Focusing Provider Attention: An Empirical Examination of Incentives and Feedback in Flu Vaccinations

Abstract

Background: Interest in a vaccine for the novel coronavirus soared over the course of 2020, but how will the public respond when a vaccine becomes available? Consider that between 2010 and 2019 the adult flu vaccination rate fluctuated between 37% and 46% despite calls to vaccinate everyone. This led to estimated, average annual societal costs for influenza in the US of $10.4 billion in direct medical costs and $16.3 billion in lost earnings. Aim: In this paper, we explore how to improve clinic vaccination rates by altering provider behavior.Methodology: We study a randomized flu vaccine intervention among 145 independent clinics, where a provider-centric approach leads to an increase in flu shots. Results: Our study led to a 12% increase in flu shots for a group of clinics receiving relative performance feedback. Surprisingly, we find clinics in this group outperformed all others, including financially incented clinics. Moreover, we also find clinics in this group exhibit rank response behavior, specifically Last-Place Aversion; in particular, clinics near Last-Place outperform the corresponding control clinics by 23 percentage points. Conclusion: Overall, we find that clinic-level performance feedback can be an effective driver of operational change, and we discuss the implications of our work for healthcare operations theory, healthcare providers, and healthcare administrators.