Financial Incentive Schemes Research Articles

Effect of a Financial Incentive Scheme for Medication Review on Polypharmacy in Elderly Inpatients With Dementia: A Retrospective Before-and-After Study.

Polypharmacy is an important healthcare issue, especially in elderly patients with dementia. As an incentive to reduce polypharmacy, a health insurance reimbursement scheme was introduced in 2016 for medication review and the reduction of medications for inpatients in Japan. However, the effects of these incentive schemes were not evaluated. We identified 1,465,881 inpatients aged ≥65 years with dementia. An interrupted time-series analysis was conducted by fitting a Prais-Winsten linear regression model. The outcome measure was the number of classes of medications prescribed during discharge. No significant changes were observed in the average number of medication classes at discharge immediately after the introduction of the scheme (coefficient: -0.022, 95% confidence interval [CI]: -0.17 to 0.13). The slope change, representing the effect of the intervention over time, was also not significant (coefficient: -0.00053, 95% confidence interval: -0.0012 to 0.00018). The incentive scheme was not associated with a reduction in the number of medication classes at discharge among older inpatients with dementia.

Evaluation of a financial incentive intervention on malaria prevalence among the residents in Lake Victoria basin, Kenya: study protocol for a cluster-randomized controlled trial

BackgroundIn the Lake Victoria basin of western Kenya, malaria remains highly endemic despite high coverage of interventions such as mass distribution of long-lasting insecticidal nets (LLIN), indoor residual spraying (IRS) programs, and improvement of availability and accessibility of rapid diagnostic tests (RDT) and artemisinin-based combination therapy (ACT) at community healthcare facilities. We hypothesize that one major cause of the residual transmission is the lack of motivation among residents for malaria prevention and early treatment.MethodsThis study will aim to develop a demand-side policy tool to encourage local residents’ active malaria prevention and early treatment-seeking behaviors. We examine the causal impact of a financial incentive intervention complemented with malaria education to residents in malaria-prone areas. A cluster-randomized controlled trial is designed to assess the effect of the financial incentive intervention on reducing malaria prevalence in residents of Suba South in Homa Bay County, Kenya. The intervention includes two components. The first component is the introduction of a financial incentive scheme tied to negative RDT results for malaria infection among the target population. This study is an attempt to promote behavioral changes in the residents by providing them with monetary incentives. The project has two different forms of incentive schemes. One is a conditional cash transfer (CCT) that offers a small reward (200 Ksh) for non-infected subjects during the follow-up survey, and the other is a lottery incentive scheme (LIS) that gives a lottery with a 10% chance of winning a large reward (2000 Ksh) instead of the small reward. The second component is a knowledge enhancement with animated tablet-based malaria educational material (EDU) developed by the research team. It complements the incentive scheme by providing the appropriate knowledge to the residents for malaria elimination. We evaluate the intervention’s impact on the residents’ malaria prevalence using a cluster-randomized control trial.DiscussionA policy tool to encourage active malaria prevention and early treatment to residents in Suba South, examined in this trial, may benefit other malaria-endemic counties and be incorporated as part of Kenya’s national malaria elimination strategy.Trial registrationUMIN000047728. Registered on 29th July 2022.

Exploring the influence of a financial incentive scheme on early mobilization and rehabilitation in ICU patients: an interrupted time-series analysis

BackgroundClinical guidelines recommend early mobilization and rehabilitation (EMR) for patients who are critically ill. However, various barriers impede its implementation in real-world clinical settings. In 2018, the Japanese universal healthcare coverage system announced a unique financial incentive scheme to facilitate EMR for patients in intensive care units (ICU). This study evaluated whether such an incentive improved patients’ activities of daily living (ADL) and reduced their hospital length of stay (LOS).MethodsUsing the national inpatient database in Japan, we identified patients admitted to the ICU, who stayed over 48 hours between April 2017 and March 2019. The financial incentive required medical institutions to form a multidisciplinary team approach for EMR, development and periodic review of the standardized rehabilitation protocol, starting rehabilitation within 2 days of ICU admission. The incentive amounted to 34.6 United States Dollars per patient per day with limit 14 days, structured as a per diem payment. Hospitals were not mandated to provide detailed information on individual rehabilitation for government, and the insurer made payments directly to the hospitals based on their claims. Exposure was the introduction of the financial incentive defined as the first day of claim by each hospital. We conducted an interrupted time-series analysis to assess the impact of the financial incentive scheme. Multivariable radon-effects regression and Tobit regression analysis were performed with random intercept for the hospital of admission.ResultsA total of 33,568 patients were deemed eligible. We confirmed that the basic assumption of ITS was fulfilled. The financial incentive was associated with an improvement in the Barthel index at discharge (0.44 points change in trend per month; 95% confidence interval = 0.20–0.68) and shorter hospital LOS (− 0.66 days change in trend per month; 95% confidence interval = − 0.88 – -0.44). The sensitivity and subgroup analyses showed consistent results.ConclusionsThe study suggests a potential association between the financial incentive for EMR in ICU patients and improved outcomes. This incentive scheme may provide a unique solution to EMR barrier in practice, however, caution is warranted in interpreting these findings due to recent changes in ICU care practices.

Designing Diversity-aware Sustainable Mobility Policies in Social Networks: a Data-driven Approach

To maximize the efficacy of governmental measures promoting electric vehicles (EVs) adoption, a careful consideration of socio-economic factors that influence EV acceptance is imperative. To do so within a diversity-aware approach, we present a data-driven framework to capture key individual elements driving EV adoption and design effective promotion policies that take such elements into account. Specifically, based on UK survey data, we construct a socio-economic characterization of individual attitudes towards EV adoption (the EV-DNA) and use it to shape interactions within a London-based social network. Employing optimal control and reinforcement learning, we evaluate strategies for promoting EV within the network, leveraging the reciprocal influence between the individuals themselves. The simulation results highlight the efficacy of implementing customized policies targeting social dimensions, thus going beyond the pure financial incentive schemes that are commonly adopted by several governments worldwide.

Stakeholder perceptions of the benefits and barriers of implementing environmental management systems in the Maldivian construction industry

Unprecedented increases in both tourism and population growth have put extreme pressure on the Republic of the Maldives, which has resulted in significant changes to the islands as a result of construction activities. This study is the first to investigate perceptions of the benefits and barriers of implementing environmental management systems (EMS) in the Maldivian construction industry, and what effective measures and strategies exist to drive environmental management practices. A subjectivist stance and deductive approach have been taken with an online survey adopting a quantitative strategy with a range of construction professions across the Maldivian construction sector. Using a central tendency measure of weighted average, the respondents’ opinions suggest that the primary benefits of having an EMS in the Maldives are perceived as the enhancement of corporate image and environmental protection; while the major barriers are lack of legal enforcement and the requirement for company structures and policies to change to accommodate an EMS. The findings also suggest that those companies who establish a waste management plan and where authorities enforce legal environmental requirements are believed to be the most effective means to encourage more widespread adoption. Based on these findings, it is recommended that managers, need to increasingly promote the principles of environmental management and sustainable practices/behaviours amongst construction industry stakeholders. Furthermore, policy makers within the Maldives should be exploring the viability of establishing financial incentive schemes (particularly for SMEs), in addition to encouraging wider adoption of EMSs across the Maldivian industry sectors.

Analysing Citizen-centric Administration in the Context of Assam with Special Reference to Assam Chah Bagicha Dhan Puraskar Scheme

Citizen-centric administration is one of the significant components of good governance. Public administration in India has been trying to provide different measures for the welfare of marginalised and disadvantaged sections of the society. Tea-garden workers of Assam are significantly in a disadvantaged position since the colonial period. Low wages, poverty, illiteracy and poor socio-economic conditions of the tea-garden workers of Assam have further pushed them into a marginalised state. Therefore, the Government of Assam has adopted different welfare mechanisms for the upliftment of the tea-garden workers of the State. It is in this context that the present study tries to analyse the role of the Assam Chah Bagicha Dhan Puraskar Scheme (Tea Garden Financial Incentive Scheme) primarily aimed at financial inclusion of the tea-garden workers of Assam as a step-forward to citizen-centric administration. This article also highlights the perception and challenges of the tea-garden workers while accessing the financial inclusion measure in their respective tea estates.

Impact of a financial incentive scheme for team-based palliative care in patients with heart failure in Japan: A nationwide database study

BackgroundPalliative care provided to patients with heart failure (HF) are reported to be inadequate. Herein, we examined the impact of the recently introduced financial incentive scheme for team-based palliative care for patients with HF in acute care hospitals in Japan. MethodsUsing a nationwide inpatient database, we identified patients aged ≥65 years with HF who had died between April 2015 and March 2021. Interrupted time-series analyses were used to compare practice patterns in end-of-life care (symptom management and invasive medical procedures within one week before death) before and after the financial incentive scheme issuance in April 2018. ResultsOverall, 53,857 patients in 835 hospitals were eligible. The adoption of the financial incentive was 1.10 to 1.22% after the introduction. There were upward pre-trends in opioid use (+0.11% per month; 95% confidence interval [CI], 0.06 to 0.15) and antidepressant use (+0.06% per month; 95% CI, 0.04 to 0.09). Opioid use showed a downward slope change during the post-period (−0.07% change in trend; 95% CI, −0.13 to −0.01). Intensive care unit stay showed a downward pre-trend (−0.09% per month; 95% CI, −0.14 to −0.04) and upward slope changes during the post-period (+0.12% change in trend; 95% CI, 0.04 to 0.19). Invasive mechanical ventilation showed downward slope changes during the post-period (−0.11% change in trend; 95% CI, −0.18 to −0.04). ConclusionsThe financial incentive scheme for team-based palliative care was rarely adopted and not associated with changes in end-of-life care. Further multifaceted strategies to promote palliative care for HF are warranted.

Impact of a financial incentive scheme on purchase of fruits and vegetables from unorganised retailers in rural India: a cluster-randomised controlled trial.

Inadequate intake of fruits and vegetables is prevalent in rural areas of India, where around 65% of the population reside. Financial incentives have been shown to increase the purchase of fruits and vegetables in urban supermarkets, but their feasibility and effectiveness with unorganised retailers in rural India is unclear. A cluster-randomised controlled trial of a financial incentive scheme involving ∼20% cashback on purchase of fruits and vegetables from local retailers was conducted in six villages (3535 households). All households in three intervention villages were invited to participate in the scheme which ran for three months (February-April 2021), while no intervention was offered in control villages. Self-reported (pre-intervention and post-intervention) data on purchase of fruits and vegetables were collected from a random sub-sample of households in control and intervention villages. A total of 1109 households (88% of those invited) provided data. After the intervention, the weekly quantity of self-reported fruits and vegetables purchased were (i) 18.6kg (intervention) and 14.2kg (control), baseline-adjusted mean difference 4kg (95% CI:-6.4 to 14.4) from any retailer (primary outcome); and (ii) 13.1kg (intervention) and 7.1kg (control), baseline-adjusted mean difference 7.4kg (95% CI: 3.8-10.9) from local retailers participating in the scheme (secondary outcome). There was no evidence of differential effects of the intervention by household food security or by socioeconomic position, and no unintended adverse consequences were noted. Financial incentive schemes are feasible in unorganised food retail environments. Effectiveness in improving diet quality of the household likely hinges on the percentage of retailers willing to participate in such a scheme. This research has been funded by the Drivers of Food Choice (DFC) Competitive Grants Program, which is funded by the UK Government's Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health, USA; however, the views expressed do not necessarily reflect the UK Government's official policies.

Aspiring teachers, financial incentives, and principals’ recruitment practices in hard-to-staff schools

ABSTRACT The crisis of teacher shortages in Anglophone nation states can no longer be ignored as this long-term issue has been compounded by the pandemic. Growing evidence of the challenges of attracting and retaining a teaching workforce is now foregrounded in education policy internationally. This issue provides increased impetus for studying teacher motivations and principal dispositions particularly in relation to roles in hard-to-staff schools that tend to be in disadvantaged or rural communities in terms of how policies are received and enacted. This mixed methods study examined a teacher financial incentive (TFI) scheme aimed at facilitating the appointment of qualified teachers in hard-to-staff government schools in Victoria, Australia. Although evidence of TFI scheme’s effects and effectiveness as a policy solution to teacher shortages is limited, TFI schemes are widespread internationally. Our study shows that while the Victorian TFI scheme resulted in successful appointments for most participating schools, a financial incentive was only one among many other policy settings, personal and professional factors and other motivations informing teachers’ decisions to apply for a TFI position and the recruitment practices of principals.

Effects of a financial incentive scheme for dementia care on medical and long-term care expenditures: A propensity score-matched analysis using LIFE study data.

Japan introduced a financial incentive scheme in April 2016 to improve hospital-based dementia care, but its effectiveness remains unclear. This study aimed to investigate the scheme's impact on medical and long-term care (LTC) expenditures, as well as on changes in care needs levels and daily living independence levels among older persons one year after hospital discharge. We linked medical and LTC claims databases, and retrospectively identified patients who received LTC needs certification and daily living independence assessments in Fukuoka, Japan. Case patients (received care under the new scheme) were those admitted from April 2016 to March 2018, and control patients were those admitted from April 2014 to March 2016 (before the scheme was implemented). Through propensity score matching, we identified 260 case patients and 260 control patients, and compared using t-tests, and chi-square tests. The analyses found no significant differences between the case and control groups in medical expenditure (US$26,685 vs US$24,823, P = 0.37), LTC expenditure (US$16,870 vs US$14,374, P = 0.08), daily living independence level changes (26.5% vs 20.4%, P = 0.12), or care needs level changes (36.9% vs 30%, P = 0.11). The financial incentive scheme for dementia care did not demonstrate any beneficial effects on patients' healthcare expenditures or health conditions. Further studies are needed to examine the scheme's long-term effects.

Comparative Ethics of Modern Payment Models

Comparative Ethics of Modern Payment Models

Designing financial incentives for health behaviour change: a mixed-methods case study of weight loss in men with obesity

AimDesigning financial incentives for health behaviour change requires choices across several domains, including value (the size of the incentive), frequency of incentives, and direction (gain or loss). However, the rationale underlying complex incentive design is infrequently reported. Transparent reporting is important if we want to understand and improve the incentive development process. This paper describes a mixed methods approach for designing financial incentives for health behaviour change which involves stakeholders throughout the design process.Subject and methodsThe mixed methods approach focuses on incentives for weight loss for men with obesity living in areas with high levels of disadvantage. The approach involves: (a) using an existing framework to identify all domains of a financial incentive scheme for which choices need to be made, deciding what criteria are relevant (such as effectiveness, acceptability and uptake) and making choices on each domain on the basis of the criteria; (b) conducting a survey of target population preferences to inform choices for domains and to design the incentive scheme; and (c) making final decisions at a stakeholder consensus workshop.ResultsThe approach was implemented and an incentive scheme for weight loss for men living with obesity was developed. Qualitative interview data from men receiving the incentives in a feasibility trial endorses our approach.ConclusionThis paper demonstrates that a mixed methods approach with stakeholder involvement can be used to design financial incentives for health behaviour change such as weight loss.Trial registration numberNCT03040518. Date: 2 February 2017.

Ghana renewable energy master plan: The benefits of private sector participation

This paper assesses the benefits of private sector participation in the Ghana Renewal Energy Master Plan (REMP) using a stylized Generation Expansion Planning model and concludes with a discussion on a financial incentive that could be offered to private investors to encourage their participation in the REMP. Using cost of electricity provision and level of demand unmet, the paper argues that there is significant benefit in incentivizing the private sector to participate in the REMP especially when the government faces budgetary constraint and unable to meet all electricity demands. Based on its 2016 feed-in-tariff for renewable energy generators and going by its annual investment levels in new generation capacity, Ghana stands to save on average, as much as US$265 million per year in cost of electricity provision along with a reduction in unmet demand by an average of 6.5% if it could attract private investors to participate in the REMP at desired levels. This potential cost savings can serve as the basis for a financial incentive scheme aimed at attracting private sector participation. This research has the tendency to unlock the conundrum of attracting private financing towards energy transition in similar developing economies.

Financial incentives and moral distress in Australian audiologists and audiometrists

Introduction Financial incentive schemes have been commonly used by the hearing aid industry as a way of encouraging device sales. These schemes can lead to a conflict of interest as the hearing device dispenser is torn between personal reward over the best interests of their client. This conflict of interest has the potential for the dispenser to develop “moral distress”, a negative state of mind when an individual’s ethical values contrast with those of the employing organization. The purpose of this study was to investigate if there was a relationship between financial incentives and moral distress in Australian audiologists and audiometrists. Methods An online survey was distributed to all members of Audiology Australia and the Australian College of Audiology via email. Participants rated their perceived moral distress from 0 to 10 on the Moral Distress Thermometer and answered four questions about financial incentives in their respective workplace. Results A total of 65 participants, 42 females and 23 males, completed the online survey. A quarter of participants rated their moral distress corresponding to levels of uncomfortable or above. A statistically significant association was found between financial incentives, sales target setting, and higher perceived moral distress in participants. Conclusions For our sample, the implementation of financial incentives created ethical challenges for practicing audiologists and audiometrists. Modifications to employee rewards programs as well as a regulation of device sales are recommended.

Exploring pregnant women's experiences of stopping smoking with an incentive scheme with 'enhanced' support: a qualitative study.

This study aims to understand pregnant women's experiences of smoking cessation with an incentive scheme in a deprived UK city. This is important because smoking cessation with pregnant women is one of the most crucial public health initiatives to promote, and is particularly challenging in deprived areas. While financial incentive schemes are controversial, there is a need to better understand pregnant women's experiences. The scheme combined quasi-financial incentives (shopping vouchers) for validated quits (carbon monoxide (CO) validated at < 10 ppm), enhanced support from smoking cessation advisors, the opportunity to identify a 'Significant Other Supporter' and nicotine replacement therapy. With the focus on understanding pregnant women's experiences, a qualitative design was adopted. Semi-structured interviews were completed with 12 pregnant women from the scheme, and the three advisors. All interviews were transcribed, and thematic analysis conducted. Pregnant women reported various challenges to quitting, including long-established routines, and stress. Participants were aware of stigma around incentives but were all very positive about the scheme. The relationship with advisors was described as fundamental. The women valued their advice and support, while uptake of the 'Significant Other Supporter' appeared low. Participants viewed the CO monitoring as 'an incentive', while the vouchers were framed as a 'bonus'. Advisors perceived the vouchers as helping engage pregnant women and maintain quit status, and women appreciated the vouchers both as financial assistance and recognition of their accomplishments. This study highlights the great value women placed on the support, advice and monitoring from specialist advisors. The distinction between vouchers as a welcomed bonus, rather than 'the incentive' to engage, is important. How smoking cessation and schemes to promote this are communicated to pregnant women and health professionals is important, particularly given the stigma and controversy involved.

Contrasting effects of electricity prices on retrofit and new-build installations of solar PV: Fukushima as a natural experiment

This study examines the effects of financial incentives, particularly electricity prices, on residential solar photovoltaic (PV) system installations. We highlight the importance of a factor in the adoption of low-carbon building technologies that the literature has largely overlooked: the distinction between retrofit and new-build installations. To address the endogeneity of electricity prices, we use the 2011 Fukushima nuclear accident and the subsequent shutdown of nuclear power plants in Japan as a natural experiment that caused substantial, exogenous, and regionally varying increases in electricity generation costs and prices. Electricity prices have a statistically significant, positive effect on PV system installations for existing homes (with a mean elasticity of 1.6), but a statistically insignificant, much smaller effect for new-build homes. A policy implication of these contrasting responses is that the cost-effectiveness of financial incentive schemes for low-carbon building technologies can be improved if they are targeted more at retrofits. We also find a large downward bias (40%–60%) in the estimated effect of electricity prices if they are not instrumented with exogenous cost-shifters.

Incentive Schemes Increase Risky Behavior in a Safety-Critical Working Task: An Experimental Comparison in a Simulated High-Reliability Organization

As financial incentive schemes have the tendency to increase risky behavior, we analyzed their effect on rule-related behavior in a safety-critical task. We compared risky behavior (in terms of the amount of rule violations) between three payment condition: continuous, up-front, and bonus pay. Fifty-nine participants were trained as production personnel to conduct a start-up procedure of a simulated wastewater treatment plant, representing a high reliability organization. During the 5-h experimental study, risky behavior could have been applied 48 times while building a simulated production year. The results show that the conditions with an incentive scheme (up-front and bonus pay) led to significantly more rule violations than the condition with continuous payment without an incentive scheme. Our study highlights the general increased risk effect of incentive schemes and provides a starting point for industries to assess their implicit and explicit incentive schemes.

Transactions Involving Electric Vehicles for Green Technology

This study focuses on using consumer motivation to encourage the adoption of cleaner technologies. Consumers are varied since they may be driven by internal or external reasons. Though information provision methods may be helpful in encouraging some consumers to purchase electric vehicles. Also, financial incentive schemes such as discounts or penalties may be more persuasive to extrinsically driven customers. This article offers a sophisticated theory of environmental innovation adoption in which information-provision methods are complemented with economic incentives. The different studies have been done to find out the policies for encouraging customers to reduce the harmful impacts of transportation system on environment. The projection of electric cars sales by 2030 is examined. Finally, the different reasons fueling development of electric cars are explored in depth. The results of this study would be of particular relevance to legislators who seek to push consumers toward greener technologies.

Randomized controlled trial of financial incentives during weight-loss induction and maintenance in online group weight control.

This study examined the impact of a financial incentive scheme integrating process and outcome incentives across weight-loss induction and weight maintenance on 18-month weight outcomes. This was a randomized controlled trial. Participants with overweight or obesity (n = 418; 91% female; 28% racial/ethnic minority) were randomized to an 18-month, online, group-based behavioral weight-control program (Internet-Only) or the same program with financial incentives provided for 12 months, contingent on self-regulatory weight-control behaviors (self-weighing, dietary self-monitoring, and physical activity) and weight-outcome benchmarks (Internet+Incentives). No financial incentives were provided from Months 13 to 18 to examine the durability of weight-control behaviors and outcomes without incentives. Weight-loss induction at Month 6 was significantly greater for Internet+Incentives than Internet-Only (6.8% vs. 4.9%, respectively, p = 0.01). Individuals receiving incentives were significantly more likely to maintain weight loss ≥ 5% at Month 12 (45% in Internet+Incentives vs. 32% in Internet-Only, p < 0.02) and remain weight stable (39% vs. 27%, respectively, p < 0.01). Internet+Incentives participants also reported significantly greater behavioral engagement through Month 12. However, once incentives ceased, there were no differences in sustained weight outcomes (Month 18), and engagement declined dramatically. Despite promoting greater treatment engagement and initial weight loss, financial incentives as offered in this study did not promote better extended weight control.

The Impact of Transparency and Decision Risk on Human-Automation Teaming Outcomes.

Examine the effects of decision risk and automation transparency on the accuracy and timeliness of operator decisions, automation verification rates, and subjective workload. Decision aids typically benefit performance, but can provide incorrect advice due to contextual factors, creating the potential for automation disuse or misuse. Decision aids can reduce an operator's manual problem evaluation, and it can also be strategic for operators to minimize verifying automated advice in order to manage workload. Participants assigned the optimal unmanned vehicle to complete missions. A decision aid provided advice but was not always reliable. Two levels of decision aid transparency were manipulated between participants. The risk associated with each decision was manipulated using a financial incentive scheme. Participants could use a calculator to verify automated advice; however, this resulted in a financial penalty. For high- compared with low-risk decisions, participants were more likely to reject incorrect automated advice and were more likely to verify automation and reported higher workload. Increased transparency did not lead to more accurate decisions and did not impact workload but decreased automation verification and eliminated the increased decision time associated with high decision risk. Increased automation transparency was beneficial in that it decreased automation verification and decreased decision time. The increased workload and automation verification for high-risk missions is not necessarily problematic given the improved automation correct rejection rate. The findings have potential application to the design of interfaces to improve human-automation teaming, and for anticipating the impact of decision risk on operator behavior.