Personal Financial Incentives Research Articles

Retaining Healing Hands: A Transnational Study on Job Retention Interventions for the Healthcare Workforce

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce’s intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution.

Enhancing employability through training programmes in Chile: A qualitative study of the challenges identified by local actors involved in a subnational experience

AbstractActive labour policies are globally adopted to tackle unemployment and enhance job matching. In Chile, a predominantly supply‐focused approach involves training workers, especially in vulnerable groups, as it is believed that investing in human capital will align job demand and available skills. This subnational Chilean case study in the Coquimbo region delves into the factors influencing worker training and placement programme implementation, with a specific focus on stakeholders' perceptions. Through qualitative data from interviews and focus groups, the research seeks to explore subjective challenges, including individual perspectives, governance and structural factors. Various variables affect policy implementation at different levels. On the micro level, actor motivations like personal goals and financial incentives are crucial for policy design. Regional governance levels grapple with coordination difficulties that impact programme implementation. Collaboration among stakeholders like government agencies, educational institutions and employers is essential. Structural issues within the regional economy and the target population also pose challenges to policy implementation. The study suggests that a comprehensive policy approach that considers the interconnectedness of institutions, labour markets, skills and the various stakeholders involved in the process is vital to address the complexity of active labour policies at the local level in Chile.

Community health workers and Covid-19: Cross-country evidence on their roles, experiences, challenges and adaptive strategies.

Community health workers (CHWs) are a key part of the health workforce, with particular importance for reaching the most marginalised. CHWs' contributions during pandemics have received growing attention, including for COVID-19. This paper contributes to learning about CHWs' experiences during COVID-19, based on evidence from India, Bangladesh, Pakistan, Sierra Leone, Kenya and Ethiopia. The paper synthesises evidence from a set of research projects undertaken over 2020-2021. A thematic framework based on the research focus and related literature was used to code material from the reports. Following further analysis, interpretations were verified with the original research teams. CHWs made important contributions to the COVID-19 response, including in surveillance, community education, and support for people with COVID-19. There was some support for CHWs' work, including training, personal protective equipment and financial incentives. However, support varied between countries, cadres and individual CHWs, and there were significant gaps, leaving CHWs vulnerable to infection and stress. CHWs also faced a range of other challenges, including health system issues such as disrupted medical supply chains, insufficient staff and high workloads, a particular difficulty for female CHWs who were balancing domestic responsibilities. Their work was also affected by COVID-19 public health measures, such as restrictions on gatherings and travel; and by supply-side constraints related to community access and attitudes, including distrust and stigmatization of CHWs as infectious or informers. CHWs demonstrated commitment in adapting their work, for example ensuring patients had adequate drugs in advance of lockdowns, and using their own money and time to address increased transport costs and higher workloads. Effectiveness of these adaptations varied, and some involved coping in a context of inadequate support. CHW are critical for effective response to disease outbreaks, including pandemics like COVID-19. To support CHWs' contribution and protect their wellbeing, CHWs need adequate resources, managerial support, and motivation.

Can Reminders and Incentives Improve Implementation Within Government? Evidence from a Field Experiment

Abstract Existing research demonstrates how governments can use insights from behavioral science to design policy and alter residents’ behavior. This article proposes that the effect of behavioral interventions may be different in hierarchical organizations where the decision to change behavior and the execution of that decision are split between different individuals. We examine the effect of two small-scale interventions—personal reminders and financial incentives—in a large-scale field experiment with public schools in Denmark. The Ministry of Education invited a representative sample of public schools to adopt a program that provides information on students’ socio-emotional competencies. Results show that small financial incentives increased managers’ adoption of the program by 7 percentage points. Frontline workers’ subsequent data generation and performance information acquisition were also increased in the incentive treatment groups, even though the latter was not incentivized. Reminders paired with incentives had an impact on the managers’ adoption, but the reminder effect disappeared during the implementation phase. These findings demonstrate both the potentials and limitations of applying behavioral research on individual residents to hierarchical organizations.

Personal Financial Incentives and Corporate Campaign Contributions

Despite the well-documented benefits of political participation, few firms engage in politics. We argue that low levels of corporate political participation can be rationalized by financial incentives of employees and shareholders who are the ultimate source of corporate contributions. Since even large firm-level benefits are trivial for individuals with small equity-stakes, few people have sufficient incentives to contribute. This logic explains why corporate political contributions are relatively small and why firms seek alternative channels of political influence. Empirically, we document that corporate PACs are financially constrained and that financial incentives of individual contributors are a strong determinant of campaign contributions.

Food Loss and Food Waste, Causes and Solutions, by MichaelBlakeney. Published by Edward Elgar Publishing, Cheltenham, UK, 2019, 225 pp, ISBN: 978‐1‐78897‐538‐4.

Food Loss and Food Waste, Causes and Solutions, by MichaelBlakeney. Published by Edward Elgar Publishing, Cheltenham, UK, 2019, 225 pp, ISBN: 978‐1‐78897‐538‐4.

Executives’ Personal Tax Behavior and Corporate Tax Avoidance Consistency

We analyze executives’ (CEOs, CFOs, and Board Chairpersons) personal tax returns to investigate whether and how their personal tax behavior is associated with the tax avoidance of their firms. We develop various measures of executives’ personal tax behavior that are related to their personal risk propensity, ethics, financial incentives, and awareness of tax planning opportunities and risks. Our empirical results show that CEOs’ and CFOs’ personal tax behavior is related both to nonconforming and conforming corporate tax avoidance. We find no such results for Board Chairpersons.

Behavioral Economics, Motivating Psycho-Education Improvements: A Mobile Technology Initiative in South Africa.

Here we report on a health behavioral support project, using incentivized behavior on a mobile platform through M4JAM. This was a proof of concept study to support further developments, more specifically targeted at the management of tuberculosis and human immunodeficiency virus. The study reported here examines the impact of financial rewards and app toward improving mental health outcomes in South Africa. A total of 136 participants were recruited from a database and dichotomized into self-determined and heteronomous groups based on self-report scores. Overall the findings reported here highlight that personal financial incentives have a role in motivating behavior. The findings are discussed in light of the usefulness of an incentivized mobile platform in real-world practice to encourage mental health improvements in low- to middle-income countries.

A Cluster-Randomized Trial on Small Incentives to Promote Physical Activity

There has been limited research investigating whether small financial incentives can promote participation, behavior change, and engagement in physical activity promotion programs. This study evaluates the effects of two types of small financial incentives within a physical activity promotion program of a Swiss health insurance company. Three-arm cluster-randomized trial comparing small personal financial incentives and charity financial incentives (10 Swiss Francs, equal to US$10.40) for each month with an average step count of >10,000 steps per day to control. Insureds' federal state of residence was the unit of randomization. Data were collected in 2015 and analyses were completed in 2018. German-speaking insureds of a large health insurer in Switzerland were invited. Invited insureds were aged ≥18 years, enrolled in complementary insurance plans and registered on the insurer's online platform. Primary outcome was the participation rate. Secondary outcomes were steps per day, the proportion of participant days in which >10,000 steps were achieved and non-usage attrition over the first 3 months of the program. Participation rate was 5.94% in the personal financial incentive group (OR=1.96, 95% CI=1.55, 2.49) and 4.98% in the charity financial incentive group (OR=1.59, 95% CI=1.25, 2.01) compared with 3.23% in the control group. At the start of the program, the charity financial group had a 12% higher chance of walking 10,000 steps per day than the control group (OR=1.68, 95% CI=1.23, 2.30), but this effect dissipated after 3 months. Steps per day and non-usage attrition did not differ significantly between the groups. Small personal and charity financial incentives can increase participation in physical activity promotion programs. Incentives may need to be modified in order to prevent attrition and promote behavior change over a longer period of time. This study is registered at www.isrctn.com ISRCTN24436134.

Putting social rewards and identity salience to the test: Evidence from a field experiment with teachers in Philadelphia

We partnered with the School District of Philadelphia (SDP) to run a randomized experiment testing interventions to increase teacher participation in an annual feedback survey, an uncompensated task that requires a teacher's time but helps the educational system overall. Our experiment varied the nature of the incentive scheme used, and the associated messaging. In the experiment, all 8,062 active teachers in the SDP were randomly assigned to receive one of four emails using a 2x2 experimental design; specifically, teachers received a lottery-based financial incentive to complete the survey that was either "personal" (a chance to win one of fifteen $100 gift cards for themselves) or "social" (a chance to win one of fifteen $100 gift cards for supplies for their students), and also received email messaging that either did or did not make salient their identity as an educator. Despite abundant statistical power, we find no discernible differences across our conditions on survey completion rates. One implication of these null results is that from a public administration perspective, social rewards may be preferable since funds used for this purpose by school districts go directly to students (through increased expenditure on student supplies), and do not seem less efficacious than personal financial incentives for teachers.

Putting Social Rewards and Identity Salience to the Test: Evidence from a Field Experiment on Teachers in Philadelphia

We partnered with the School District of Philadelphia (SDP) to run a randomized experiment testing interventions to increase teacher participation in an annual feedback survey, an uncompensated task that requires a teacher’s time but helps the educational system overall. Our experiment varied the nature of the incentive scheme used, and the associated messaging. In the experiment, all 8,062 active teachers in the SDP were randomly assigned to receive one of four emails using a 2x2 experimental design; specifically, teachers received a lottery-based financial incentive to complete the survey that was either (a chance to win one of fifteen $100 gift cards for themselves) or (a chance to win one of fifteen $100 gift cards for supplies for their students), and also received email messaging that either did or did not make salient their identity as an educator. Despite abundant statistical power, we find no discernible differences across our conditions on survey completion rates. One implication of these null results is that from a public administration perspective, social rewards may be preferable since funds used for this purpose by school districts go directly to students (through increased expenditure on student supplies), and do not seem less efficacious than personal financial incentives for teachers.

More Than Money: Motivating Physician Behavior Change in Accountable Care Organizations.

Policy Points: For accountable care organizations (ACOs) to be successful they need to change the behavior of their physicians. To stimulate this change, a broad range of motivators are being used, including ways to see a greater impact on patients (social purpose) and opportunities to be a more effective physician (mastery), in addition to personal financial incentives. From our analysis of case studies, it does not appear that the full range of motivators is being deployed by ACOs, which suggests an opportunity to develop more sophisticated and wider‐ranging portfolios of motivators for greater impact. ContextThere are approximately 800 accountable care organizations (ACOs) in the United States. In order to achieve the ACO goals of reduced cost, improved outcomes of care, and better population health, it is critical to change how physicians within ACOs deliver care. While knowledge of ACO development and evolution is growing, relatively little is known about the motivational drivers that are being used to effect change among participating physicians.MethodsWe synthesized 9 well‐established and empirically tested theories of motivation into an overarching framework of 6 motivator domains. This framework was then used to explore the types of motivators that leaders use to stimulate change within 4 case study ACOs. We explored the organizational characteristics, strategies, and motivators for changing physicians’ behaviors through in‐depth interviews and document review.FindingsThe case study ACOs more strongly emphasized nonfinancial motivators for changing physician behavior than financial incentives. These motivators included mastery and social purpose, which were used frequently across all case study sites. Overall, the ACO case studies illustrated variability across all motivational domains. While there was evidence of changing motivators as a result of the ACO, the case study ACOs found it difficult to comprehensively change the use of motivators, in part due to dispersed managerial attention and the complexity and diversity of programs and contracts that fragmented efforts to improve.ConclusionsMotivating behavior change within ACOs goes beyond financial incentives. ACOs are using a broad range of motivators, including creating ways to make a greater impact on patients and opportunities to be a more effective physician. Overall, it does not appear that ACOs are deploying the full range of available motivators. This suggests an opportunity to develop more sophisticated and wider‐ranging portfolios of motivators to drive behavior change.

Acceptability of Financial Incentives for Health Behaviours: A Discrete Choice Experiment.

BackgroundHealthy behaviours are important determinants of health and disease, but many people find it difficult to perform these behaviours. Systematic reviews support the use of personal financial incentives to encourage healthy behaviours. There is concern that financial incentives may be unacceptable to the public, those delivering services and policymakers, but this has been poorly studied. Without widespread acceptability, financial incentives are unlikely to be widely implemented. We sought to answer two questions: what are the relative preferences of UK adults for attributes of financial incentives for healthy behaviours? Do preferences vary according to the respondents’ socio-demographic characteristics?MethodsWe conducted an online discrete choice experiment. Participants were adult members of a market research panel living in the UK selected using quota sampling. Preferences were examined for financial incentives for: smoking cessation, regular physical activity, attendance for vaccination, and attendance for screening. Attributes of interest (and their levels) were: type of incentive (none, cash, shopping vouchers or lottery tickets); value of incentive (a continuous variable); schedule of incentive (same value each week, or value increases as behaviour change is sustained); other information provided (none, written information, face-to-face discussion, or both); and recipients (all eligible individuals, people living in low-income households, or pregnant women).ResultsCash or shopping voucher incentives were preferred as much as, or more than, no incentive in all cases. Lower value incentives and those offered to all eligible individuals were preferred. Preferences for additional information provided alongside incentives varied between behaviours. Younger participants and men were more likely to prefer incentives. There were no clear differences in preference according to educational attainment.ConclusionsCash or shopping voucher-type financial incentives for healthy behaviours are not necessarily less acceptable than no incentives to UK adults.

The impact of non-financial and financial encouragements on participation in non school-based human papillomavirus vaccination: a retrospective cohort study.

Adolescent vaccination coverage under a system of non school-based vaccination is likely to be suboptimal, but might be increased by targeted encouragement campaigns. We analysed the effect on human papillomavirus (HPV) vaccination initiation by girls aged 12-18 of two campaigns set up in Flanders (Belgium) in 2007 and 2009: a personal information campaign and a combined personal information and financial incentive campaign. We analysed (objective) data on HPV vaccination behaviour from the National Alliance of Christian Mutualities (NACM), Flanders' largest sickness fund. We used z-scores to compare the monthly proportion of girls initiating HPV vaccination over time between carefully selected intervention and control groups. Separate analyses were done for older and younger girls. Total sample sizes of the intervention (control) groups were 221 (243) for the personal information campaign and 629 (5,322) for the combined personal information and financial incentive campaign. The personal information campaign significantly increased vaccination initiation, with older girls reacting faster. One year after the campaign the percentages of vaccination initiation for the oldest girls were 64.6 and 42.8 % in the intervention and control group, respectively (z = 3.35, p = 0.0008); for the youngest girls the percentages were 78.4 and 68.1 % (z = 1.71, p = 0.09). The combined personal information and financial incentive campaign increased vaccination initiation among certain age groups. One year after the campaign the difference in percentage points for HPV vaccination initiation between intervention and control groups varied between 18.5 % (z = 3.65, p = 0.0002) and 5.1 % (z = 1.12, p = 0.26). Under a non school-based vaccination system, personal information and removing out-of-pocket costs had a significant positive effect on HPV vaccination initiation, although the effect substantially varied in magnitude. Overall, the obtained vaccination rates remained far below those realised under school-based HPV vaccination.

The Impact of CFOs’ Incentives and Earnings Management Ethics on their Financial Reporting Decisions: The Mediating Role of Moral Disengagement

Despite regulatory reforms aimed at inhibiting aggressive financial reporting, earnings management persists and continues to concern practitioners, regulators, and standard setters. To provide insight into this practice and how to mitigate it, we conduct an experiment to examine the impact of two independent variables on CFOs’ discretionary expense accruals. One independent variable, incentive conflict, is manipulated at two levels (present, absent) – i.e., the presence or absence of a personal financial incentive that conflicts with a corporate financial incentive. The other independent variable is CFOs' earnings management ethics (“EM-Ethics”, high vs. low), measured as their assessment of the ethicalness of key earnings management motivations. We find that incentive conflict and EM-Ethics interact to determine CFOs’ discretionary accruals such that (a) in the presence of incentive conflict, CFOs with low (high) EM-Ethics tend to give in to(resist) the personal incentive by booking higher (lower) expense accruals; and (b) in the absence of an incentive conflict, CFOs with low (high) EM-Ethics tend to give in to (resist) the corporate incentive by booking lower (higher) expense accruals. We also find support for a mediated-moderation model in which CFOs’ level of EM-Ethics influences their moral disengagement tendencies which, in turn, differentially affect their discretionary accruals, depending on the presence or absence of incentive conflict. Theoretical and practical implications of these findings are discussed.

Do CFOs’ Bonuses and Earning Management Ethics Impact Their Financial Reporting Decisions?

Despite regulatory reforms aimed at inhibiting aggressive financial reporting, earnings management persists and continues to concern practitioners, regulators, and standard setters. To provide insight into this practice and how to mitigate it, we conduct an experiment to examine the impact of two independent variables on CFOs’ discretionary expense accruals. One independent variable, incentive conflict, is manipulated at two levels (present, absent) – i.e., the presence or absence of a personal financial incentive that conflicts with a corporate financial incentive. The other independent variable is CFOs' earnings management ethics (“EM-Ethics”, high vs. low), measured as their assessment of the ethicalness of key earnings management motivations. We find that incentive conflict and EM-Ethics interact to determine CFOs’ discretionary accruals such that (a) in the presence of incentive conflict, CFOs with low (high) EM-Ethics tend to give in to(resist) the personal incentive by booking higher (lower) expense accruals; and (b) in the absence of an incentive conflict, CFOs with low (high) EM-Ethics tend to give in to (resist) the corporate incentive by booking lower (higher) expense accruals. We also find support for a mediated-moderation model in which CFOs’ level of EM-Ethics influences their moral disengagement tendencies which, in turn, differentially affect their discretionary accruals, depending on the presence or absence of incentive conflict. Theoretical and practical implications of these findings are discussed.

Systemic Bias and the Institution of International Arbitration: A New Approach to Arbitral Decision-Making

As international arbitration expands, arbitral decision-making comes under scrutiny, with many raising legitimate questions: how do arbitrators decide? Do they tend to favour certain classes of parties? This article examines arbitral decision-making and puts forward three main propositions. First, that the legal concept of bias needs revisiting. For arbitration law and practice to effectively respond to criticism about the integrity of arbitration, the focus of our inquiry should include not only apparent bias associated with individual arbitrators, but also implicit and systemic bias. Second, the article provides a critical assessment of the existing empirical studies on arbitral decision-making. Although empirical studies have provided useful insight in arbitral judicial behaviour, they all depart from the same behavioural assumption that arbitral decision-making is driven almost exclusively by extra-legal factors, such as the personal traits, policy preferences or financial incentives of individual arbitrators. The article discusses the theoretical and methodological limitations of such a behavioural approach, and it, finally, offers an alternative model for the analysis of arbitral decision-making, which takes into account the influence of the broader institutional context within which arbitrators are embedded. Drawing on institutional theories, the article compares the procedural design of international arbitration with that of national and international judiciaries, and provides a description of the institutional structures of international arbitration and how they can affect the way that arbitrators decide.

The Goose Is (Half) Cooked: a Consideration of the Mechanisms and Interpersonal Context Is Needed to Elucidate the Effects of Personal Financial Incentives on Health Behaviour

While we agree that personal financial incentives (PFIs) may have some utility in public health interventions to motivate people in the uptake and persistence of health behaviour, we disagree with some of the sentiments outlined by Lynagh et al. (Int J Behav Med 20:114-120, 2012). Specifically, we feel that the article gives a much stronger impression that PFIs will likely lead to long-term behaviour change once the incentive has been removed than is warranted by current research. This claim has not received strong empirical support nor is it grounded in psychological theory on the role of incentives and motivation. We also feel that the presentation of some of the tenets of self-determination theory by the authors is misleading. Based on self-determination theory, we propose that PFIs, without sufficient consideration of the mechanisms by which external incentives affect motivation and the interpersonal context in which they are presented, are unlikely to lead to persistence in health behaviour once the incentive is removed. We argue that interventions that adopt PFIs as a strategy to promote health-behaviour change should incorporate strategies in the interpersonal context to minimise the undermining effect of the incentives on intrinsic motivation. Interventions should present incentives as informational regarding individuals' competence rather than as purely contingent on behavioural engagement and emphasise self-determined reasons for pursuing the behaviour.

A farmers' market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics

ObjectiveA 22-week federally qualified health center (FQHC)-based farmers' market (FM) and personal financial incentive intervention designed to improve access to and consumption of fruits and vegetables (FVs) among low-income diabetics in rural South Carolina was evaluated. MethodsA mixed methods, one-group, repeated-measures design was used. Data were collected in 2011 before (May/June), during (August), and after (November) the intervention with 41 diabetes patients from the FQHC. FV consumption was assessed using a validated National Cancer Institute FV screener modified to include FV sold at the FM. Sales receipts were recorded for all FM transactions. A mixed-model, repeated measures analysis of variance was used to assess intervention effects on FV consumption. Predictors of changes in FV consumption were examined using logistic regression. ResultsA marginally significant (p=0.07) average increase of 1.6 servings of total FV consumption per day occurred. The odds of achieving significant improvements in FV consumption increased for diabetics using financial incentives for payment at the FM (OR: 38.8, 95% CI: 3.4–449.6) and for those frequenting the FM more often (OR: 2.1, 95% CI: 1.1–4.0). ConclusionsResults reveal a dose–response relationship between the intervention and FV improvements and emphasize the importance of addressing economic barriers to food access.

Use of advanced imaging and biomarker tests for post-treatment surveillance in early-stage breast cancer survivors.

168 Background: The American Society of Clinical Oncology (ASCO) released a “Top Five” list of opportunities to improve the quality of cancer care. #4 focused on post-treatment surveillance in breast cancer patients treated with curative intent. The ASCO guideline on breast cancer follow up advises against using advanced imaging and biomarkers in this setting. We undertook an examination of the patterns of follow-up care for breast cancer survivors treated at an academic medical center to evaluate use of non-recommended services. Methods: Claims data and medical records were reviewed and abstracted for early stage (0-IIIA) breast cancer survivors starting one year post diagnosis, with an average of 5 years of follow-up data. A trained abstractor classified imaging tests as diagnostic/surveillance based on medical record content. A 10% random sample was abstracted by a second abstractor and compared for concordance. Descriptive statistics were generated for patient demographic and medical characteristics, and proportions for receipt of non-recommended services, including if imaging procedures were performed for diagnostic/surveillance purposes. Multivariate logistic regression modeling was used to determine factors associated with receiving non-recommended services. Results: Records were available for 258 patients. The mean age was 62 (SD 13), mean time since diagnosis was 6 years (SD 2), 66% were stage 0/1. 35% received at least one abdominal CT, 31% at least one chest CT, 20% at least one PET, 30% at least one bone scan. Of these services, 90 abdominal CT scans (47%), 131 chest CT scans (65%), 77 PET scans (90%), and 29 bone scans (26%) were classified as surveillance. 80% received CEA and/or CA 27.29 tests; 8% received CA 15-3 tests. Logistic regression revealed no consistent association of medical, demographic, or provider factors with receiving non-recommended services. Conclusions: Use of non-recommended services for surveillance occurs frequently among early stage survivors. Providers in this academic center had no personal financial incentive for ordering these services. There are opportunities to increase use of guideline concordant post-treatment care for breast cancer survivors.