Financial Incentive Strategies Research Articles

Cost-Effectiveness of Off-Road Equipment Electrification Incentives: Cost Estimation, Evaluation, and Usage Framework

Effective incentive strategies have played a major role in the electrification of on-road vehicles. Similar approaches to the off-road sector will be needed to continue decarbonizing the transportation sector. Estimating cost-effectiveness with given incentive funds is crucial to successfully develop and implement financial incentive strategies. Because of the lack of cost information for electric off-road equipment, forecasting cost-effectiveness of electrifying the off-road fleet is not feasible. We developed cost projection models for major components of off-road equipment and combined them into an equipment cost simulation tool. This simulation tool was then used to estimate NO x, particulate matter, and CO2 emission-based cost-effectiveness when diesel off-road equipment is replaced with equivalent electric equipment. Use of the developed cost-effectiveness framework in developing incentive strategies was also demonstrated. Finally, a sensitivity analysis was conducted to address potential variations of the assumptions made for projecting the cost of components and the resulting cost-effectiveness estimates. The framework demonstrated in this paper will inform governmental inventive funding programs to design the most cost-effective strategies, considering equipment vocation, model year, and usage.

Implementation strategies to promote linkage to care for key populations after HIV self-testing: a scoping review

Background In human immunodeficiency virus (HIV) care, key populations are sex workers, people who inject drugs, prisoners, transgender people, and men who have sex with men (MSM), who are at high risk and burden of HIV infection but face barriers to HIV prevention, treatment, and health services. HIV self-testing (HIVST) is effective in scaling up HIV testing uptake among key populations due to its cost-effective, confidential, and convenient feature. However, lacking linkage to care support remains a key challenge. This scoping synthesised the global evidence regarding implementing strategies to promote linkage to care for key populations after HIVST. Methods This scoping review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. A data search was conducted on September 1, 2021. The searched databases were PubMed, Embase, EBSCOhost, Cochrane Library, Wan Fang Data (Chinese), China National Knowledge Infrastructure (Chinese), and Japan Medical Abstracts Society (Japanese). Results Twenty studies from 2011 records met the eligibility criteria and were included for review. The study populations were MSM (9), mixed high-risk populations (7), female sex workers (3), and transgender youth (1). Implementation strategies to promote linkage to care for key populations after HIVST were classified into seven categories: 1) HIVST kits with linkage-to-care information, 2) web-based or mobile app-guided HIVST, 3) remote HIVST counselling, 4) intensive follow-up, 5) HIVST promotion through social media and key opinion leaders, 6) community engagement in HIVST and 7) financial incentive. The digital-supported intervention mainly targeted MSM in high-income settings, and the community-based approach and financial incentive strategies were mainly implemented in low and middle-income settings. Comparison of linkage outcomes between studies is problematic due to mixed interpretation and measurement of linkage to care after HIVST. Conclusions Implementation strategies to promote linkage to care for key populations are diverse and should be incorporated in different settings and backgrounds. Innovative digital-supported HIVST research for female sex workers and high-risk populations in low and middle-income settings is warranted. A standardised definition of linkage to care following HIVST and a unified measurement of linkage outcomes should be developed and applied in future research.

Effectiveness of Goal-Directed and Outcome-Based Financial Incentives for Weight Loss in Primary Care Patients With Obesity Living in Socioeconomically Disadvantaged Neighborhoods

Financial incentives for weight management may increase use of evidence-based strategies while addressing obesity-related economic disparities in low-income populations. To examine the effects of 2 financial incentive strategies developed using behavioral economic theory when added to provision of weight management resources. Three-group, randomized clinical trial conducted from November 2017 to May 2021 at 3 hospital-based clinics in New York City, New York, and Los Angeles, California. A total of 1280 adults with obesity living in low-income neighborhoods were invited to participate, and 668 were enrolled. Participants were randomly assigned to goal-directed incentives, outcome-based incentives, or a resources-only group. The resources-only group participants were given a 1-year commercial weight-loss program membership, self-monitoring tools (digital scale, food journal, and physical activity monitor), health education, and monthly one-on-one check-in visits. The goal-directed group included resources and linked financial incentives to evidence-based weight-loss behaviors. The outcome-based arm included resources and linked financial incentives to percentage of weight loss. Participants in the incentive groups could earn up to $750. Proportion of patients achieving 5% or greater weight loss at 6 months. The mean (SD) age of the 668 participants enrolled was 47.7 (12.4) years; 541 (81.0%) were women, 485 (72.6%) were Hispanic, and 99 (14.8%) were Black. The mean (SD) weight at enrollment was 98.96 (20.54) kg, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 37.95 (6.55). At 6 months, the adjusted proportion of patients who lost at least 5% of baseline weight was 22.1% in the resources-only group, 39.0% in the goal-directed group, and 49.1% in the outcome-based incentive group (difference, 10.08 percentage points [95% CI, 1.31-18.85] for outcome based vs goal directed; difference, 27.03 percentage points [95% CI, 18.20-35.86] and 16.95 percentage points [95% CI, 8.18-25.72] for outcome based or goal directed vs resources only, respectively). However, mean percentage of weight loss was similar in the incentive arms. Mean earned incentives was $440.44 in the goal-directed group and $303.56 in the outcome-based group, but incentives did not improve financial well-being. In this randomized clinical trial, outcome-based and goal-directed financial incentives were similarly effective, and both strategies were more effective than providing resources only for clinically significant weight loss in low-income populations with obesity. Future studies should evaluate cost-effectiveness and long-term outcomes. ClinicalTrials.gov Identifier: NCT03157713.

Consequences of Social and Environmental Corporate Responsibility Practices: Managers’ Perception in Mozambique

The objective of this paper is to analyze the relationship between the social and environmental practices of Corporate Social Responsibility (CSR), and the economic–financial, social, and environmental performance in Mozambican companies, from the managers’ perspectives. The data were collected from a sample of 227 companies through a survey questionnaire. We used structural equation modelling to analyze how the managers correlate the different social and environmental practices with performance at the financial, social, and environmental levels. The results showed that the relationship between all major components of the social and environmental practices, and the economic–financial, social, and environmental performance is positive but insignificant with the exception of the social practices of community support, which has a weak relationship with the economic–financial performance, environmental performance, and social performance, as well as the environmental practices. The data indicate that there is a need for strengthening the appropriate economic–financial incentive policies and strategies for the agents who promote good CSR practices in the country, in order to obtain satisfactory, measurable, and comparable economic–financial, social, and environmental performance.

The impact of financial incentives on utilization and outcomes of diabetes prevention programs among Medicaid managed care adults in New York state

Diabetes prevalence has risen rapidly and has become a global health challenge. The Diabetes Prevention Program (DPP) has been shown to prevent or delay the development of diabetes among individuals with prediabetes. Yet, diabetes prevention studies within the Medicaid population are limited and results are mixed. This study aimed to evaluate the impact of different financial incentive strategies on the utilization of the DPP for Medicaid managed care adults in New York State.A four-arm randomized controlled trial was conducted among Medicaid managed care adult enrollees diagnosed with prediabetes and/or obesity. Study participants were offered a 16-week DPP with various incentive strategies based on class attendance and weight loss as follows: Attendance-Only, Weight-Loss Only, and both Attendance and Weight-Loss. A control group was offered DPP with no incentives for attendance or weight loss. We evaluated the impact of incentives on achievement of the program completion and weight-loss milestone.Participants who received incentives for the Attendance-Only class were least likely to be lost to follow-up, more likely to complete the program, and had two times higher percentage of meeting the weight-loss milestone compared to the control group. Results for the other incentive cohorts were mixed. A strong positive association was observed for participants who attended 9 or more classes and weight-loss regardless of incentive strategies.Providing monetary incentives for DPP class attendance had a positive impact on program completion and achieving the weight-loss milestone. However, the results from this study indicate that participant enrollment and retention remained challenges despite the incentives.

A pilot randomized trial of five financial incentive strategies to increase study enrollment and retention rates

BackgroundEnrollment and retention difficulties remain major barriers to conducting clinical trials. Financial incentives may promote clinical trial enrollment, however delivery methods to maximize enrollment, maximize retention, and minimize cost remains uncertain. MethodsWe conducted a single-blind, web-based randomized controlled trial of five financial incentive strategies on enrollment and retention rates in a longitudinal study of advance directives among community-dwelling older adults. Participants were eligible to receive a fixed total financial incentive, but the disbursement amounts at each study timepoint (baseline, 2-weeks, 4-weeks, and 6-weeks) differed between study arms. At each timepoint, participants completed a different advance directive. We conducted an intention-to-treat analysis for the primary and secondary outcomes of enrollment and retention. Results1803 adults were randomized to one of five incentive strategies: constant n = 361; increasing n = 357; U-shaped n = 361; surprise n = 360; self-select n = 364. Overall, 989 (54.9%) participants elected to enroll in the advance directive study. There were no differences in enrollment rates between the control (constant 53.5%) and any of the four intervention study arms (increasing 54.3%, p = 0.81; U-shaped 57.3%, p = 0.30; surprise 56.9%, p = 0.35; and self-select 52.2%, p = 0.73). There were no differences in retention rates between the control (constant 2.1%) and any of the four intervention study arms (increasing 5.2%, p = 0.09; U-shaped 3.9%, p = 0.23; surprise 2.4%, p = 0.54; self-select 2.1%, p = 0.63). ConclusionsFinancial incentive programs for trial enrollment informed by behavioral economic insights were no more effective than a constant-payment approach in this web-based pilot study.

Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial

IntroductionObesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals’ utilisation of evidence-based...

SHOULD WE PAY THE SMOKERS? A META-ANALYSIS OF FINANCIAL INCENTIVES FOR SMOKING CESSATION AMONG SMOKERS IN LOW SOCIOECONOMIC GROUP

Today around 80% of smokers worldwide live in low- and middle-income countries, and in most countries, regardless of country income group, tobacco use is more concentrated in low socioeconomic status (SES) populations. This meta-analysis was conducted to review current available evidences to determine the effectiveness of financial incentive strategies on smoking cessation among low-SES smokers. Database search using PubMed, Science Direct and Cochrane Library were used to search financial incentive intervention prior to October 2018. Appraisal of methodological quality was assessed using Cochrane Collaboration’s tool. Six identified randomized control trials with 2450 and 2437 participants in intervention and control group respectively were included in the analysis. The random-effect model was used to combine results from individual studies. The pooled odds ratio (OR) was 2.16 (95% CI: 1.66-2.82) comparing financial incentive intervention with control. Heterogeneity was not significant across studies (Chi 2 = 8.17, p = 0.15, I 2 = 39%). Current evidences from the RCT researches suggest that financial incentives are promising potential strategy to encourage smoking cessation among low-SES smokers. Keyword: financial incentive, smoking cessation, low socioeconomic status, meta-analysis

Social marketing including financial incentive programs at worksite cafeterias for preventing obesity: a systematic review

BackgroundAs with food-taxation strategies, such interventions as discounted healthy menus, point-of-purchase advertisements, and sugar-free beverages for employees at worksites could help prevent obesity. This study assessed the effectiveness of food environment interventions incorporating financial incentive or social marketing strategies at workplace cafeterias, vending machines, and kiosks toward preventing obesity and improving dietary habits.MethodsWe conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO databases. The study designs included were randomized control trials (RCTs) and cluster RCTs. We evaluated the effectiveness of financial incentive or social marketing strategies interventions (such as discounts) on health outcomes or food intake behavior. Two reviewers independently screened the studies for inclusion. We assessed the risk of bias using the Cochrane Collaboration’s tool. This protocol was published in 2014.ResultsWe included three trials, with a combined total of 3013 participants. There were limited available data from RCTs on changes in body weight. No eligible social marketing studies were retrieved. In some cases, a meta-analysis could not be conducted owing to differences in the analytic methods for the outcomes.ConclusionsLack of evidence made it difficult to draw any conclusions. In future surveys, it will be necessary to conduct interventions focusing only on financial incentive intervention versus no intervention in order to determine whether the incentive strategy has a clear impact.Systematic review registrationPROSPERO CRD4201401056

Financial IncEntives for Smoking TreAtment: protocol of the FIESTA trial and FIESTA Oral Microbiome Substudy

BackgroundSmoking is the leading preventable cause of death in the United States, but evidence-based smoking cessation therapy is underutilized. Financial incentive strategies represent an innovative approach for increasing the use of counseling and pharmacotherapy. If effective, they could supplement or supplant resource-intensive policy options, particularly in populations for whom smoking has substantial societal costs. FIESTA (Financial IncEntives for Smoking TreAtment) will randomize hospitalized smokers to receive usual smoking cessation care alone or usual smoking care augmented with financial incentives. We aim to compare the impact of these two strategies on 1) smoking abstinence, 2) use of counseling and nicotine replacement therapy, and 3) quality of life of participants. We also will evaluate the short-term and long-term return on the investment of incentives. The FIESTA Oral Microbiome Substudy will compare the oral microbiome of smokers and nonsmokers to longitudinally assess whether smoking cessation changes oral microbiome composition.MethodsWe will enroll 182 inpatient participants from the Manhattan campus of the Veterans Affairs New York Harbor Healthcare System. All participants receive enhanced usual care, including screening for tobacco use, counseling while hospitalized, access to nicotine replacement therapy, and referral to a state Quitline. Patients in the financial incentive arm receive enhanced usual care and up to $550 for participating in the New York Smoker’s Quitline, using nicotine replacement therapy (NRT), and achieving biochemically confirmed smoking cessation at 2 months and 6 months. In the microbiome substudy, we enroll nonsmoking control participants matched to each recruited smoker’s hospital ward, sex, age, diabetes status, and antibiotic use. After discharge, participants are asked to complete periodic phone interviews at 2 weeks, 2 months, 6 months, and 12 months and provide expired carbon monoxide and saliva samples at 2 months, 6 months, and 12 months for cotinine testing and oral microbiome analysis.DiscussionThe incentive interventions of FIESTA may benefit hospitalized smokers, an objective made all the more critical because smoking rates among hospitalized patients are higher than those in the general population. Moreover, the focus of FIESTA on evidence-based therapy and bioconfirmed smoking cessation can help guide policy efforts to reduce smoking-related healthcare costs in populations with high rates of tobacco use and costly illnesses.Trial registrationClinicalTrials.gov, NCT02506829. Registered on 1 July 2014.

Using financial incentives to promote physical activity in American Indian adolescents: A randomized controlled trial.

American Indians (AI) have high prevalence of diabetes in youth and may benefit from increasing physical activity as a strategy to improve metabolic health. We tested whether financial incentives would elicit greater frequency and/or duration of exercise in AI youth at high risk for developing diabetes. Overweight/obese AI boys and girls, 11–20 years old, were instructed to exercise on 3 days/week for 48 weeks at a tribal wellness center. The program was divided into three, 16-week-long phases to test different financial incentive strategies. Within each phase participants were randomly assigned to one of two groups that received different payments for exercise. Phase 1 was designed to test whether the size of the incentive would affect exercise frequency. In Phase 1, the number of exercise sessions did not differ between the group receiving a modest fixed-value payment per exercise session and the group receiving enhanced incentives to exercise more frequently (26 ± 3 versus 28 ± 2 sessions, respectively, p = 0.568). In Phase 2, the provision of an enhanced financial incentive to increase exercise duration resulted longer sessions, as the incentivized and standard payment groups exercised 38 ± 2 versus 29 ± 1 minutes per session (p = 0.002), respectively. In Phase 3, the effect of reducing the incentives on maintenance of exercise behaviors was inconclusive due to high participant withdrawal. Aerobic fitness increased 10% during Phase 1 but was unchanged thereafter. Insulin sensitivity and body composition were unchanged during the study. In conclusion, enhanced financial incentives increased the duration of exercise sessions, but had minimal effects on exercise participation. These results indicate that financial incentives hold promise in motivating previously sedentary, overweight/obese adolescents to exercise longer, but motivating them to sustain an exercise program remains the major challenge.Trial Registration: ClinicalTrials.gov NCT01848353.

Financial incentive strategies for maintenance of weight loss: results from an internet-based randomized controlled trial

Background/objectiveFinancial incentives can improve initial weight loss; we examined whether financial incentives can improve weight loss maintenance.Subjects/methodsParticipants aged 30–80 years who lost at least 5 kg during the first 4–6 months in a nationally available commercial weight loss program were recruited via the internet into a three-arm randomized trial of two types of financial incentives versus active control during months 1–6 (Phase I) followed by passive monitoring during months 7–12 (Phase II). Interventions were daily self-weighing and text messaging feedback alone (control) or combined with a lottery-based incentive or a direct incentive. The primary outcome was weight change 6 months after initial weight loss. Secondary outcomes included weight change 12 months after initial weight loss (6 months after cessation of maintenance intervention), and self-reported physical activity and eating behaviors.ResultsOf 191 participants randomized, the mean age was 49.0 (SD = 10.5) years and weight loss prior to randomization was 11.4 (4.7) kg; 92% were women and 89% were White. Mean weight changes during the next 6 months (Phase I) were: lottery −3.0 (5.8) kg; direct −2.8 (5.8) kg; and control −1.4 (5.8) kg (all pairwise comparisons p > 0.1). Weight changes through the end of 12 months post-weight loss (Phase II) were: lottery −1.8 (10.5) kg; direct −0.7 (10.7) kg; and control −0.3 (9.4) kg (all pairwise comparisons p > 0.1). The percentages of participants who maintained their weight loss (defined as gaining ≤1.36 kg) were: lottery 79%, direct 76%, and control 67% at 6 months and lottery 66%, direct 62%, and control 59% at 12 months (all pairwise comparisons p > 0.1). At 6 and 12 months after initial weight loss, changes in self-reported physical activity or eating behaviors did not differ across arms.ConclusionsCompared with the active control of daily texting based on daily home weighing, lottery-based and direct monetary incentives provided no additional benefit for weight loss maintenance.

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

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

Sources, determinants and utilization of health workers' revenues: evidence from Sierra Leone.

Exploring the entire set of formal and informal payments available to health workers (HWs) is critical to understand the financial incentives they face and devise effective incentive packages to motivate them. We investigate this issue in the context of Sierra Leone by collecting quantitative data through a survey and daily logbooks on the incomes of 266 HWs in three districts, and carrying out 39 qualitative in-depth interviews. We find that, while earnings related to the HWs official jobs represent the largest share, their income is fragmented and composed of a variety of payments, and there is a large heterogeneity in the importance of each income source within the total remuneration. Importantly, each income has different features in terms of regularity, reliability, ease of access, etc. Our analysis also reveals the determinants of the incomes received and their level based on individual and facility characteristics, and finds that these are not in line with HRH policies defined at national level. Additionally, from their narratives, it emerges that HWs are ‘managing’, in the sense both of ‘getting by’ and of enacting financial coping strategies, such as mental accounting (spending different incomes differently), income hiding to shelter it from family pressures, and re-investment of incomes to stabilize overall earnings over time, in order to ensure their livelihoods and those of their families. These strategies question the assumption of fungibility of incomes and the neutrality of increasing or regulating one rather than another of them. Together, our findings on earning and income use patterns have important policy implications for how we go about (re)thinking financial incentive strategies.

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

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

A unified model for energy and environmental performance assessment of natural gas-fueled poly-generation systems

Poly-generation systems for combined production of manifold energy vectors such as electricity, heat at different enthalpy levels (for instance, in the form of hot water and steam), and cooling power from a unique source of primary energy (typically natural gas) are increasingly spreading, above all on a small-scale basis (below 1 MW e), owing to their enhanced energy, environmental and economic characteristics. Availability of suitable tools for assessing the performance of such systems is therefore fundamental. In this paper, a unified general model is proposed for assessing the energy and CO 2 emission performance of any type of poly-generation system with natural gas as the energy input. In particular, the classical energy saving model for cogeneration systems is extended to include in the analysis further energy vectors by defining the novel PPES (Poly-generation Primary Energy Saving) indicator. In addition, equivalent efficiencies for CO 2 emission assessment are defined and used in the formulation of the new PCO2ER (Poly-generation CO 2 Emission Reduction) indicator, specifically introduced for environmental analysis. The formal analogy between the PPES and the PCO2ER indicators is highlighted. Numerical applications are provided to show the effectiveness of the proposed models and to quantify the typical benefits that poly-generation systems can bring. In particular, the new indicators are of relevant interest for both energy planners and policy makers, above all in the outlook of formulating financial incentive strategies, as it already occurs for cogeneration systems, or of participating to specific energy-related markets such as the ones for trading white certificates or emission allowances.

Employee Incentives in the Public Sector: A National Survey of Urban Mass Transit Authorities

Managers in this decade are facing a number of challenges that hinge on the demand for increased productivity. This study focuses on the viability of financial incentive strategies to improve public sector productivity. The transit industry was chosen for the survey due to its interest in financial incentive programs (FIPs) and its concern with productivity. The data indicate that numerous FIPs are being used within the transit industry and that these programs are for the most part evaluated positively.