but there also are unique needs in the pediatric population. Development of health information technology that addresses children's needs and effective adoption of that technology are critical for US children to receive care of the highest possible quality in the future.

Ecological restoration of farmland: progress and prospects.

PubMed

Wade, Mark R; Gurr, Geoff M; Wratten, Steve D

2008-02-27

Sustainable agricultural practices in conjunction with ecological restoration methods can reduce the detrimental effects of agriculture. The Society for Ecological Restoration International has produced generic guidelines for conceiving, organizing, conducting and assessing ecological restoration projects. Additionally, there are now good conceptual frameworks, guidelines and practical methods for developing ecological restoration programmes that are based on sound ecological principles and supported by empirical evidence and modelling approaches. Restoration methods must also be technically achievable and socially acceptable and spread over a range of locations. It is important to reconcile differences between methods that favour conservation and those that favour economic returns, to ensure that conservation efforts are beneficial for both landowners and biodiversity. One option for this type of mutual benefit is the use of agri-environmental schemes to provide financial incentives to landholders in exchange for providing conservation services and other benefits. However, further work is required to define and measure the effectiveness of agri-environmental schemes. The broader potential for ecological restoration to improve the sustainability of agricultural production while conserving biodiversity in farmscapes and reducing external costs is high, but there is still much to learn, particularly for the most efficient use of agri-environmental schemes to change land use practice.

Viability of Carbon Capture and Sequestration Retrofits for Existing Coal-Fired Power Plants under an Emission Trading Scheme.

PubMed

Talati, Shuchi; Zhai, Haibo; Morgan, M Granger

2016-12-06

Using data on the coal-fired electric generating units (EGUs) in Texas we assess the economic feasibility of retrofitting existing units with carbon capture and sequestration (CCS) in order to comply with the Clean Power Plan's rate-based emission standards under an emission trading scheme. CCS with 90% capture is shown to be more economically attractive for a range of existing units than purchasing emission rate credits (ERCs) from a trading market at an average credit price above $28 per MWh under the final state standard and $35 per MWh under the final national standard. The breakeven ERC trading prices would decrease significantly if the captured CO 2 were sold for use in enhanced oil recovery, making CCS retrofits viable at lower trading prices. The combination of ERC trading and CO 2 use can greatly reinforce economic incentives and market demands for CCS and hence accelerate large-scale deployment, even under scenarios with high retrofit costs. Comparing the levelized costs of electricity generation between CCS retrofits and new renewable plants under the ERC trading scheme, retrofitting coal-fired EGUs with CCS may be significantly cheaper than new solar plants under some market conditions.

Cost accounting in radiology: new directions and importance for policy.

PubMed

Muchantef, Karl; Forman, Howard P

2005-12-01

The purpose of this article is to promote insight into radiology costs through improvements in assessing patient-level cost data. Accurate patient costing is a prerequisite for establishing a proper payment system-one where the price paid for a service approximates the cost of delivering that service. In the absence of an accurate payment scheme, margins can vary significantly from one patient to the next. The resulting financial incentives skew the radiology marketplace away from the provision of efficient and appropriate care toward the selection of patients whose costs are low relative to reimbursements.

Applications of DC-Self Bias in CCP Deposition Systems

NASA Astrophysics Data System (ADS)

Keil, D. L.; Augustyniak, E.; Sakiyama, Y.

2013-09-01

In many commercial CCP plasma process systems the DC-self bias is available as a reported process parameter. Since commercial systems typically limit the number of onboard diagnostics, there is great incentive to understand how DC-self bias can be expected to respond to various system perturbations. This work reviews and examines DC self bias changes in response to tool aging, chamber film accumulation and wafer processing. The diagnostic value of the DC self bias response to transient and various steady state current draw schemes are examined. Theoretical models and measured experimental results are compared and contrasted.

Safety programmes in the Egyptian construction industry.

PubMed

Hassanein, Amr A G; Hanna, Ragaa S

2007-12-01

This study is aimed at exploring the nature of the safety programmes applied by large-size contractors operating in Egypt. Results revealed that safety programmes applied by those contractors were less formal than the programmes applied by their American counterparts. Only three contractors out of the surveyed sample had accident records broken down by projects, provided workers with formal safety orientation, and trained safety personnel on first-aid. The study recommended that reforms to the scheme of the employers' contribution to social insurance are necessary. This is meant to serve as a strong incentive for safety management.

Altruism and reward: motivational compatibility in deceased organ donation.

PubMed

Voo, Teck Chuan

2015-03-01

Acts of helping others are often based on mixed motivations. Based on this claim, it has been argued that the use of a financial reward to incentivize organ donation is compatible with promoting altruism in organ donation. In its report Human Bodies: Donation for Medicine and Research, the Nuffield Council on Bioethics uses this argument to justify its suggestion to pilot a funeral payment scheme to incentivize people to register for deceased organ donation in the UK. In this article, I cast a sceptical eye on the above Nuffield report's argument that its proposed funeral payment scheme would prompt deceased organ donations that remain altruistic (as defined by and valued the report). Specifically, I illustrate how this scheme may prompt various forms of mixed motivations which would not satisfy the report's definition of altruism. Insofar as the scheme produces an expectation of the reward, it stands diametrical to promoting an 'altruistic perspective'. My minimal goal in this article is to argue that altruism is not motivationally compatible with reward as an incentive for donation. My broader goal is to argue that if a financial reward is used to incentivize organ donation, then we should recognize that the donation system is no longer aiming to promote altruism. Rewarded donation would not be altruistic but it may be ethical given a persistent organ shortage situation. © 2014 John Wiley & Sons Ltd.

Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand.

PubMed

Patcharanarumol, Walaiporn; Panichkriangkrai, Warisa; Sommanuttaweechai, Angkana; Hanson, Kara; Wanwong, Yaowaluk; Tangcharoensathien, Viroj

2018-01-01

Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand's two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare's gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole.

Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand

PubMed Central

2018-01-01

Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand’s two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare’s gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole. PMID:29608610

Alaska's renewable energy potential.

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

Not Available

2009-02-01

This paper delivers a brief survey of renewable energy technologies applicable to Alaska's climate, latitude, geography, and geology. We first identify Alaska's natural renewable energy resources and which renewable energy technologies would be most productive. e survey the current state of renewable energy technologies and research efforts within the U.S. and, where appropriate, internationally. We also present information on the current state of Alaska's renewable energy assets, incentives, and commercial enterprises. Finally, we escribe places where research efforts at Sandia National Laboratories could assist the state of Alaska with its renewable energy technology investment efforts.

Solar geoengineering economics: From incredible to inevitable and half-way back

NASA Astrophysics Data System (ADS)

Harding, Anthony; Moreno-Cruz, Juan B.

2016-12-01

Solar geoengineering technologies are unique in many ways, and the economic incentives they could unleash are just as interesting. Since their introduction as a potential alternative, economists have been intrigued by the potential of these technologies to dramatically alter the way we think about climate policy. As our scientific understanding of the technologies evolve, so does the way economists think about them. In this paper, we document the evolution of economic thinking around these technologies since before Crutzen (2006) until today and provide some fruitful areas for further research.

Proof of cipher text ownership based on convergence encryption

NASA Astrophysics Data System (ADS)

Zhong, Weiwei; Liu, Zhusong

2017-08-01

Cloud storage systems save disk space and bandwidth through deduplication technology, but with the use of this technology has been targeted security attacks: the attacker can get the original file just use hash value to deceive the server to obtain the file ownership. In order to solve the above security problems and the different security requirements of cloud storage system files, an efficient information theory security proof of ownership scheme is proposed. This scheme protects the data through the convergence encryption method, and uses the improved block-level proof of ownership scheme, and can carry out block-level client deduplication to achieve efficient and secure cloud storage deduplication scheme.

Serve the people or close the sale? Profit-driven overuse of injections and infusions in China's market-based healthcare system.

PubMed

Reynolds, Lucy; McKee, Martin

2011-01-01

Treatment by injection or infusion is widespread in China. Using the common cold as a tracer condition, we explored the reasons for over-prescription of injections and infusions in Guizhou, China. Interviews with prescribers, patients and key informants were supplemented by focus groups. These revealed how historical ideas encourage unnecessary use of percutaneous treatment: faith in the healing power of needles is locally attributed to association with acupuncture. Many patients and some staff believe that injections per se are therapeutic. However, the structure of health service financing and remuneration now reinforces this irrational faith. Market-based reforms have attempted to control costs and increase productivity with an incentive scheme which rewards prescribers financially for over-prescription in general and for use of injections and infusions in particular. Aggressive marketing has displaced oral treatment from health facilities into independent pharmacies, leaving doctors functioning mainly as injection providers. There is a need for a multi-faceted response encompassing education and reform of financial incentives to reduce the use of unnecessary treatment. Copyright © 2011 John Wiley & Sons, Ltd.

Exploration risks and mineral taxation: how fiscal regimes affect exploration incentives

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

Stauffer, T.R.; Gault, J.C.

1985-01-01

This paper investigates the effects of taxation on exploration risk and establishes certain criteria for an optimal tax on mineral resources, such as oil and gas, where exploration risk (i.e., geological risk) is a key decision variable. The optimization is considered in the context of government ownership of the resource rights, but with an eye to the after-tax incentives perceived by private-sector explorationists. Any government that relies on the private sector for discovery and development must recognize those effects. Taxation affects not only the expected returns from mineral exploration ventures but also the riskiness of such ventures. The potential formore » misdesign is great. The authors show, however, that it is possible, in realistic cases, simultaneously to increase government revenues, improve the explorationist's return, and reduce exploration risk. The opportunity for such improvements arises because most common mineral tax schemes skew the tax burdens across fields of different sizes or qualities. A key consideration in optimizing a tax regime is designing the tax to assign the appropriate burdens to different classes of discoveries. 7 tables.« less

To what extent could performance-based schemes help increase the effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) programs in resource-limited settings? a summary of the published evidence

PubMed Central

2010-01-01

Background In resource-limited settings, HIV/AIDS remains a serious threat to the social and physical well-being of women of childbearing age, pregnant women, mothers and infants. Discussion In sub-Saharan African countries with high prevalence rates, pediatric HIV/AIDS acquired through mother-to-child transmission (MTCT) can in largely be prevented by using well-established biomedical interventions. Logistical and socio-cultural barriers continue, however, to undermine the successful prevention of MTCT (PMTCT). In this paper, we review reports on maternal, neonatal and child health, as well as HIV care and treatment services that look at program incentives. Summary These studies suggest that comprehensive PMTCT strategies aiming to maximize health-worker motivation in developing countries must involve a mix of both financial and non-financial incentives. The establishment of robust ethical and regulatory standards in public-sector HIV care centers could reduce barriers to PMTCT service provision in sub-Saharan Africa and help them in achieving universal PMTCT targets. PMID:21080926

Motivation and incentives of rural maternal and neonatal health care providers: a comparison of qualitative findings from Burkina Faso, Ghana and Tanzania.

PubMed

Prytherch, Helen; Kagoné, Moubassira; Aninanya, Gifty A; Williams, John E; Kakoko, Deodatus C V; Leshabari, Melkidezek T; Yé, Maurice; Marx, Michael; Sauerborn, Rainer

2013-04-25

In Burkina Faso, Ghana and Tanzania strong efforts are being made to improve the quality of maternal and neonatal health (MNH) care. However, progress is impeded by challenges, especially in the area of human resources. All three countries are striving not only to scale up the number of available health staff, but also to improve performance by raising skill levels and enhancing provider motivation. In-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Interviews were held with 25 MNH providers, 8 facility and district managers, and 2 policy-makers in each country. Across the three countries some differences were found in the reasons why people became health workers. Commitment to remaining a health worker was generally high. The readiness to remain at a rural facility was far less, although in all settings there were some providers that were willing to stay. In Burkina Faso it appeared to be particularly difficult to recruit female MNH providers to rural areas. There were indications that MNH providers in all the settings sometimes failed to treat their patients well. This was shown to be interlinked with differences in how the term 'motivation' was understood, and in the views held about remuneration and the status of rural health work. Job satisfaction was shown to be quite high, and was particularly linked to community appreciation. With some important exceptions, there was a strong level of agreement regarding the financial and non-financial incentives that were suggested by these providers, but there were clear country preferences as to whether incentives should be for individuals or teams. Understandings of the terms and concepts pertaining to motivation differed between the three countries. The findings from Burkina Faso underline the importance of gender-sensitive health workforce planning. The training that all levels of MNH providers receive in professional ethics, and the way this is reinforced in practice require closer attention. The differences in the findings across the three settings underscore the importance of in-depth country-level research to tailor the development of incentives schemes.

A Profile of Tax Subsidies and Investment Behavior in Six Major Polluting Industries (1997)

EPA Pesticide Factsheets

Reviews investment trends in pollution control technology to determine existing patterns and to highlight the likely investment incentives that six industries, metals mining, petroleum, primary metals, pulp and paper, chemicals, and electric utilities.

MIT Experiments with Joint Venture Contract.

ERIC Educational Resources Information Center

American School and University, 1981

1981-01-01

A new dormitory at Massachusetts Institute of Technology was constructed using a joint venture contract with safeguards and incentives that brought university, architect, and building contractor into a closer and more productive relationship than under conventional contract arrangements. (Author/MLF)

42 CFR 495.362 - Retroactive approval of FFP with an effective date of February 18, 2009.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.362... payments to providers, a State may request consideration of FFP by recorded request in a HIT advance...

Clean Energy Application Center

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

Freihaut, Jim

2013-09-30

The Mid Atlantic Clean Energy Application Center (MACEAC), managed by The Penn State College of Engineering, serves the six states in the Mid-Atlantic region (Pennsylvania, New Jersey, Delaware, Maryland, Virginia and West Virginia) plus the District of Columbia. The goals of the Mid-Atlantic CEAC are to promote the adoption of Combined Heat and Power (CHP), Waste Heat Recovery (WHR) and District Energy Systems (DES) in the Mid Atlantic area through education and technical support to more than 1,200 regional industry and government representatives in the region. The successful promotion of these technologies by the MACEAC was accomplished through the followingmore » efforts; (1)The MACEAC developed a series of technology transfer networks with State energy and environmental offices, Association of Energy Engineers local chapters, local community development organizations, utilities and, Penn State Department of Architectural Engineering alumni and their firms to effectively educate local practitioners about the energy utilization, environmental and economic advantages of CHP, WHR and DES; (2) Completed assessments of the regional technical and market potential for CHP, WHR and DE technologies application in the context of state specific energy prices, state energy and efficiency portfolio development. The studies were completed for Pennsylvania, New Jersey and Maryland and included a set of incentive adoption probability models used as a to guide during implementation discussions with State energy policy makers; (3) Using the technical and market assessments and adoption incentive models, the Mid Atlantic CEAC developed regional strategic action plans for the promotion of CHP Application technology for Pennsylvania, New Jersey and Maryland; (4) The CHP market assessment and incentive adoption model information was discussed, on a continuing basis, with relevant state agencies, policy makers and Public Utility Commission organizations resulting in CHP favorable incentive programs in New Jersey, Pennsylvania, Maryland and Delaware; (5) Developed and maintained a MACEAC website to provide technical information and regional CHP, WHR and DE case studies and site profiles for use by interested stakeholders in information transfer and policy discussions; (6) Provided Technical Assistance through feasibility studies and on site evaluations. The MACEAC completed 28 technical evaluations and 9 Level 1 CHP analyses ; and (7) the MACEAC provided Technical Education to the region through a series of 29 workshops and webinars, 37 technical presentations, 14 seminars and participation in 13 CHP conferences.« less

Lightweight ECC based RFID authentication integrated with an ID verifier transfer protocol.

PubMed

He, Debiao; Kumar, Neeraj; Chilamkurti, Naveen; Lee, Jong-Hyouk

2014-10-01

The radio frequency identification (RFID) technology has been widely adopted and being deployed as a dominant identification technology in a health care domain such as medical information authentication, patient tracking, blood transfusion medicine, etc. With more and more stringent security and privacy requirements to RFID based authentication schemes, elliptic curve cryptography (ECC) based RFID authentication schemes have been proposed to meet the requirements. However, many recently published ECC based RFID authentication schemes have serious security weaknesses. In this paper, we propose a new ECC based RFID authentication integrated with an ID verifier transfer protocol that overcomes the weaknesses of the existing schemes. A comprehensive security analysis has been conducted to show strong security properties that are provided from the proposed authentication scheme. Moreover, the performance of the proposed authentication scheme is analyzed in terms of computational cost, communicational cost, and storage requirement.

The electronic medical record in dermatology.

PubMed

Grosshandler, Joshua A; Tulbert, Brittain; Kaufmann, Mark D; Bhatia, Ashish; Brodell, Robert T

2010-09-01

Governmental incentives to stimulate the "meaningful use" of electronic medical records and future disincentives for Medicaid and Medicare provide an impetus for dermatologists to consider adding this technology to their clinical practice. Dermatologists should carefully weigh the pros and cons of establishing an electronic medical record system before incorporating this expensive technology. This article reviews available scientific and economic data required for dermatologists to help make an informed choice.

Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial.

PubMed

Priebe, Stefan; Bremner, Stephen A; Lauber, Christoph; Henderson, Catherine; Burns, Tom

2016-09-01

Poor adherence to long-term antipsychotic injectable (LAI) medication in patients with psychotic disorders is associated with a range of negative outcomes. No psychosocial intervention has been found to be consistently effective in improving adherence. To test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives. A cluster randomised controlled trial with economic and nested qualitative evaluation. The intervention period lasted for 12 months with 24 months' follow-up. The unit of randomisation was mental health teams in the community. Community teams in secondary mental health care. Patients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (intervention n = 78 and control n = 63) were included. Participants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual. adherence to LAI medication (the percentage of received out of those prescribed). percentage of patients with at least 95% adherence; clinical global improvement; subjective quality of life; satisfaction with medication; hospitalisation; adverse events; and costs. Qualitative evaluation: semistructured interviews with patients in the intervention group and their clinicians. outcome data were available for 131 patients. Baseline adherence was 69% in the intervention group and 67% in the control group. During the intervention period, adherence was significantly higher in the intervention group than in the control group (85% vs. 71%) [adjusted mean difference 11.5%, 95% confidence interval (CI) 3.9% to 19.0%; p = 0.003]. Secondary outcome: patients in the intervention group showed statistically significant improvement in adherence of at least 95% (adjusted odds ratio 8.21, 95% CI 2.00 to 33.67; p = 0.003) and subjective quality of life (difference in means 0.71, 95% CI 0.26 to 1.15; p = 0.002). Follow-ups: after incentives stopped, adherence did not differ significantly between groups, neither during the first 6 months (adjusted difference in means -7.4%, 95% CI -17.0% to 2.1%; p = 0.175) nor during the period from month 7 to month 24 (difference in means -5.7%, 95% CI -13.1% to 1.7%; p = 0.130). Cost-effectiveness: the average costs of the financial incentives was £303. Overall costs per patient were somewhat higher in the intervention group, but the difference was not significant. Semistructured interviews: the majority of patients and clinicians reported positive experiences with the incentives beyond their monetary value. These included improvement in the therapeutic relationship. The majority of both patients and clinicians perceived no negative impact after the intervention was stopped after 1 year. Financial incentives are effective in improving adherence to LAI medication. Health-care costs (including costs of the financial incentive) are unlikely to be increased substantially by this intervention. Once the incentives stop, the advantage is not maintained. The experiences of both patients and clinicians are largely, but not exclusively, positive. Whether or not financial incentives are effective for patients with more favourable background, those on oral mediation or for shorter or longer time periods remains unknown. Current Controlled Trials ISRCTN77769281. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 70. See the NIHR Journals Library website for further project information.

Our leadership in science and technology as provided by the national space program

NASA Technical Reports Server (NTRS)

Kock, W. E.

1972-01-01

The contributions of science and technology to the success of the United States as a world leader are discussed. Specific instances of the manner in which science advances and new technologies resulting from space research have contributed to a higher standard of living are presented. It is concluded that the benefits of the space program are not reflected only in the material advancements, but that intangible results have also been achieved in greater incentives to improve the present culture.

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.

42 CFR 495.334 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false [Reserved] 495.334 Section 495.334 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements...

76 FR 28791 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

... participation for expenditures under their Medicaid Electronic Health Record Incentive Program related to health... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document... currently approved collection; Title of Information Collection: State Medicaid Health Information Technology...

42 CFR 495.356 - Nondiscrimination requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Nondiscrimination requirements. 495.356 Section 495.356 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE...

20 CFR 628.325 - Incentive grants, capacity building, and technical assistance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... for the development of Statewide communications and training mechanisms involving computer-based communication technologies that directly facilitate interaction with the National Capacity Building and... section 205(a) of the Act, in developing electronic communications, training mechanisms and/or...

20 CFR 628.325 - Incentive grants, capacity building, and technical assistance.

Code of Federal Regulations, 2012 CFR

2012-04-01

... for the development of Statewide communications and training mechanisms involving computer-based communication technologies that directly facilitate interaction with the National Capacity Building and... section 205(a) of the Act, in developing electronic communications, training mechanisms and/or...

The QKD network: model and routing scheme

NASA Astrophysics Data System (ADS)

Yang, Chao; Zhang, Hongqi; Su, Jinhai

2017-11-01

Quantum key distribution (QKD) technology can establish unconditional secure keys between two communicating parties. Although this technology has some inherent constraints, such as the distance and point-to-point mode limits, building a QKD network with multiple point-to-point QKD devices can overcome these constraints. Considering the development level of current technology, the trust relaying QKD network is the first choice to build a practical QKD network. However, the previous research didn't address a routing method on the trust relaying QKD network in detail. This paper focuses on the routing issues, builds a model of the trust relaying QKD network for easily analysing and understanding this network, and proposes a dynamical routing scheme for this network. From the viewpoint of designing a dynamical routing scheme in classical network, the proposed scheme consists of three components: a Hello protocol helping share the network topology information, a routing algorithm to select a set of suitable paths and establish the routing table and a link state update mechanism helping keep the routing table newly. Experiments and evaluation demonstrates the validity and effectiveness of the proposed routing scheme.

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.

Maximizing Energy Savings Reliability in BC Hydro Industrial Demand-side Management Programs: An Assessment of Performance Incentive Models

NASA Astrophysics Data System (ADS)

Gosman, Nathaniel

For energy utilities faced with expanded jurisdictional energy efficiency requirements and pursuing demand-side management (DSM) incentive programs in the large industrial sector, performance incentive programs can be an effective means to maximize the reliability of planned energy savings. Performance incentive programs balance the objectives of high participation rates with persistent energy savings by: (1) providing financial incentives and resources to minimize constraints to investment in energy efficiency, and (2) requiring that incentive payments be dependent on measured energy savings over time. As BC Hydro increases its DSM initiatives to meet the Clean Energy Act objective to reduce at least 66 per cent of new electricity demand with DSM by 2020, the utility is faced with a higher level of DSM risk, or uncertainties that impact the costeffective acquisition of planned energy savings. For industrial DSM incentive programs, DSM risk can be broken down into project development and project performance risks. Development risk represents the project ramp-up phase and is the risk that planned energy savings do not materialize due to low customer response to program incentives. Performance risk represents the operational phase and is the risk that planned energy savings do not persist over the effective measure life. DSM project development and performance risks are, in turn, a result of industrial economic, technological and organizational conditions, or DSM risk factors. In the BC large industrial sector, and characteristic of large industrial sectors in general, these DSM risk factors include: (1) capital constraints to investment in energy efficiency, (2) commodity price volatility, (3) limited internal staffing resources to deploy towards energy efficiency, (4) variable load, process-based energy saving potential, and (5) a lack of organizational awareness of an operation's energy efficiency over time (energy performance). This research assessed the capacity of alternative performance incentive program models to manage DSM risk in BC. Three performance incentive program models were assessed and compared to BC Hydro's current large industrial DSM incentive program, Power Smart Partners -- Transmission Project Incentives, itself a performance incentive-based program. Together, the selected program models represent a continuum of program design and implementation in terms of the schedule and level of incentives provided, the duration and rigour of measurement and verification (M&V), energy efficiency measures targeted and involvement of the private sector. A multi criteria assessment framework was developed to rank the capacity of each program model to manage BC large industrial DSM risk factors. DSM risk management rankings were then compared to program costeffectiveness, targeted energy savings potential in BC and survey results from BC industrial firms on the program models. The findings indicate that the reliability of DSM energy savings in the BC large industrial sector can be maximized through performance incentive program models that: (1) offer incentives jointly for capital and low-cost operations and maintenance (O&M) measures, (2) allow flexible lead times for project development, (3) utilize rigorous M&V methods capable of measuring variable load, process-based energy savings, (4) use moderate contract lengths that align with effective measure life, and (5) integrate energy management software tools capable of providing energy performance feedback to customers to maximize the persistence of energy savings. While this study focuses exclusively on the BC large industrial sector, the findings of this research have applicability to all energy utilities serving large, energy intensive industrial sectors.

A profile of PMS salaried GP contracts and their impact on recruitment.

PubMed

Williams, J; Petchey, R; Gosden, T; Leese, B; Sibbald, B

2001-06-01

Personal medical services (PMS) pilot sites aim to use salaried GP schemes to improve GP recruitment and retention and enhance the quality of service provision, particularly in underserved areas. Our objectives were to (i) compare the work incentives of salaried compared with standard GP contracts; (ii) assess recruitment success to salaried posts; and (iii) describe the types of GPs attracted to these new posts. All first wave PMS pilot sites with salaried GP posts known to be 'live' in October 1998 were included in the analysis of employment contracts and job descriptions. Information on recruitment was obtained by a questionnaire survey of PMS sites that were intending to recruit a salaried GP. The mean full-time equivalent salary was 43,674 pounds sterling with additional benefits in terms of sick leave, maternity leave and paid expenses. Eighty-nine percent of posts were eligible for the NHS pension scheme. Posts were mainly full time (40.8 hours per week). GPs were responsible for providing services equivalent in scope to general medical services. One-fifth of contracts freed GPs from out-of-hours responsibility and most freed them from practice management. Forty-three of the pilot sites actively recruited to fill 63 salaried posts, which involved a total of 51 recruitment 'rounds', with some pilots advertising more than once. There were 291 applications. The median number of applicants per post was three and the median time to recruitment was 6 weeks. Eighty-five percent of sites were satisfied with the quality of their applicants and 64% with the quantity. Eighty-five percent of applicants previously had been working in general practice, most in locum or salaried posts. Applicants tended to be young and male. Sixty posts were filled. Salaried contracts offer positive incentives to recruitment in terms of reduced hours of work and freedom from administrative responsibility. Recruitment success was similar to that achieved by inner city practices generally. This modest achievement might be enhanced by the addition of professional development schemes and increased flexible/part-time working.

Competitions and incentives for smoking cessation.

PubMed

Cahill, Kate; Perera, Rafael

2011-04-13

Background Material or financial incentives may be used in an attempt to reinforce behaviour change, including smoking cessation. They have been widely used in workplace smoking cessation programmes, and to a lesser extent within community programmes. Public health initiatives in the UK are currently planning to deploy incentive schemes to change unhealthy behaviours. Quit and Win contests are the subject of a companion review. To determine whether competitions and incentives lead to higher long-term quit rates. We also set out to examine the relationship between incentives and participation rates. We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE, EMBASE, CINAHL and PsycINFO. Search terms included incentive*, competition*, contest*, reward*, prize*, contingent payment*, deposit contract*. The most recent searches were in November 2010. We considered randomized controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. Data were extracted by one author (KC) and checked by the second (RP). We contacted study authors for additional data where necessary. The main outcome measure was abstinence from smoking at least six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Where possible we performed meta-analysis using a generic inverse variance model, grouped by timed endpoints, but not pooled across the subgroups. Nineteen studies met our inclusion criteria, covering >4500 participants. Only one study, the largest in our review and covering 878 smokers, demonstrated significantly higher quit rates for the incentives group than for the control group beyond the six-month assessment. This trial referred its participants to local smoking cessation services, and offered substantial cash payments (up to US$750) for prolonged abstinence. In the remaining trials, there was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that contingent rewards enhanced success rates over fixed payment schedules. There is some evidence that recruitment rates can be improved by rewarding participation, which may be expected to deliver higher absolute numbers of successful quitters. Cost effectiveness analysis was not appropriate to this review, since the efficacy of most of the interventions was not demonstrated. With the exception of one recent trial, incentives and competitions have not been shown to enhance long-term cessation rates. Early success tended to dissipate when the rewards were no longer offered. Rewarding participation and compliance in contests and cessation programmes may have potential to deliver higher absolute numbers of quitters. The one trial that achieved sustained success rates beyond the reward schedule concentrated its resources into substantial cash payments for abstinence rather than into running its own smoking cessation programme. Such an approach may only be feasible where independently-funded smoking cessation programmes are already available. Future research might explore the scale and longevity of possible cash reward schedules, within a variety of smoking populations.

77 FR 53967 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-04

...This final rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. In addition, it specifies payment adjustments under Medicare for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology (CEHRT) and other program participation requirements. This final rule revises certain Stage 1 criteria, as finalized in the July 28, 2010 final rule, as well as criteria that apply regardless of Stage.

Western municipal water conservation policy: The case of disaggregated demand

NASA Astrophysics Data System (ADS)

Burness, Stuart; Chermak, Janie; Krause, Kate

2005-03-01

We investigate aspects of the felicity of both incentive-based and command and control policies in effecting municipal water conservation goals. When demand can be disaggregated according to uses or users, our results suggest that policy efforts be focused on the submarket wherein demand is more elastic. Under plausible consumer parameters, a household production function approach to water utilization prescribes the nature of demand elasticities in alternative uses and squares nicely with empirical results from the literature. An empirical example illustrates. Overall, given data and other informational limitations, extant institutional structures, and in situ technology, our analysis suggests a predisposition for command and control policies over incentive-based tools.

How to successfully implement extended producer responsibility: considerations from an economic point of view.

PubMed

Wiesmeth, Hans; Häckl, Dennis

2011-09-01

This paper investigates the concept of extended producer responsibility (EPR) from an economic point of view. Particular importance will be placed on the concept of 'economic feasibility' of an EPR policy, which should guide decision-making in this context. Moreover, the importance of the core EPR principle of 'integrating signals throughout the product chain' into the incentive structure will be demonstrated with experiences from Germany. These examples refer to sales packaging consumption, refillable drinks packages and waste electrical and electronic equipment collection. As a general conclusion, the interaction between economic principles and technological development needs to be observed carefully when designing incentive-compatible EPR policies.

Global Journal of Computer Science and Technology. Volume 9, Issue 5 (Ver. 2.0)

ERIC Educational Resources Information Center

Dixit, R. K.

2010-01-01

This is a special issue published in version 1.0 of "Global Journal of Computer Science and Technology." Articles in this issue include: (1) [Theta] Scheme (Orthogonal Milstein Scheme), a Better Numerical Approximation for Multi-dimensional SDEs (Klaus Schmitz Abe); (2) Input Data Processing Techniques in Intrusion Detection…

What drives health policy formulation: insights from the Nepal maternity incentive scheme?

PubMed

Ensor, Tim; Clapham, Susan; Prasai, Devi Prasad

2009-05-01

Although maternal health outcomes have improved considerably in Nepal, continued low levels of skilled attendance and unequal access to safe emergency obstetric care continues to be central policy concern. The financial costs of delivery exacerbated are thought to continue to represent a major barrier to care to accessing services. Policy interest in this area moved swiftly. Skilled birth attendance came under the spotlight in 2001 while research on costs was commissioned in 2003. The resulting conclusions suggested substantial costs particularly on the demand side in the form of transport costs. After the research was completed the Government moved quickly to develop policy on financial barriers to skilled attendance leading to the Maternity Incentive Scheme that was implemented in 2005. We explored the reasons for policy acceptance and implementation based on recent studies in this area and a series of key informant interviews in the country. A variety of reasons can be shown to be important in ensuring that the research was utilised quickly. The conduct of the research process was importance, particularly by ensuring that results were communicated widely in a way that responded to both technical and political policy-making concerns. A convergence of political interests that meant that the policy became an ideal vehicle for improving the flagging fortunes of the government was also seen as crucial in expediting policy change although it also meant that the policy had to be adjusted to cater to political rather purely technical concerns. The experience also underlines the importance of political champions within or close to government in advocating a strong policy line through channels that researchers can rarely access.

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.

Applying deep learning technology to automatically identify metaphase chromosomes using scanning microscopic images: an initial investigation

NASA Astrophysics Data System (ADS)

Qiu, Yuchen; Lu, Xianglan; Yan, Shiju; Tan, Maxine; Cheng, Samuel; Li, Shibo; Liu, Hong; Zheng, Bin

2016-03-01

Automated high throughput scanning microscopy is a fast developing screening technology used in cytogenetic laboratories for the diagnosis of leukemia or other genetic diseases. However, one of the major challenges of using this new technology is how to efficiently detect the analyzable metaphase chromosomes during the scanning process. The purpose of this investigation is to develop a computer aided detection (CAD) scheme based on deep learning technology, which can identify the metaphase chromosomes with high accuracy. The CAD scheme includes an eight layer neural network. The first six layers compose of an automatic feature extraction module, which has an architecture of three convolution-max-pooling layer pairs. The 1st, 2nd and 3rd pair contains 30, 20, 20 feature maps, respectively. The seventh and eighth layers compose of a multiple layer perception (MLP) based classifier, which is used to identify the analyzable metaphase chromosomes. The performance of new CAD scheme was assessed by receiver operation characteristic (ROC) method. A number of 150 regions of interest (ROIs) were selected to test the performance of our new CAD scheme. Each ROI contains either interphase cell or metaphase chromosomes. The results indicate that new scheme is able to achieve an area under the ROC curve (AUC) of 0.886+/-0.043. This investigation demonstrates that applying a deep learning technique may enable to significantly improve the accuracy of the metaphase chromosome detection using a scanning microscopic imaging technology in the future.

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.

Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage.

PubMed

Baine, Sebastian Olikira; Kakama, Alex; Mugume, Moses

2018-06-15

Kisiizi Hospital Health Insurance scheme started in 1996 to; improve access to health services, and provide a stable source of funding and reduce bad debts to Kisiizi hospital. Objectives of this study were; to describe Kisiizi Hospital Health Insurance scheme and to document lessons learned and implications for universal health coverage. This was a descriptive cross-sectional study. Data from different sources were triangulated and thematically analysed. Most households (96%) were organized in Engozi societies (e-Societies), met monthly, and made financial contributions. Cultural solidarity in e-Societies provided a platform for the Kisiizi hospital health insurance scheme establishment, operation and made it compulsory for members. e-Societies disciplinary measures and fear of high out-of-pocket payment for health care enforced enrolment, retention and increased membership. Community sensitisation and community participation in setting premiums and co-payments provided for better understanding of health insurance and rendered them acceptable, affordable and equitable. Membership increased from 330 in 1996 to 38,400 families in 2017. Kisiizi hospital health insurance scheme covered only health services obtained from Kisiizi hospital. Kisiizi hospital health insurance scheme offered no exemption, credit and referral facilities. e-Societies sometimes paid premiums for members from savings and offered them loans to. Kisiizi hospital provided good quality health services, which were easily accessed by insured members. Kisiizi hospital got a stable source of funding and reduced debt burden. Kisiizi hospital health insurance scheme improved access to health services, provided a stable source of funding and reduced bad debts to the hospital. Internal and external factors to e-Society enforced enrolment and retention of members in Kisiizi hospital health insurance scheme. Good quality health services at Kisiizi hospital demonstrated value for money and offered incentives for enrolment and retention, and coverage expansion. Community sensitization and participation in setting premiums and co-payments rendered Kisiizi hospital health insurance scheme acceptable, affordable and catered for equity. Insured members enjoyed benefits; protection against catastrophic health spending, impoverishment, and easy access to quality health care.

The impact of early retirement on perceptions of life at work and at home: qualitative analyses of British civil servants participating in the Whitehall II Retirement Study.

PubMed

Mein, Gill; Ellison, George T H

2006-01-01

This study examined pathways to retirement and the role of circumstances at work and at home (including the introduction of financially-enhanced early retirement schemes) on retirement-related decision-making. In-depth qualitative interviews were conducted within 2 years of retirement with 59 British civil servants participating in the Whitehall II Study. Focusing on the experiences of 33 interviewees who spontaneously discussed "early retirement" we identified three pathways to retirement (non-applicants, successful applicants, and unsuccessful applicants for early retirement) each influenced by a range of complementary positive and negative factors at work and at home. The early retirement schemes influenced the balance between these factors in three ways: by encouraging participants to reflect on (and reconsider) existing retirement plans; by offering financial incentives to retire early; and because they were part of the ongoing process of restructuring and downsizing within the Civil Service which was accompanied by a perceived deterioration in conditions at work.

Paying for performance and the social relations of health care provision: an anthropological perspective.

PubMed

Magrath, Priscilla; Nichter, Mark

2012-11-01

Over the past decade, the use of financial incentive schemes has become a popular form of intervention to boost performance in the health sector. Often termed "paying for performance" or P4P, they involve "…the transfer of money or material goods conditional upon taking a measurable action or achieving a predetermined performance target" (Eldridge & Palmer, 2009, p.160). P4P appear to bring about rapid improvements in some measured indicators of provider performance, at least over the short term. However, evidence for the impact of these schemes on the wider health system remains limited, and even where evaluations have been positive, unintended effects have been identified. These have included: "gaming" the system; crowding out of "intrinsic motivation"; a drop in morale where schemes are viewed as unfair; and the undermining of social relations and teamwork through competition, envy or ill feeling. Less information is available concerning how these processes occur, and how they vary across social and cultural contexts. While recognizing the potential of P4P, the authors argue for greater care in adapting schemes to particular local contexts. We suggest that insights from social science theory coupled with the focused ethnographic methods of anthropology can contribute to the critical assessment of P4P schemes and to their adaptation to particular social environments and reward systems. We highlight the need for monitoring P4P schemes in relation to worker motivation and the quality of social relations, since these have implications both for health sector performance over the long term and for the success and sustainability of a P4P scheme. Suggestions are made for ethnographies, undertaken in collaboration with local stakeholders, to assess readiness for P4P; package rewards in ways that minimize perverse responses; identify process variables for monitoring and evaluation; and build sustainability into program design through linkage with complementary reforms. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

Reconsideration of the scheme of the international classification of functioning, disability and health: incentives from the Netherlands for a global debate.

PubMed

Heerkens, Yvonne F; de Weerd, Marjolein; Huber, Machteld; de Brouwer, Carin P M; van der Veen, Sabina; Perenboom, Rom J M; van Gool, Coen H; Ten Napel, Huib; van Bon-Martens, Marja; Stallinga, Hillegonda A; van Meeteren, Nico L U

2018-03-01

The ICF (International Classification of Functioning, Disability and Health) framework (used worldwide to describe 'functioning' and 'disability'), including the ICF scheme (visualization of functioning as result of interaction with health condition and contextual factors), needs reconsideration. The purpose of this article is to discuss alternative ICF schemes. Reconsideration of ICF via literature review and discussions with 23 Dutch ICF experts. Twenty-six experts were invited to rank the three resulting alternative schemes. The literature review provided five themes: 1) societal developments; 2) health and research influences; 3) conceptualization of health; 4) models/frameworks of health and disability; and 5) ICF-criticism (e.g. position of 'health condition' at the top and role of 'contextual factors'). Experts concluded that the ICF scheme gives the impression that the medical perspective is dominant instead of the biopsychosocial perspective. Three alternative ICF schemes were ranked by 16 (62%) experts, resulting in one preferred scheme. There is a need for a new ICF scheme, better reflecting the ICF framework, for further (inter)national consideration. These Dutch schemes should be reviewed on a global scale, to develop a scheme that is more consistent with current and foreseen developments and changing ideas on health. Implications for Rehabilitation We propose policy makers on community, regional and (inter)national level to consider the use of the alternative schemes of the International Classification of Functioning, Disability and Health within their plans to promote functioning and health of their citizens and researchers and teachers to incorporate the alternative schemes into their research and education to emphasize the biopsychosocial paradigm. We propose to set up an international Delphi procedure involving citizens (including patients), experts in healthcare, occupational care, research, education and policy, and planning to get consensus on an alternative scheme of the International Classification of Functioning, Disability and Health. We recommend to discuss the alternatives for the present scheme of the International Classification of Functioning, Disability and Health in the present update and revision process within the World Health Organization as a part of the discussion on the future of the International Classification of Functioning, Disability and Health framework (including ontology, title and relation with the International Classification of Diseases). We recommend to revise the definition of personal factors and to draft a list of personal factors that can be used in policy making, clinical practice, research, and education and to put effort in the revision of the present list of environmental factors to make it more useful in, e.g., occupational health care.

EDUCATION IN BUSINESS AND INDUSTRY.

ERIC Educational Resources Information Center

DECARLO, CHARLES R.; ROBINSON, ORMSBEE W.

CONTINUING EDUCATION IS DISCUSSED AS VITAL TO THE PROSPERITY OF BUSINESS AND INDUSTRY WHEN TECHNOLOGICAL CHANGES REQUIRE CONTINUAL READJUSTMENT OF JOB REQUIREMENTS. ROLES OF INDUSTRY, UNIVERSITIES, AND GOVERNMENT COOPERATING TO PROVIDE THE RESOURCES, MATERIALS, AND INCENTIVES FOR CONTINUING EDUCATION ARE PROPOSED. DISCUSSIONS INCLUDE--(1) PROBLEMS…

42 CFR 495.100 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... professionals: (1) A doctor of medicine or osteopathy. (2) A doctor of dental surgery or medicine. (3) A doctor of podiatric medicine. (4) A doctor of optometry. (5) A chiropractor. Geographic health professional...

42 CFR 495.100 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... professionals: (1) A doctor of medicine or osteopathy. (2) A doctor of dental surgery or medicine. (3) A doctor of podiatric medicine. (4) A doctor of optometry. (5) A chiropractor. Geographic health professional...

42 CFR 495.100 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... professionals: (1) A doctor of medicine or osteopathy. (2) A doctor of dental surgery or medicine. (3) A doctor of podiatric medicine. (4) A doctor of optometry. (5) A chiropractor. Geographic health professional...

42 CFR 495.100 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... professionals: (1) A doctor of medicine or osteopathy. (2) A doctor of dental surgery or medicine. (3) A doctor of podiatric medicine. (4) A doctor of optometry. (5) A chiropractor. Geographic health professional...

42 CFR 495.100 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements... professionals: (1) A doctor of medicine or osteopathy. (2) A doctor of dental surgery or medicine. (3) A doctor of podiatric medicine. (4) A doctor of optometry. (5) A chiropractor. Geographic health professional...

42 CFR 495.348 - Procurement standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... solicit nor accept gratuities, favors, or anything of monetary value from contractors, or parties to sub... or the gift is an unsolicited item of nominal value. (5) The standards of conduct provide for...

42 CFR 495.348 - Procurement standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... solicit nor accept gratuities, favors, or anything of monetary value from contractors, or parties to sub... or the gift is an unsolicited item of nominal value. (5) The standards of conduct provide for...

42 CFR 495.348 - Procurement standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... solicit nor accept gratuities, favors, or anything of monetary value from contractors, or parties to sub... or the gift is an unsolicited item of nominal value. (5) The standards of conduct provide for...

42 CFR 495.312 - Process for payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Process for payments. 495.312 Section 495.312 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE...

75 FR 44313 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-28

... care issues. Frank Szeflinski, (303) 844-7119, Medicare Advantage issues. SUPPLEMENTARY INFORMATION... MCO Managed Care Organization MITA Medicaid Information Technology Architecture MMIS Medicaid... Payment Calculation for Eligible Hospitals c. Medicare Share d. Charity Care e. Transition Factor f...

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.

Multiple Behavior Change in Diet and Activity: A Randomized Controlled Trial Using Mobile Technology

PubMed Central

Spring, Bonnie; Schneider, Kristin; McFadden, H.G.; Vaughn, Jocelyn; Kozak, Andrea T.; Smith, Malaina; Moller, Arlen C.; Epstein, Leonard H.; DeMott, Andrew; Hedeker, Donald; Siddique, Juned; Lloyd-Jones, Donald M.

2012-01-01

Background Many patients exhibit multiple chronic disease risk behaviors. Research provides little information about advice that can maximize simultaneous health behavior changes. Methods To test which combination of diet and activity advice maximizes healthy change, we randomized 204 adults with elevated saturated fat and low fruit/vegetable intakes, high sedentary leisure time and low physical activity to one of four treatments: increase fruit/vegetable and physical activity; decrease fat and sedentary leisure; decrease fat and increase physical activity; increase fruit/vegetable and decrease sedentary leisure. Treatments provided three weeks of remote coaching supported by mobile decision support technology and financial incentives. During treatment, incentives were contingent on using the mobile device to self-monitor and attain behavioral targets; during follow-up they were contingent only on recording. The outcome was standardized, composite improvement on the four diet and activity behaviors at end of treatment and five month follow-up. Results Of those randomized, 200 (98%) completed follow-up. The increase fruit/vegetable and decrease sedentary leisure treatment improved more than the other 3 treatments (p<.001). Specifically, fruit/vegetables increased from 1.2 servings/day to 5.5; sedentary leisure decreased from 219.2 minutes/day to 89.3; saturated fat decreased from 12.0% of calories consumed to 9.5%. Differences between treatment groups were maintained through follow-up. Traditional dieting (decrease fat and increase physical activity) improved less than the other 3 treatments (p<.001). Conclusions Remote coaching supported by mobile technology and financial incentives holds promise to improve diet and activity. Targeting fruits/vegetables and sedentary leisure together maximizes overall adoption and maintenance of multiple healthy behavior changes. PMID:22636824

The doctor-patient relationship, defensive medicine and overprescription in Chinese public hospitals: evidence from a cross-sectional survey in Shenzhen city.

PubMed

He, Alex Jingwei

2014-12-01

Defensive medicine describes physicians' behavioral response to threats from medical malpractice litigation. Previous studies have found widespread practice of defensive medicine that is responsible for the global escalation of health care costs. Defying the traditional explanations, this study, with a case of a Chinese city, reveals that in a country where medical malpractice lawsuits are rare, physicians' self-perceived threats from patients may constitute a major reason for defensive practices. Defensive behaviors in the Chinese context mainly take the form of overprescribing diagnostic tests, procedures and drugs. The existing literature tends to explain this in terms of Chinese doctors' desire to supplement their low incomes. Behind this is a series of misaligned incentives deeply embedded in the Chinese health system. Using a cross-sectional survey of physicians, this study shows that overprescription in Chinese hospitals is driven not only by hard economic incentives, but also by doctors' motive of avoiding disputes with patients. The survey was carried out in Shenzhen City, in December 2013. A sample containing 504 licensed physicians was drawn by random sampling. Descriptive analyses identified significant dissatisfaction with income and workload as well as severe tensions between doctors and patients. Drawing from the literature on defensive medicine, multivariate analysis revealed that physicians' previous experience of medical disputes is significantly associated with defensive behaviors, particularly overprescription. Low income continued to be a critical predictor, reinforcing the target income hypothesis and suggesting the resilience of perverse economic incentives. This study sheds fresh light on China's recent health policy reforms by highlighting the critical impact of the doctor-patient relationship. The effort to contain health care costs must progress on two fronts, mitigating the tensions between doctors and patients while still reforming the remuneration scheme cautiously to enable physicians to respond to right incentives. Copyright © 2014 Elsevier Ltd. All rights reserved.

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.

Making User-Generated Content Communities Work in Higher Education - The Importance of Setting Incentives

NASA Astrophysics Data System (ADS)

Vom Brocke, Jan; White, Cynthia; Walker, Ute; Vom Brocke, Christina

The concept of User-Generated Content (UGC) offers impressive potential for innovative learning and teaching scenarios in higher education. Examples like Wikipedia and Facebook illustrate the enormous effects of multiple users world-wide contributing to a pool of shared resources, such as videos and pictures and also lexicographical descriptions. Apart from single examples, however, the systematic use of these virtual technologies in higher education still needs further exploration. Only few examples display the successful application of UGC Communities at university scenarios. We argue that a major reason for this can be seen in the fact that the organizational dimension of setting up UGC Communities has widely been neglected so far. In particular, we indicate the need for incentive setting to actively involve students and achieve specific pedagogical objectives. We base our study on organizational theories and derive strategies for incentive setting that have been applied in a practical e-Learning scenario involving students from Germany and New Zealand.

Scientific Utopia: An agenda for improving scientific communication (Invited)

NASA Astrophysics Data System (ADS)

Nosek, B.

2013-12-01

The scientist's primary incentive is publication. In the present culture, open practices do not increase chances of publication, and they often require additional work. Practicing the abstract scientific values of openness and reproducibility thus requires behaviors in addition to those relevant for the primary, concrete rewards. When in conflict, concrete rewards are likely to dominate over abstract ones. As a consequence, the reward structure for scientists does not encourage openness and reproducibility. This can be changed by nudging incentives to align scientific practices with scientific values. Science will benefit by creating and connecting technologies that nudge incentives while supporting and improving the scientific workflow. For example, it should be as easy to search the research literature for my topic as it is to search the Internet to find hilarious videos of cats falling off of furniture. I will introduce the Center for Open Science (http://centerforopenscience.org/) and efforts to improve openness and reproducibility such as http://openscienceframework.org/. There will be no cats.

Investment subsidies and the adoption of electronic medical records in hospitals.

PubMed

Dranove, David; Garthwaite, Craig; Li, Bingyang; Ody, Christopher

2015-12-01

In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH. Copyright © 2015 Elsevier B.V. All rights reserved.

Meaningful use: a roadmap for the advancement of health information exchange

PubMed Central

2013-01-01

Frankel and colleagues have compared Israel and the U.S.’s experiences with health information exchange (HIE). They highlight the importance of institutional factors in fostering HIE development, notably the influence of local structures, experience and incentives. Historically, information infrastructure in the U.S. has been limited due to lack of standards, fragmented institutions and competition. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized billions of dollars for the adoption and “Meaningful Use” of electronic health records. HITECH programs and Meaningful Use incentives target the advancement of HIE through 1) building blocks, 2) local support and 3) payment incentives. Meaningful Use requirements create a roadmap to broader electronic exchange of health information among providers and with patients. Ultimately, successful HIE in the U.S. will depend on whether Meaningful Use can address institutional needs within local markets. This is a commentary on http://www.ijhpr.org/content/2/1/722 PMID:23880399

[Options for a future risc structure compensation in Germany].

PubMed

Greiner, W

2006-07-01

AIM OF THE ARTICLE: The risc structure compensation scheme within the German compulsory health insurance system is intended to enforce the principle of solidarity all over the statutory health insurance and not only within the different sickness funds. Differences in the contribution rates should not reflect different risc profiles, but the differences of the efficiency in social care. The criticism against the current adjustment system in Germany is multifarious and points e. g. on the missing orientation to morbidity. This article follows the question, whether this criticism is valid. The variables and methods, which are currently used to calculate the risc structure adjustment are discussed and compared to an alternative proposal for the future form of the risc structure adjustment, which includes both a higher orientation to riscs and incentives for social health insurance funds to decline the costs for the social care system on long-term. Currently, for the calculation of the risc structure adjustment the following variables are used: age, sex, income, number of family members who are exempted from contributions and persons who get occupational disability pension, and number of insured persons who are registered to an accredited Disease-Management-Program (DMP). Especially the last variable includes a high control effort, because the higher co-payments of the adjustment system are aligned to the voluntariness of participation and active collaboration of the patients in DMP. The argument, a further development to a morbidity-oriented risc structure adjustment leads to less cost management of the sickness funds is not totally correct, because not actual, but standardised costs are the basis for compensation. On the other hand the morbidity determined cost components should not totally be adjusted, as a proper distribution of savings to the risc structure adjustment and the single funds would still be an incentive for cost management and prevention. An ongoing refining of the risc structure adjustment might cause new incentive problems. Instead a morbidity orientated risc structure compensation scheme should leave a part of the savings due to better social care structures in the sickness funds and should include outpatient care parameters. The change to a new honorarium system could create a better data basis for this improved form of risc structure adjustment in the future.

Gaming across different consoles: exploring the influence of control scheme on game-player enjoyment.

PubMed

Limperos, Anthony M; Schmierbach, Michael G; Kegerise, Andrew D; Dardis, Frank E

2011-06-01

Many studies have investigated how different technological features impact the experience of playing video games, yet few have focused on how control schemes may affect the play experience. This research employed a between-subjects design to explore the relationship between the type of console played (Nintendo Wii, Playstation 2) and feelings of flow and enjoyment during the game-play experience. Results indicated that participants reported greater feelings of control and enjoyment with a traditional control scheme (Playstation 2) than with the more technologically advanced control scheme (Nintendo Wii). Further mediation analysis showed that enjoyment was driven by the sense of control that participants experienced and not simply by whether they won the game. Theoretical and practical implications are discussed.

A privacy authentication scheme based on cloud for medical environment.

PubMed

Chen, Chin-Ling; Yang, Tsai-Tung; Chiang, Mao-Lun; Shih, Tzay-Farn

2014-11-01

With the rapid development of the information technology, the health care technologies already became matured. Such as electronic medical records that can be easily stored. However, how to get medical resources more convenient is currently concerning issue. In spite of many literatures discussed about medical systems, these literatures should face many security challenges. The most important issue is patients' privacy. Therefore, we propose a privacy authentication scheme based on cloud environment. In our scheme, we use mobile device's characteristics, allowing peoples to use medical resources on the cloud environment to find medical advice conveniently. The digital signature is used to ensure the security of the medical information that is certified by the medical department in our proposed scheme.

Policy options for increasing the supply of transplantable kidneys in Singapore

PubMed Central

Chong, Jia Loon

2016-01-01

Kidney transplantation is the preferred treatment for eligible end-stage renal disease patients. However, the supply of donated kidneys has been consistently insufficient to meet the transplantation requirements of the population. In this paper, I discuss the feasibility of several policy options that engage potential donors or key individuals in a Singapore context, including financial and non-financial incentives for deceased/living organ donors and their families, improving actualisation rates of both donation after brain death, donation after cardiac death through quality improvement programmes and remuneration schemes, and a media platform for directed organ donation. I conclude by highlighting the most feasible policies to be considered. PMID:27779281

Ambulatory care trends in Germany: a road toward more integration of care?

PubMed

Redaelli, Marcus; Meuser, Susanne; Stock, Stephanie

2012-01-01

Traditionally, Germany has a weak primary care system. In addition, the number of general practitioners (GPs) has declined in the past years. Main challenges are an aging population, disintegration of care, variations in care, an increase in chronic conditions, and a shortage of GPs especially in rural areas. Policy reacted by implementing financial incentives for GPs in rural areas and special GP training programs. Improvements in chronic care aim to better integrate care through Disease Management Programs, the electronic health card, and voluntary primary care schemes. The largest challenge to be addressed is the delegation of physician tasks to physician assistants.

Workshop Summary for Maintaining Innovation and Security in Biotechnology: Lessons Learned from Nuclear, Chemical, and Informational Technologies

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

Althouse, Paris

In the fast-paced field of biotechnology where innovation has such far-reaching impacts on human health and the environment, dealing with the implications of possible illicit activities, accidents or unintended research consequences with potential detrimental societal impacts tends to remain in the background. While controls may be inevitable for the biotech industry, workshop attendees agreed that the way in which controls are implemented will play a major role in the agility and innovation of the biotechnology industry. There is little desire to slow down the pace of the gains while dealing with the security issues that arise. As was seen frommore » the brief examinations of the Nuclear, Chemical, and Information Technology sectors explored in this workshop, establishing a regulatory regime needs to be a partnership between the public, corporate interests, scientists, and the government. Regulation is often written to combat perceived risk rather than actual risk—the public’s perceptions (occasionally even fictional portrayals) can spur regulatory efforts. This leads to the need for a thorough and continuing assessment of the risks posed by modern biotechnology. Inadequate or minimal risk assessment might expedite development in the short term but has potential negative long-term security and economic consequences. Industry and the technical community also often have a large role in setting regulatory policy, especially when well-crafted incentives are incorporated into the regulations. Such incentives might actually lead to enhanced innovation while poorly designed incentives can actually reduce safety and security. Any regulations should be as agile and flexible as the technology they regulate and when applied to biotechnologies they will need a new framework for thinking and implementing. The new framework should consider biotechnology as a technology and not simply a science since it is an extremely complex and adaptive system. This suggests the need to invest in social and political systems, rather than exclusively in technology, as a part of maintaining not only robust, but agile regulation. Modeling and simulations to illustrate how the biotech ecosystem might respond to new policies may be a promising approach to crafting regulations.« less

Collective Bargaining As an Instrument of Change.

ERIC Educational Resources Information Center

Ayers, Steven V.

1998-01-01

The Hilton Central School District, New York, utilized the collective bargaining process to create a financial incentive that would motivate teachers to achieve a baseline level of technological competency. Describes the negotiated agreement, results obtained during the initial year of implementation, and future plans. (MLF)

Prize-Winning Money Savers

ERIC Educational Resources Information Center

AGB Reports, 1978

1978-01-01

Thirteen ideas from the NACUBO-U.S. Steel Foundation "Cost Reduction Incentive Awards" of the past three years are presented. Among them are: Rochester Institute of Technology's employee assistance plan (counseling for drug or alcohol abuse or family or financial problems); and Duke's Consolidation of duplicating services. (Author/LBH)

Tapping Resources in Municipal Solid Waste

ERIC Educational Resources Information Center

Blum, S. L.

1976-01-01

Municipal solid waste disposal is becoming complex as costs, wastes, and environmental restrictions increase. Recovery and recycling of materials presents problems of financing, ownership, and operation, technology, and marketing. Energy and materials recovery offers long-term economic and environmental incentives in terms of growing shortages and…

76 FR 14379 - Advanced Placement Incentive Program; Office of Elementary and Secondary Education; Overview...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-16

... competitive preference priority. Absolute Priority 1: Promoting Science, Technology, Engineering, and... applications that meet these priorities. These priorities are: Absolute Priority 1: Promoting Science... participation in the core academic areas of English, mathematics, and science; (4) Involving business and...

A Data Envelopment Analysis Approach to Prioritize Renewable Energy Technologies

USDA-ARS?s Scientific Manuscript database

Due to growing financial and environmental concerns, governmental rules, regulations and incentives alternative energy sources will soon grow at a much faster pace than conventional sources of energy. However, the current body of research providing comparative decision making models that either rank...

Key enablers to facilitate healthy behavior change: workshop summary.

PubMed

Teyhen, Deydre S; Aldag, Matt; Centola, Damon; Edinborough, Elton; Ghannadian, Jason D; Haught, Andrea; Jackson, Theresa; Kinn, Julie; Kunkler, Kevin J; Levine, Betty; Martindale, Valerie E; Neal, David; Snyder, Leslie B; Styn, Mindi A; Thorndike, Frances; Trabosh, Valerie; Parramore, David J

2014-05-01

The increases in preventable chronic diseases and the rising costs of health care are unsustainable. The US Army Surgeon General's vision to transition from a health care system to a system of health requires the identification of key health enablers to facilitate the adoption of healthy behaviors. In support of this vision, the US Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled "Incentives to Create and Sustain Change for Health." Members of government and academia participated to identify key health enablers that could ultimately be leveraged by technology. The key health enablers discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior-change intervention, and (5) the role of peer and social networks on change. This report summarizes leading evidence and the group consensus on evidence-based practices with respect to the key enablers in creating healthy behavior change.

Implementing EHRs: An Exploratory Study to Examine Current Practices in Migrating Physician Practice

PubMed Central

Dolezel, Diane; Moczygemba, Jackie

2015-01-01

Implementation of electronic health record (EHR) systems in physician practices is challenging and complex. In the past, physicians had little incentive to move from paper-based records. With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, Medicare and Medicaid incentive payments are now available for physicians who implement EHRs for meaningful use. The Office of the National Coordinator for Health Information Technology (ONC) has ample detail on clinical data needed for meaningful use in order to assess the quality of patient care. Details are lacking, however, on how much clinical data, if any, should be transferred from the old paper records during an EHR implementation project. The purpose of this exploratory study was to investigate and document the elements of longitudinal clinical data that are essential for inclusion in the EHR of physicians in a clinical practice setting, as reported by the office managers of the physicians in the study group. PMID:26807077

Using Publicly Available Data to Characterize Consumers Use of Email to Communicate with Healthcare Providers.

PubMed

Sandefer, Ryan H; Khairat, Saif S; Pieczkiewicz, David S; Speedie, Stuart M

2015-01-01

The use of patient focused technology has been proclaimed as a means to improve patient satisfaction and improve care outcomes. The Center for Medicaid/Medicare Services, through its EHR Incentive Program, has required eligible hospitals and professionals to send and receive secure messages from patients in order to receive financial incentives and avoid reimbursement penalties. Secure messaging between providers and patients has the potential to improve communication and care outcomes. The purpose of this study was to use National Health Interview Series (NHIS) data to identify the patient characteristics associated with communicating with healthcare providers via email. Individual patient characteristics were analyzed to determine the likelihood of emailing healthcare providers. The use of email for this purpose is associated with educational attainment, having a usual place of receiving healthcare, income, and geography. Publicly available data such as the NHIS may be used to better understand trends in adoption and use of consumer health information technologies.

An examination of automation and robotics in the context of Space Station operations

NASA Technical Reports Server (NTRS)

Criswell, David R.; Lee, Douglas S.; Ragusa, James; Starks, Scott A.; Woodruff, John; Paules, Granville

1988-01-01

A NASA-sponsored review of Space Station automation and robotics (A&R) applications from an operations and utilization perspective is presented. The goals of the A&R panel and this report are to identify major suggestions for advanced A&R operations application in Space Station as well as key technologies that have emerged or gained prominence since the completion of previous reports; to review and incorporate the range of possible Space Station A&R applications into a framework for evaluation of A&R opportunities; and to propose incentives for the government, work packages, and subcontractors to more aggressively identify, evaluate, and incorporate advanced A&R in Space Station Operations. The suggestions for A&R focused on narrow objectives using a conservative approach tuned to Space Station at IOC and limiting the Station's growth capabilities. A more aggressive stance is to identify functional needs over the Program's life, exploit and leverage available technology, and develop the key advanced technologies permitting effective use of A&R. The challenge is to systematically identify candidate functions to be automated, provide ways to create solutions resulting in savings or increased capabilities, and offer incentives that will promote the automation.

Quality Assurance in Engineering Education: Comparison of Accreditation Schemes and ISO 9001.

ERIC Educational Resources Information Center

Karapetrovic, Stanislav; Rajamani, Divakar; Willborn, Walter

1998-01-01

Outlines quality assurance schemes for distance-education technologies that are based on the ISO 9000 family of international quality-assurance standards. Argues that engineering faculties can establish such systems on the basis of and integrated with accreditation schemes. Contains 34 references. (DDR)

Incentive Mechanism for P2P Content Sharing over Heterogenous Access Networks

NASA Astrophysics Data System (ADS)

Sato, Kenichiro; Hashimoto, Ryo; Yoshino, Makoto; Shinkuma, Ryoichi; Takahashi, Tatsuro

In peer-to-peer (P2P) content sharing, users can share their content by contributing their own resources to one another. However, since there is no incentive for contributing contents or resources to others, users may attempt to obtain content without any contribution. To motivate users to contribute their resources to the service, incentive-rewarding mechanisms have been proposed. On the other hand, emerging wireless technologies, such as IEEE 802.11 wireless local area networks, beyond third generation (B3G) cellular networks and mobile WiMAX, provide high-speed Internet access for wireless users. Using these high-speed wireless access, wireless users can use P2P services and share their content with other wireless users and with fixed users. However, this diversification of access networks makes it difficult to appropriately assign rewards to each user according to their contributions. This is because the cost necessary for contribution is different in different access networks. In this paper, we propose a novel incentive-rewarding mechanism called EMOTIVER that can assign rewards to users appropriately. The proposed mechanism uses an external evaluator and interactive learning agents. We also investigate a way of appropriately controlling rewards based on the system service's quality and managing policy.

VideoScheme: A Research, Authoring, and Teaching Tool for Multimedia.

ERIC Educational Resources Information Center

Matthews, James W.; And Others

The availability of digital multimedia technology poses new challenges to researchers, authors, and educators, even as it creates new opportunities for communication. VideoScheme, a prototype video programming environment is described, along with its applications in research, authoring and education. In terms of research, VideoScheme can help…

Electromyographic Activity of Hand Muscles in a Motor Coordination Game: Effect of Incentive Scheme and Its Relation with Social Capital

PubMed Central

Censolo, Roberto; Craighero, Laila; Ponti, Giovanni; Rizzo, Leonzio; Canto, Rosario; Fadiga, Luciano

2011-01-01

Background A vast body of social and cognitive psychology studies in humans reports evidence that external rewards, typically monetary ones, undermine intrinsic motivation. These findings challenge the standard selfish-rationality assumption at the core of economic reasoning. In the present work we aimed at investigating whether the different modulation of a given monetary reward automatically and unconsciously affects effort and performance of participants involved in a game devoid of visual and verbal interaction and without any perspective-taking activity. Methodology/Principal Findings Twelve pairs of participants were submitted to a simple motor coordination game while recording the electromyographic activity of First Dorsal Interosseus (FDI), the muscle mainly involved in the task. EMG data show a clear effect of alternative rewards strategies on subjects' motor behavior. Moreover, participants' stock of relevant past social experiences, measured by a specifically designed questionnaire, was significantly correlated with EMG activity, showing that only low social capital subjects responded to monetary incentives consistently with a standard rationality prediction. Conclusions/Significance Our findings show that the effect of extrinsic motivations on performance may arise outside social contexts involving complex cognitive processes due to conscious perspective-taking activity. More importantly, the peculiar performance of low social capital individuals, in agreement with standard economic reasoning, adds to the knowledge of the circumstances that makes the crowding out/in of intrinsic motivation likely to occur. This may help in improving the prediction and accuracy of economic models and reconcile this puzzling effect of external incentives with economic theory. PMID:21464986

Understanding and Integrating Local Perceptions of Trees and Forests into Incentives for Sustainable Landscape Management

NASA Astrophysics Data System (ADS)

Pfund, Jean-Laurent; Watts, John Daniel; Boissière, Manuel; Boucard, Amandine; Bullock, Renee Marie; Ekadinata, Andree; Dewi, Sonya; Feintrenie, Laurène; Levang, Patrice; Rantala, Salla; Sheil, Douglas; Sunderland, Terence Clarence Heethom; Urech, Zora Lea

2011-08-01

We examine five forested landscapes in Africa (Cameroon, Madagascar, and Tanzania) and Asia (Indonesia and Laos) at different stages of landscape change. In all five areas, forest cover (outside of protected areas) continues to decrease despite local people's recognition of the importance of forest products and services. After forest conversion, agroforestry systems and fallows provide multiple functions and valued products, and retain significant biodiversity. But there are indications that such land use is transitory, with gradual simplification and loss of complex agroforests and fallows as land use becomes increasingly individualistic and profit driven. In Indonesia and Tanzania, farmers favor monocultures (rubber and oil palm, and sugarcane, respectively) for their high financial returns, with these systems replacing existing complex agroforests. In the study sites in Madagascar and Laos, investments in agroforests and new crops remain rare, despite government attempts to eradicate swidden systems and their multifunctional fallows. We discuss approaches to assessing local values related to landscape cover and associated goods and services. We highlight discrepancies between individual and collective responses in characterizing land use tendencies, and discuss the effects of accessibility on land management. We conclude that a combination of social, economic, and spatially explicit assessment methods is necessary to inform land use planning. Furthermore, any efforts to modify current trends will require clear incentives, such as through carbon finance. We speculate on the nature of such incentive schemes and the possibility of rewarding the provision of ecosystem services at a landscape scale and in a socially equitable manner.

Policy brief on the current status of certification of electronic Health Records in the US and Europe.

PubMed

De Moor, Georges; O'Brien, John; Fridsma, Doug; Bean, Carol; Devlies, Jos; Cusack, Caitlin M; Bloomrosen, Meryl; Lorenzi, Nancy; Coorevits, Pascal

2011-01-01

If Electronic Health Record systems are to provide an effective contribution to healthcare, a set of benchmarks need to be set to ensure quality control and interoperability of systems. This paper outlines the prevailing status of EHR certification in the US and the EU, compares and contrasts established schemes and poses opportunities for convergence of activity in the domain designed to advance certification endeavours generally. Several EU Member States have in the past proceeded with EHR systems quality labeling and/or certification, but these differ in scope, in legal framework under which they operate, in policies (legislation and financial incentives), in organization, and perhaps most importantly in the quality criteria used for benchmarking. Harmonization, therefore, became a must. Now, through EuroRec (with approaches ranging from self-assessment to third party certification depending on the level of confidence needed) and its Seals, the possibility to achieve this for EHR systems has started in the whole of Europe. The US HITECH Act also attempts to create incentives for all hospitals and eligible providers to adopt and use electronic information. A centerpiece of the Act is to put in place strong financial incentives to adopt and meaningfully use EHRs. The HHS/EHR Certification Programme makes use of ISO/IEC 170XX standards for accreditation, testing and certification. The approved test method addresses the functional and the interoperability requirements defined in the Final Rule criteria and standards. To date six Authorized Testing and Certification Bodies (ATCBs) are testing and certifying products in the US.

Insights on the effectiveness of reward schemes from 10-year longitudinal case studies in 2 Italian regions.

PubMed

Vainieri, Milena; Lungu, Daniel Adrian; Nuti, Sabina

2018-01-30

Pay for performance (P4P) programs have been widely analysed in literature, and the results regarding their impact on performance are mixed. Moreover, in the real-life setting, reward schemes are designed combining multiple elements altogether, yet, it is not clear what happens when they are applied using different combinations. To provide insights on how P4P programs are influenced by 5 key elements: whom, what, how, how many targets, and how much to reward. A qualitative longitudinal analysis of 10 years of P4P reward schemes adopted by the regional administrations of Tuscany and Lombardy (Italy) was conducted. The effects of the P4P features on performance are discussed considering both overall and specific indicators. Both regions applied financial reward schemes for General Managers by linking the variable pay to performance. While Tuscany maintained a relatively stable financial incentive design and governance tools, Lombardy changed some elements of the design and introduced, in 2012, a P4P program aimed to reward the providers. The main differences between the 2 cases regard the number of targets (how many), the type (what), and the method applied to set targets (how). Considering the overall performance obtained by the 2 regions, it seems that whom, how, and how much to reward are not relevant in the success of P4P programs; instead, the number (how many) and the type (what) of targets set may influence the performance improvement processes driven by financial reward schemes. © 2018 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

The Effect of Performance-Based Financial Incentives on Improving Health Care Provision in Burundi: A Controlled Cohort Study

PubMed Central

Rudasingwa, Martin; Soeters, Robert; Bossuyt, Michel

2015-01-01

To strengthen the health care delivery, the Burundian Government in collaboration with international NGOs piloted performance-based financing (PBF) in 2006. The health facilities were assigned - by using a simple matching method - to begin PBF scheme or to continue with the traditional input-based funding. Our objective was to analyse the effect of that PBF scheme on the quality of health services between 2006 and 2008. We conducted the analysis in 16 health facilities with PBF scheme and 13 health facilities without PBF scheme. We analysed the PBF effect by using 58 composite quality indicators of eight health services: Care management, outpatient care, maternity care, prenatal care, family planning, laboratory services, medicines management and materials management. The differences in quality improvement in the two groups of health facilities were performed applying descriptive statistics, a paired non-parametric Wilcoxon Signed Ranks test and a simple difference-in-difference approach at a significance level of 5%. We found an improvement of the quality of care in the PBF group and a significant deterioration in the non-PBF group in the same four health services: care management, outpatient care, maternity care, and prenatal care. The findings suggest a PBF effect of between 38 and 66 percentage points (p<0.001) in the quality scores of care management, outpatient care, prenatal care, and maternal care. We found no PBF effect on clinical support services: laboratory services, medicines management, and material management. The PBF scheme in Burundi contributed to the improvement of the health services that were strongly under the control of medical personnel (physicians and nurses) in a short time of two years. The clinical support services that did not significantly improved were strongly under the control of laboratory technicians, pharmacists and non-medical personnel. PMID:25948432

Captivate: Building Blocks for Implementing Active Learning

ERIC Educational Resources Information Center

Kitchens, Brent; Means, Tawnya; Tan, Yinliang

2018-01-01

In this study, the authors propose a set of key elements that impact the success of an active learning implementation: content delivery, active learning methods, physical environment, technology enhancement, incentive alignment, and educator investment. Through a range of metrics the authors present preliminary evidence that students in courses…