Individual Financial Incentives Research Articles

Academic Medicine and Rural Health System Partnerships: Enhancing Education While Advancing Physician Workforce Priorities.

A worsening shortage of rural physicians paralleling increasing health disparities demands attention. Past and ongoing efforts to address this shortage have had positive effects and can inform new strategies to achieve even greater impact. Interventions have included the development of regional medical school campuses and rural-focused tracks to recruit medical students from rural areas, expansion of rural-based graduate medical education (GME) programs and tracks, and use of institutional and individual financial incentives for rural-based training and/or practice. National policy has also taken aim at this challenge with provisions aimed at expanding rural GME in the Medicare, Medicaid, and State Children's Health Insurance Program Balanced Budget Refinement Act of 1999 and the Consolidated Appropriations Act of 2021. Additionally, several states have funded growth in GME, and supportive pathways for Medicare reimbursement and for Veterans Administration funding have been implemented. The authors recommend a new strategy for bolstering the rural physician workforce, focused on using academic-rural partnerships to incorporate rural rotations as a routine part of GME. They explain how the current health care landscape supports this approach and outline additional steps toward implementation. Centralized data collection and analysis are noted as essential to guide future efforts.

Feasibility of a randomised controlled trial of financial incentives to promote alternative travel modes to the car

IntroductionAlternatives to the car, such as walking, cycling and public transport can integrate physical activity into everyday life. Interventions promoting alternatives to the car targeting individual behaviour have shown modest effects, and supportive environments appear important. MethodsThis mixed-method study assesses the scientific and operational feasibility of conducting a randomised controlled trial (RCT) of individual financial incentives within a supportive physical environment. We invited residents of Northstowe, Cambridgeshire, UK who had not previously claimed financial incentives to complete a baseline questionnaire assessing socio-demographic characteristics and travel behaviour. On completion, households were randomly assigned to (1) control – claimed incentives online; (2) intervention - received incentives via email; and (3) intervention plus - received greater value incentives via email. We assessed incentive use via questionnaires at three and six months. Longitudinal qualitative interviews at baseline, three months and six months elicited views of incentives and factors influencing use. Results99 residents from 88 households (household response rate: 88/475 (19%)) completed the baseline questionnaire and were randomised at household level. The local authority delivered all incentives. Compared to the control group, incentive use was higher in the intervention and intervention plus groups at six months, but there was little difference between intervention and intervention plus group. Qualitative data suggests that incentives worked by prompting existing intentions, raising awareness of alternative travel modes and to a lesser degree by reducing travel cost. This resulted in some new leisure travel behaviour, but most often to subsidise existing travel. Qualitative data suggests that existing travel preferences and environmental conditions influenced incentive use. ConclusionIt is feasible to deliver an RCT in collaboration with a local authority and future trials should account for recruitment challenges. Reducing the effort required to obtain incentives increased their use, but future research should investigate the surrounding enabling environmental contexts.

Assessing organizational implementation context in the education sector: confirmatory factor analysis of measures of implementation leadership, climate, and citizenship

BackgroundA substantial literature has established the role of the inner organizational setting on the implementation of evidence-based practices in community contexts, but very little of this research has been extended to the education sector, one of the most common settings for the delivery of mental and behavioral health services to children and adolescents. The current study examined the factor structure, psychometric properties, and interrelations of an adapted set of pragmatic organizational instruments measuring key aspects of the organizational implementation context in schools: (1) strategic implementation leadership, (2) strategic implementation climate, and (3) implementation citizenship behavior.MethodThe Implementation Leadership Scale (ILS), Implementation Climate Scale (ICS), and Implementation Citizenship Behavior Scale (ICBS) were adapted by a research team that included the original scale authors and experts in the implementation of evidence-based practices in schools. These instruments were then administered to a geographically representative sample (n = 196) of school-based mental/behavioral health consultants to assess the reliability and structural validity via a series of confirmatory factor analyses.ResultsOverall, the original factor structures for the ILS, ICS, and ICBS were confirmed in the current sample. The one exception was poor functioning of the Rewards subscale of the ICS, which was removed in the final ICS model. Correlations among the revised measures, evaluated as part of an overarching model of the organizational implementation context, indicated both unique and shared variance.ConclusionsThe current analyses suggest strong applicability of the revised instruments to implementation of evidence-based mental and behavioral practices in the education sector. The one poorly functioning subscale (Rewards on the ICS) was attributed to typical educational policies that do not allow for individual financial incentives to personnel. Potential directions for future expansion, revision, and application of the instruments in schools are discussed.

Do intrinsic and extrinsic motivation relate differently to employee outcomes?

In most theories that address how individual financial incentives affect work performance, researchers have assumed that two types of motivation—intrinsic and extrinsic—mediate the relationship between incentives and performance. Empirically, however, extrinsic motivation is rarely investigated. To explore the predictive validity of these theories of intrinsic and extrinsic motivation in work settings, we tested how both intrinsic and extrinsic motivation affected supervisor-rated work performance, affective and continuance commitment, turnover intention, burnout, and work–family conflict. In the course of three studies (two cross-sectional and one cross-lagged) across different industries, we found that intrinsic motivation was associated with positive outcomes and that extrinsic motivation was negatively related or unrelated to positive outcomes. In addition, intrinsic motivation and extrinsic motivation were moderately negatively correlated in all three studies. We also discuss the theoretical and practical implications of the study and directions for future research.

Feasibility of a Mobile Group Financial-Incentives Intervention Among Pairs of Smokers With a Prior Social Relationship

Smoking is associated with a number of chronic health conditions, including cardiovascular disease and various types of cancer. The decision to smoke can be conceptualized as preference for small, immediate rewards (e.g., relief from withdrawal) over larger, delayed rewards (e.g., good health). Contingency management (CM) takes advantage of this preference for immediate outcomes by delivering incentives, usually financial, for making the healthier choice to abstain from smoking. The current study tested the feasibility of harnessing naturally occurring social contingencies associated with smoking cessation to increase the promise of CM in initiating and sustaining long-term abstinence. Pairs of smokers with an existing relationship (i.e., friends, roommates, family, significant others) were recruited to quit together in the context of a smartphone-delivered, group CM intervention. Approximately 50% of interested participants identified a partner who also met criteria to participate, and five pairs (N = 10) completed the study. Using a within-subject design, participants could earn individual financial incentives for submitting breath carbon monoxide (CO) samples twice daily that met targeted goals for abstinence, and they could earn bonus incentives when both members of the pair met their targets together. Nine participants (90%) successfully reduced their mean breath CO during the intervention relative to baseline conditions. Individuals within a pair performed similarly to one another, for better or worse (i.e., both participants abstained, smoked, or missed samples at the same time). The social contingencies of quitting with someone with whom the smoker has an existing relationship may be helpful, but may also introduce unique challenges, particularly with regard to recruitment and treatment retention.

Collecting Data from mHealth Users via SMS Surveys: A Case Study in Kenya

We report results from a set of experimental surveys designed to assess the feasibility of using SMS surveys to collect data on users of an mHealth service in Kenya. We sent a short set of five or six questions to all new users of m4RH, an SMS-based service in Kenya which provides information on family planning methods. The timing of the survey, the talk-time incentive offered for completing the survey, and access to the family planning service were randomized to estimate the impact of these factors on response rates. In addition, a subset of users were sent a second follow up survey 5 to 11 weeks later. We find that 39.5% of users began the first survey and 20.9% of users completed all questions on the first survey. In contrast, 28.4% of users began the second survey and 14.1% of users completed the second survey. The vast majority of responses received were properly formatted and comprehensible. Survey timing, survey incentives for completion, and access to treatment had no effect on the response rates for either the first or second surveys. Our results indicate that SMS surveys are a feasible mode of data collection for our population of interest and, for this population, do not require individual financial incentives to encourage response.

The Impact of School-Based Financial Incentives on Teachers’ Strategic Moves: A Descriptive Analysis

Background Prior research has found that teacher dissatisfaction with low salaries is one reason for teacher turnover. Accordingly, policy makers have championed financial incentives as a way of increasing teachers’ job satisfaction and making the teaching profession and specific schools more attractive to current and potential teachers. Despite the enthusiasm for such incentive policies, empirical evidence of their effects on teacher mobility is mixed. Purpose In this study, we contribute to the extant literature on teacher financial incentives by shifting focus from the probability of teacher turnover to investigate how incentives, particularly school-based incentives, structure teachers’ patterns of mobility within districts. We explore the effects of financial incentives on teacher mobility patterns in the context of Denver's Professional Compensation System for Teachers (“ProComp”), one of the most prominent alternative teacher compensation reforms in the nation. Setting Denver Public Schools, Denver, Colorado. Population Denver Public Schools classroom teachers employed in the district any time during 2006–2010, who were eligible to participate in the financial incentive program (regardless of whether they did), and who made at least one voluntary within-district move during the study period (n = 989). Program Since 2006, Denver's ProComp program has offered teachers a variety of school-based and individual financial incentives. Specifically, in addition to incentives offered to teachers for their individual accomplishments, ProComp provides incentives of over $2,400 each for teachers that teach in top performing schools, high growth schools, and hard-to-serve schools. Because ProComp offers substantial incentives to teachers on the basis of school characteristics, it holds the potential to incentivize “strategic moves” to schools with more school-based incentives. Research Design The study employs a descriptive statistical research design. Data Collection and Analysis We use Denver Public Schools administrative data from 2005–2006 to 2009–2010 to estimate a series of conditional logit models predicting teachers’ moves as a function of their ProComp participation and the value of school-based incentives at the schools they leave and the schools they could potentially transfer to. Findings Our findings suggest ProComp participants tend to make more strategic moves to high value schools than their non-ProComp peers. However, these moves tend to be to schools that have high performance and growth in achievement, rather than to schools that receive incentives for serving low-income populations. Conclusions Results suggest that school-based ProComp incentives do influence strategic moves, albeit in ways not necessarily consistent with the program's intent, calling into question the ability of ProComp to attract teachers to low-income schools under its current structure.

DOES OWNERSHIP MATTER FOR THE PROVISION OF PROFESSIONALIZED SERVICES? HIP OPERATIONS AT PUBLICLY AND PRIVATELY OWNED CLINICS IN DENMARK

In terms of clinical procedures (to take the example used in this article, hip operations), both public and private organizations provide highly professionalized services. For this service type, our knowledge about ownership differences is sparse. To begin to fill this gap, we investigate how the ownership of hip clinics affects professional behaviour, treatment quality and patient satisfaction. The comparison of private and public hip clinics is based on data from the Danish Hip Arthroplasty Register and the Danish Central Patient Register combined with 20 semi-structured interviews. We find that private clinics employ stronger individual financial incentives and try harder to increase the income/costs ratio than do public clinics. Private clinics optimize non-clinical factors such as waiting time much more than public clinics and have fewer complication-prone patients than public clinics. However, the clinical procedures are very similar in the two types of clinics. Private clinics do not achieve better clinical results, but patient satisfaction is nevertheless higher with private clinics. The implication is that ownership matters for highly professionalized services, but professionalism neutralizes some – but not all – ownership differences.

Exploring the effects of different reward programs on in‐role and extra‐role performance of retail sales associates

PurposeThe purpose of this paper is to explore the effects of different reward programs on in‐role and extra‐role behaviour; and to investigate whether specific reward programs can be designed to enhance both in‐role and extra‐role behaviour simultaneously.Design/methodology/approachSemi‐structured in‐depth interviews were conducted on a total of 11 employees from four different fashion retail outlets. Informants consisted of employees from different positions within these organizations (i.e. store manager, assistant store manager and sales associates) to provide researchers with possibly differing viewpoints. Interviews were content analysed and classified, according to emerging themes.FindingsCertain reward programs, namely individual and group financial incentives motivated sales associates to engage in both in‐role and extra‐role behaviour simultaneously. Further, compared to formal recognition programs, informal reward programs (individual financial incentives, individual social recognition and group social recognition) appeared to be more effective in motivating sales associates to enhance their in‐role and extra‐role performance.Originality/valueThis paper contributes to a better understanding of the effects of different reward programs and their administration on in‐role and extra‐role performance of retail sales associates.

Individual teacher incentives and student performance

This paper is the first to systematically document the relationship between individual teacher performance incentives and student achievement using the United States data. We combine data from the National Education Longitudinal Survey on schools, students, and their families with our own survey conducted in 2000 regarding the use of teacher incentives. This survey on teacher incentives has unique data on frequency and magnitude of merit raises and bonuses, teacher evaluation, and teacher termination. We find that test scores are higher in schools that offer individual financial incentives for good performance. Moreover, the estimated relationship between the presence of merit pay in teacher compensation and student test scores is strongest in schools that may have the least parental oversight. The association between teacher incentives and student performance could be due to better schools adopting teacher incentives or to teacher incentives eliciting more effort from teachers; it is impossible to rule out the former explanation with our cross sectional data.

The impact of practice setting and financial incentives on career satisfaction and perceived practice limitations among surgeons

Objective: To study how practice setting and financial incentives affect career satisfaction and perceived impact on practice in surgery. Methods: Data are from the Community Tracking Study (CTS) physician survey, a national survey of active physicians in the United States fielded between August 1996 and August 1997. Surveys with 1,738 practicing surgeons were completed. To be eligible, surgeons had to have completed their medical training (which excludes residents, interns, or fellows), be practicing in the contiguous United States, and be providing direct patient care for at least 20 hours per week. The dependent variables measured are career dissatisfaction and perceived limitations/pressures on time spent with patients, clinical freedom, income, and continuity. The dependent variables are regressed on practice setting, percentage of managed care practice revenue, individual financial incentives, age group, gender, international medical graduate, and board certification. Results: Working in a small practice is the strongest predictor of career dissatisfaction, with about twice the adjusted rate of career dissatisfaction (26%) than other practice settings (13% in group practices, 16% in staff-model HMOs, 9% in medical schools, 18% in hospitals). Managed care plays a much smaller role; an increase in the dependence on managed care equivalent to the difference between 25th and 75th percentile only increases career dissatisfaction by 3 percentage points. Surgeons in solo or two physician practices are also more likely than surgeons in other settings to report that income pressure and limitations on clinical freedom and patient continuity compromise quality of care.

The Diffusion of Decision Support Systems in Healthcare: Are We There Yet?

Clinical decision support (CDS) systems, with the potential to minimize practice variation and improve patient care, have begun to surface throughout the healthcare industry. This study reviews historic patterns of information technology (IT) in healthcare, analyzes barriers and enabling factors, and draws three lessons. First, the widespread adoption of clinical IT, including CDS systems, depends on having the right organizational and individual financial incentives in place. Second, although CDS systems and clinical IT in general are powerful tools that can be used to support the practice of medicine, they alone cannot redefine the workflow or processes within the profession. Healthcare managers counting on technology to restructure or monitor clinicians' work patterns are likely to encounter substantial resistance to CDS systems, even those that generate valuable information. Third, while the pace of implementing IT systems in healthcare has lagged behind that of other industries, many of the obstacles are gradually diminishing. However, several factors continue to inhibit their widespread diffusion, including the organizational turmoil created by large numbers of mergers and acquisitions, and the lack of uniform data standards.

The Effects of Two Motivational Manipulations on the Neuropsychological Performance of Mildly Head-Injured College Students

Recently, much research has focused on the development and utilization of various motivational assessment techniques designed to identify malingered neuropsychological test performance. Other findings have suggested a strong link between the motivation of the subject and the degree to which the neuropsychological test results validly represent the individual's true level of functioning. However, the majority of the empirical work in this area has focused on only one end of the motivational spectrum, decreased motivation. In order to obtain a more complete assessment of the relationship between motivation and neuropsychological of test results, the present study involved an evaluation of the effects of motivational differences on test performance across three levels of motivation: high, low, and standard in 75 head-injured college students. Results supported past research showing significant decreases in test performance by participants given individual financial incentives ($25.00) to perform poorly. Additionally, the sensitivity of several malingering tests to this response set was supported. However, no reliable differences were found on neuropsychological or motivational tests between the group given financial incentives ($25.00) to perform well and the standard instruction group.

Promoting Energy Conservation in Mastered Metered Buildings

Waste of fuel and electricity is known to be higher in buildings in which occupants do not pay for the utilities they use. It is often structurally impossible or financially impractical to shift utilities payments to individual consumers. Methods of promoting conservation that do not depend upon individual financial incentives are needed. In particular, it would be of value to find methods applicable to apartment buildings and garden apartment complexes. Studies have been conducted that attempt to apply financial incentives to groups of tenants: (a) By returning to tenants equal shares of part or all of the money saved by conservation, and (b) By offering monetary prizes to those groups of tenants who conserve the most. Other studies have applied participatory management procedures in order to promote the setting of conservation goals and commitment to achieving them. A study in progress attempts to shift responsibility for energy consumption from owners/managers to tenants as a group by splitting rent into two parts: (a) A fixed individual charge for amount of space occupied and (b) A proportional share of the total utilities bill for the apartment complex. Findings from these studies indicate that a meaningful level of conservation is achieved although interpretation of causal factors has been handicapped by difficulties in maintaining experimental and control treatments under the conditions of field experimentation. Some evidence suggests that most conservation is accomplished through the acceptance or initiation of modifications in the pattern of energy consumption that are made at one point in time but have a continuing impact.