Effectiveness of Financial Incentives for Health Behavior Change: A Narrative Review and Analysis.

BackgroundUnderstanding how medical students respond to financial and non-financial incentives is crucial for recruiting health workers and attracting health talents in medical education. However, both incentives are integrated in working practice, and existing theoretical studies have suggested that various income levels may influence the substitution effect of both incentives, while the empirical evidence is lacking. Furthermore, little attention has been paid to the intrinsic motivation. This study aimed to explore the substitution effect of extrinsic incentives at different income levels, also taking intrinsic altruism into account.MethodsWe used the behavioral data from Zhang et al.’s experiments, which involved discrete choice experiments (DCEs) to assess the job preferences of medical students from six teaching hospitals in Beijing, China. The incentive factors included monthly income, work location, work environment, training and career development opportunities, work load, and professional recognition. Additionally, a lab-like experiment in the medical decision-making context was conducted to quantify altruism based on utility function. Furthermore, we separated the choice sets based on the actual income and distinguished the medical students on altruism. The willingness to pay (WTP) was used to estimate the substitution effect of incentives through conditional logit model.ResultsThere was a significant substitution effect between non-financial and financial incentives. As income increased, non-financial incentives such as an excellent work environment, and sufficient career development became relatively more important. The impact of the increase in income on the substitution effect was more pronounced among individuals with higher altruism. Concerning the non-financial incentive work environment, in contrast to the growth of 546 CNY (84 USD) observed in the low-altruism group, the high-altruism group experienced a growth of 1040 CNY (160 USD) in the substitution effect.ConclusionsThe increase in the income level exerted an influence on the substitution effect of non-financial incentives and financial incentives, especially in high-altruism medical students. Policymakers should attach importance to a favorable environment and promising career prospects on the basis of ensuring a higher income level. Medical school administrations should focus on promoting altruistic values in medical education, enhancing talent incentives and teaching strategies to encourage medical students to devote themselves to the medical professions.

Introduction & Objective: To assess the effectiveness of financial and social incentives using behavioral economics to improve glycemic control in patients with newly diagnosed type 2 diabetes. Methods: We conducted a pragmatic randomized clinical trial with a 6-month intervention period from June 2021 to December 2023. Adults with newly diagnosed type 2 diabetes (glycated hemoglobin [HbA1c] 48-75 mmol/mol) were recruited at public primary care clinics. Participants were randomly assigned to three groups to incentivize physical activity: financial incentive, financial and social incentive, and control. Participants in the incentive groups received personalized weekly step targets along with loss-framed financial incentives starting at $128 USD. Participants lost $5 USD each week if their step target was not met. For the social incentive, participant weekly step performance was shared with their nominated supporters to provide peer encouragement. Intent-to-treat analysis using weighted generalized estimating equations (WGEE) was performed to assess changes in HbA1c. ClinicalTrials.gov identifier: NCT0491792. Results: Among 104 adults newly diagnosed with type 2 diabetes, the mean age was 55.0 (53.9% female). Median baseline HbA1c for the financial incentive, financial and social incentive, and control group was 51.9, 53.0, and 50.8mmol/mol respectively. While step count increased, participants in the financial incentive group had a non-significant decrease in HbA1c (-0.8 mmol/mol) and no improvement in the financial and social incentive group compared to the control group. Conclusion: The interventions using financial and social incentives had no significant impact on improving HbA1c in patients newly diagnosed with type 2 diabetes. Disclosure W. Lai: None. J. Ye: None. C.S. Ng: None. J. Quan: None. Funding Research Grants Council of the Hong Kong Special Administrative Region, China [17607619]

Individuals’ preference for financial over social incentives for medication adherence

This study aims to determine the effect of financial and non-financial incentives on employee motivation, and the effect of financial and non-financial incentives simultaneously on CV. Sinar Telekom Regency. This research method is descriptive quantitative. The sample in this study amounted to 47 respondents who were distributed to employees of CV. Sinar Telekom Lahat Regency. Data analysis method used is quantitative analysis using validity test, reliability test, normality test, multiple linear regression analysis and average difference test. The results showed that financial incentives had a positive and significant effect on work motivation. This can be seen from the t count > t table (4.793 > 2.015). Non-financial incentives have a positive and significant effect on employee motivation, this can be seen from the t count > t table (2.356 > 2.015). And financial incentives and non-financial incentives simultaneously have a positive and significant effect on employee motivation. This can be seen from the calculated F value > F table (44.227 > 3.23) and the significance value < significance level (α) 0.05 (0.000 <0.05). In conclusion, financial incentives have a positive and significant effect on work motivation. Non-financial incentives have a positive and significant effect on employee motivation. Financial incentives and non-financial incentives simultaneously have a positive and significant effect on employee motivation.
 
 Keywords: Financial Incentives, Non-Financial Incentives, Work Motivation

This paper studies the effects of financial and non-financial incentives on job tenure of academics in Jordanian universities. The purpose of this research is to help Jordanian universities find solutions to the job tenure challenge that they face and to explore the role of incentives in job tenure. The study follows the incentives typology of Buchan and incentives are divided into two categories; financial incentive, including salary, other direct financial incentives, and indirect financial incentives, and non-financial incentives including training and education, recreational facilities, occupational health, and flexible working hours, breaks, and sabbatical. Job tenure is measured by the period that the questionnaire respondents were working with the current employers. The study considers two hypotheses and two questions to test the effect of incentives on job tenure. Results show that financial and non-financial incentives had positive significant effects on job tenure. The study recommends universities in Jordan to pay more attention to incentive given to their academics when they aim to increase job tenure.

General Background: Employee productivity is a crucial determinant of organizational success, with incentives serving as a key motivational tool in human resource management. Specific Background: While financial and non-financial incentives are widely recognized as productivity drivers, their effectiveness in small businesses, particularly in the Indonesian context, remains underexplored. Knowledge Gap: Prior research primarily focuses on large enterprises, neglecting how incentive structures function in small-scale industries. Aims: This study examines the impact of financial and non-financial incentives, along with job satisfaction, on employee productivity at UD. Budi Karya Jarorejo, Kerek, Tuban. Results: Multiple linear regression analysis indicates that financial incentives significantly influence productivity (β = 0.4736, p = 0.000), while non-financial incentives have a smaller yet significant effect. Job satisfaction, however, does not show a significant correlation. The model explains 94.7% of productivity variance (R² = 0.947). Novelty: Unlike previous studies, this research focuses on the unique dynamics of small enterprises, emphasizing the role of contextual and managerial factors in incentive effectiveness. Implications: Findings suggest that transparent, performance-based incentive policies can optimize workforce productivity in small businesses, providing insights for managerial decision-making in similar organizational settings.Highlights: Financial incentives are the primary driver of employee productivity, showing a significant positive impact, while non-financial incentives have a smaller but still notable effect. Job satisfaction alone does not significantly influence productivity, highlighting the need for well-structured incentive programs rather than relying solely on workplace satisfaction. Transparent and performance-based incentive policies are crucial, especially in small businesses, to ensure fairness, motivation, and sustained productivity improvements. Keywords: Financial Incentives, Non-Financial Incentives, Job Satisfaction, Employee Productivity, Multiple Linear Regression.

The purpose of this study is to examine the effect of financial and non-financial incentives on job satisfaction, which are used in food chain premises; and to indicate the difference of employee attitudes related to job satisfaction and incentives on some demographical variables. The questionnaires prepared for this purpose are applied to eleven employees at food premises, which are currently working in food sector in Central Anatolian Region in Turkey. The data obtained from the research are analyzed via several techniques by using SPSS 15.0 program. According to the results of the analysis, a significant relation is observed between the financial and non-financial incentives and the job satisfaction of employees. When these relations are compared, the result is that the attitudes towards financial incentives have a stronger effect on job satisfaction than the attitudes towards non-financial incentives. Besides, the differences among some demographical variables (union membership, gender, income level) and the attitudes towards these incentives and job satisfaction levels are tested. This research plays an important role to provide significant data for strategical administrative institutions of food chain premises in terms of financial and non-financial incentives, job satisfaction and some demographical characteristics of the employees.

NOTE: THIS ARTICLE WAS PUBLISHED WITH THE INFORMING SCIENCE INSTITUTE. Aim/Purpose................................................................................................................................................................................................. The Malaysian government has given numerous incentives to small and medium enterprises (SMEs), including those in the food manufacturing sector, in an attempt to boost their performance. This study aims to assess the effects of these incentives, particularly financial and tax incentives, on the performance of SMEs in the Malaysian food manufacturing sector. Background................................................................................................................................................................................................. Millions of Ringgit has been allocated for the development of SMEs by the Malaysian government. The findings of this study aim to assist the policymakers in improving the current policies in incentive give outs to enhance the effectiveness and reduce the number of SMEs that were forced to close down in less than five years of operation. Methodology................................................................................................................................................................................................. The study was conducted using structure, conduct, and performance (SCP) paradigm on secondary data from 140 companies over a period of five years (2013 – 2017). Correlation analysis was done to explore the relationship between each explanatory market variables included in the SCP paradigm. Contribution................................................................................................................................................................................................. This study provides insights into the effect of different types of government incentives on the performance of SMEs in the Malaysian food manufacturing sector. Findings....................................................................................................................................................................................................... The study found that financial and tax incentives gave different effects on the performance of SMEs in the Malaysian food manufacturing sector during the study period. Financial incentive shows a weak positive significant correlation with advertising-to-sales ratio (ASR), return on assets (ROA) and market share (MS) ratio while showing negative significant correlation towards capital intensity (CAP). On the other hand, tax incentive shows a strong significant positive correlation with MS and weak significant positive correlation with CAP, ROA and return on sales (ROS). This shows that financial incentive strongly correlates with SMEs’ performance, whereas tax incentive is associated with market structure and conduct of SMEs in the Malaysian food manufacturing sector. Recommendations for Practitioners............................................................................................................................................................ Firstly, the government should consider providing extra assistance to SMEs in entering the sector as entry barriers for the sector is relatively high. Focus can be given in increasing financial incentives at a more competitive rate as it can reduce debt or increase the firm’s equity or aid firms in acquiring assets, which are crucial for efficient and effective production of processed food. Allocation of tax incentives should be reviewed as it does not have a strong correlation with firms’ performance. Recommendation for Researchers............................................................................................................................................................... There are limitations to the number of SMEs included in this study. Hence, researchers are recommended to have direct contact with more firms to ensure more accurate data. Impact on Society........................................................................................................................................................................................... With more efficient and effective policies in the government’s financial and tax incentives, more allocation can be channeled to other areas that have direct implications to the citizen. Additionally, with better policies, more jobs will be created in the market, and a highly competitive market will lead to a production of higher quality products that can be enjoyed by the consumers. Future Research............................................................................................................................................................................................... This study has contributed to the SCP paradigm as it demonstrated the effects of government financial and tax incentives on the market structure, conduct, and performance of SMEs in the Malaysian food manufacturing sector. Future researches might focus on non-financial incentives given out by the government such as human resource development, training, industrial infrastructure and amenities, technology development and capabilities, technology transfer, and organizational innovation.

BackgroundFinancial incentives have been used to increase physical activity. However, the benefit of financial incentives is lost when an intervention ends. Thus, for this study, we combined social network incentives that leverage the power of peer pressure with financial incentives. Few reports have examined the impact of physical activity on social capital. Therefore, the main goal of this study was to ascertain whether a combination of two incentives could lead to more significant changes in physical activity and social capital during and after an intervention.MethodsThe participants were 39 older women over 65 years of age in Kumamoto, Japan. The participants were randomly divided into a financial incentive group (FI group) and a social network incentive plus financial incentive group (SNI + FI group). Both groups underwent a three-month intervention. Measurements of physical activity and social capital were performed before and after the intervention. Additionally, the effects of the incentives on physical activity and social capital maintenance were measured 6 months postintervention. The financial incentive group received a payment ranging from US$4.40 to US$6.20 per month, depending on the number of steps taken during the intervention. For the other group, we provided a social network incentive in addition to the financial incentive. The SNI + FI group walked in groups of three people to use the power of peer pressure.ResultsA two-way ANOVA revealed that in terms of physical activity, there was a statistically significant interaction between group and time (p = 0.017). The FI group showed no statistically significant improvement in physical activity during the observation period. In terms of the value of social capital, there was no significant interaction between group and time.ConclusionOur results suggest that social network incentives, in combination with financial incentives, are more effective for promoting physical activity than financial incentives alone among older women and that these effects can continue after an intervention. In the meantime, further studies should be conducted on the effect of physical activity on social capital.Trial registrationUMIN000038080, registered on 09/22/2019 (Retrospectively registered).

This research was conducted at PT. Rismawan Pratama Bersinar, Sukabumi. In this study using two independent variables namely financial incentives as (X1) and non-financial incentives as (X2) and work motivation as the dependent variable (Y) which has the purpose of knowing: (1) the effect of financial incentives on employee work motivation, (2) the effect of non-financial incentives on employee work motivation, and (3) the effect of financial incentives and non-financial incentives on employee work motivation. The research method in this study is a survey method using a questionnaire distributed to all employees of PT. Rismawan Pratama Bersinar as research respondents totaling 63 people. Quality testing techniques used by researchers are by testing validity and reliability. For data analysis techniques using descriptive analysis, while to test the hypothesis the researcher uses multiple linear regression, partial test and simultaneous test. The results of the calculation of the data that has been processed using the SPSS 25 program shows that (1) financial incentives has a positive and significant effect on work motivation, (2) non-financial incentives has a negative and significant effect on work motivation, and (3) simultaneously financial and non-financial incentives have a positive and significant effect on the work motivation of employees of PT. Rismawan Pratama Bersinar, Sukabumi.

Expanding directly observed therapy: tuberculosis to human immunodeficiency virus

Cardiovascular diseases (CVDs) is a leading cause of death globally, accounting for approximately one-third of all deaths worldwide. Preventive therapy including combination therapy with aspirin, blood pressure, serum cholesterol-lowering, or diabetes medications is effective in reducing risk by as much as an estimated 80% when adherence to treatment is very high. However, among adults with CVD risk factors such as diabetes or hypertension, between 30% and 50% of medications are not taken as prescribed.1 Adherence is defined by the World Health Organization as the extent to which a person's behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed upon recommendations from a healthcare provider.2 Poor adherence decreases the effectiveness of evidence-based prevention therapies and is associated with increased morbidity and mortality.3 In addition, poor medication adherence represents a significant source of wasteful healthcare spending. An estimated $100 billion is spent annually on US healthcare services that are directly related to poor medication adherence.3 Poor adherence is pervasive and must be addressed by all members of the cardiovascular prevention team, across the care continuum. The causes of poor adherence are myriad and complex with contributing factors at the patient, provider, and health system levels. Patient barriers to adherence include multiple comorbid conditions requiring complex medication regimens, convenience factors (eg, dosing frequency), health beliefs, behavioral factors and issues with treatment of asymptomatic diseases (eg, treatment side effects), resource constraints and high out-of-pocket costs, suboptimal health literacy, and lack of involvement in the treatment decision-making process. Provider barriers include prescription of complex drug regimens, communication barriers, ineffective communication of information about adverse effects, and poor care coordination. Health system barriers include office visit time limitations; limited access to care, prescription refills, or pharmacies; lack of team-based approaches; and inadequate health information technology. Because barriers to medication adherence are complex, solutions to improve adherence may be introduced at patient, provider, and/or healthcare system levels.4–6 Assessing Medication Adherence Assessment of medication adherence can be direct (ie, directly observed therapy, measurement of serum levels) or indirect (ie, pill count, measurement scales, pharmacy records). Measurement scales commonly used in research and practice to assess self-reported medication adherence include the Morisky Medication Adherence Scale,7 Hill-Bone Compliance to High Blood Pressure Therapy Scale,8 the Brief Medication Questionnaire,9 and the Krousel-Wood Medication Adherence Scale-4.10 Although these assessment instruments have relatively high internal validity, they may overestimate adherence because of their reliance on self-report. Electronic monitoring systems objectively assess medication adherence. An example is the Medication Event Monitoring System (Aardex, CH); microelectronics embedded in pill caps record the date and time when containers were opened and closed. Similar to the Medication Event Monitoring System is the Intelligent Drug Administration System, which records the date and hour that a drug was removed from blister packs.11 Major limitations include the inability of these systems to measure actual pill consumption and the limited practicality of their use in low-resource settings. Two measures of adherence using prescription-claims data are the proportion of days covered (PDC) and medication possession ratio. The PDC is endorsed by the Pharmacy Quality Alliance as a high-quality measure of medication adherence, and the threshold of greater than 80% produces the most clinical benefit for a given medication.12 The PDC is the ratio of the number of days the patient is covered by the medication divided by the number of days the patient is eligible to have the medication on hand. The medication possession ratio is calculated as the ratio of the number of days for which a patient has medication on hand divided by the total number of days in the observed period. Interventions and Toolkits to Improve Medication Adherence No single strategy has proven to be the panacea for improving medication adherence. Rather, a combination of interventions that address patient-, provider-, and system-level barriers is more likely to be effective. Interventions that have been demonstrated to improve medication adherence in CVD prevention are listed in Table 1, with a summary of recent evidence supporting these interventions provided hereinafter.TABLE 1: Medication Adherence Interventions in Patients With Cardiovascular DiseasesTailored Patient Education It is essential to educate patients about the importance of adhering to prescribed medications. An informed patient is better able to collaborate to establish shared goals of therapy and a plan of care. Compared with education delivered in a single session, educational interventions that incorporate follow-up sessions are generally more effective and lead to sustained behavior change.14 In Nieuwkerk et al's15 nurse-led clinical trial of 201 patients who were newly prescribed statins, an educational intervention that consisted of a "personalized risk factor passport" and was tailored to the patient's risk for CVD resulted in significant improvement in statin adherence and reduction in patient anxiety. Other interventions that have used telephone counseling delivered by nurses or trained educators have demonstrated success in reducing hemoglobin A1c levels16 and increased refill adherence.17 Meducation, an innovative health literacy tool that includes a medication calendar and customized education written at a sixth-grade reading level, improved self-reported medication adherence, although the effect was small in this pilot study.18 The authors of these studies suggest that healthcare providers who delivered tailored education on CVD risk reduction and reinforce education at an appropriate literacy level are more likely to be successful in improving cardiovascular outcomes. Fixed-Dose Combination Therapy Fixed-dose combination therapy, also known as single pill combinations, has recently been recognized as a best practice to improve hypertension control globally. The World Health Organization added fixed-dose combination antihypertensive medications to the World Health Organization Essential Medicines List in July 2019.19 A systematic review of dual combination vs monotherapy as initial therapy, including 33 trials with more than 10 000 participants, showed a 27% increase in the rate of achieving blood pressure control among patients receiving dual combination therapy.20 Providers should consider prescribing combination therapy where appropriate to reduce patient burden and improve control of cardiovascular conditions. Mobile Health Applications Mobile phones provide a patient-centered strategy for addressing medication adherence because of the ubiquitous nature of smartphones and the ability to send alerts to take medications, track doses, and provide appropriate medication instructions. A recent systematic review21 of mobile health (mhealth) applications targeting medication adherence identified 704 applications with different features. Of those, 20 applications were identified through a quality assessment focused on behavioral strategies to enhance medication adherence through alerts, reminders, and logs; these were available in English, German, Spanish, French, Japanese, Russian, and Traditional Chinese. The MediSAFE-BP trial evaluated the impact of the Medisafe mhealth application on medication adherence and blood pressure control. The study authors found a slight increase in medication adherence in the intervention group after 12 weeks (between-group difference, 0.4 points in the Morisky Medication Adherence Scale; P = .01), but there was no corresponding improvement in blood pressure control.22 Although mobile apps offer promise, the evidence of meaningful impact on adherence and CVD risk factor management is limited, and mhealth applications have the downsides of consumer costs and limited trial periods. Automatic Home Medication Dispenser To address the technology gap for medication reminders especially for older adults, products such as the automatic home medication dispenser (AHMD) integrated with a smartphone application have been developed. The AHMD differs from other in-home medication dispensers because it can hold up to 90 day's supply of several medications and includes the following components to address cognitive impairment and age-related changes: counter, clock, dispensing mechanism, power source, input/output interface, locking system, transceiver and antenna, and physical indicator for alarms. Other functionalities include notifying the user of due dosage per set dosage time or due refills through audio/visual reminders and notifying the caregiver of missing dosages through calls or text messages. In a recent study,23 use of an AHMD (MedaCube) significantly increased adherence from 49% at baseline to 97% after 6 months. Although AHMD is an emergent strategy to improve medication adherence, the cost of these devices may be prohibitive in lower-income populations and low-resource settings. Incentives Incentive-based medication adherence interventions have been demonstrated to be promising in several studies. Incentives such as a significant reduction in copayment have been associated with improved medication adherence.24 However, the reduced copayment incentives may not be applicable in some low- and middle-income countries where the health systems are not insurance based. Other incentive-based interventions have been in the form of cash, vouchers, gift cards, meals and food packages, clothing, and travel reimbursements for compliance to clinic visits and medication refills, although effectiveness has been inconsistent.25 A recent scoping review26 concluded that financial incentives were the most common behavioral economic intervention and the provision of physician-patient financial incentives was more effective in improving medication adherence than the provision of financial incentives to either physicians or patients alone. Table 2 displays 4 medication adherence toolkits designed to support health professionals and educators. These toolkits offer best practices and resources for (1) assessing medication adherence, (2) improving medication adherence through the use of aids, (3) empowering patients to improve medication adherence, and (4) resolving barriers to medication adherence.TABLE 2: Medication Adherence ToolkitsConclusion Medication adherence can be assessed and improved within the context of CVD prevention in the clinic, community, and home. However, improving medication adherence requires coordination and building on evidence-based strategies in practice and policy actions in both the public and private sectors. Using care coordination strategies, patient engagement and medication management tools can significantly improve medication adherence. Improving medication adherence also requires investments in health information technology and financial incentives for patients and providers. Innovations in drug delivery systems that offer a more holistic approach to managing adherence to drug therapy may help to alleviate the burden on patients.

BackgroundThe World Health Organization recommends that community health workers (CHWs) receive a mix of financial and non-financial incentives, yet notes that there is limited evidence to support the use of one type of incentive (i.e. financial or non-financial) over another. In preparation for a larger scale trial, we investigated the acceptability and feasibility of two different forms of incentives for CHWs in Malang District, Indonesia.MethodsCHWs working on a cardiovascular disease (CVD) risk screening and management programme in two villages were assigned to receive either a financial or non-financial incentive for 6 months. In the financial incentives village, CHWs (n = 20) received 16,000 IDR (USD 1.1) per patient followed up or 500,000 IDR (USD 34.1) if they followed up 100% of their assigned high-risk CVD patients each month. In the non-financial incentive village, CHWs (n = 20) were eligible to receive a Quality Care Certificate for following up the highest number of high-risk CVD patients each month, awarded in a public ceremony. At the end of the 6-month intervention period, focus group discussions were conducted with CHWs and semi-structured interviews with programme administrators to investigate acceptability, facilitators and barriers to implementation and feasibility of the incentive models. Data on monthly CHW follow-up activity were analysed using descriptive statistics to assess the preliminary impact of each incentive on service delivery outcomes, and CHW motivation levels were assessed pre- and post-implementation.ResultsFactors beyond the control of the study significantly interrupted the implementation of the financial incentive, particularly the threat of violence towards CHWs due to village government elections. Despite CHWs reporting that both the financial and non-financial incentives were acceptable, programme administrators questioned the sustainability of the non-financial incentive and reported CHWs were ambivalent towards them. CHW service delivery outcomes increased 17% for CHWs eligible for the non-financial incentive and 21% for CHWs eligible for the financial incentive. There was a statistically significant increase (p < 0.0001) in motivation scores for the performance domain in both villages.ConclusionIt was feasible to deliver both a performance-based financial and non-financial incentive to CHWs in Malang District, Indonesia, and both incentive types were acceptable to CHWs and programme administrators. Evidence of preliminary effectiveness also suggests that both the financial and non-financial incentives were associated with improved motivation and service delivery outcomes. These findings will inform the next phase of incentive design, in which incentive feasibility and preliminary effectiveness will need to be considered alongside their longer-term sustainability within the health system.

How do we close the intention–behavior gap?

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