Professional Incentives Research Articles

Financial and professional incentives in health care

Traditionally in health care and in the public sector more generally, little thought has been given to the impact of provider‐oriented incentives on the delivery of services. There has been an assumption that the language of incentives belonged to the private sector and was inappropriate in the public sector. Instead, the governance of health care has relied on the professional ethos of clinicians to direct decision making. Implicitly there has been an expectation that the ethical stance of clinicians would ensure that their actions were always in the best interest of patients. However, in the context of a heightened awareness of cost constraints there has been a greater emphasis on the active management of resources in medical organizations. This article argues that the structure of incentives in health care is highly significant in resource allocation, as medical ethics does not provide an unambiguous guide to clinical decision making. The paper defines the nature of the financial and professional incentives in medical organizations and discusses their impact on the delivery of services through an analysis of positive and negative effects. By undertaking a comparison between the UK and Canada, the paper identifies the differential nature of the incentives present in the health care systems of these two countries and discusses some of their consequences.

Legal Aid in the Eye of a Storm: Rationing, Contracting, and a New Institutionalism

This article discusses possible rationales underlying a legal aid system through an articulation of theories of distribution in the legal services market, considers the idea of prioritization and planning or, in the political vernacular, rationing of public funding, and addresses the impact of economic and social theories of the professions on legal aid structures. Finally, the emerging concepts of '‘new‐institutionalism’ and ‘new public management’ are introduced to indicate the organizational and sociological complexity of reforming the legal services market. Each of these threads illustrate competing values and institutional influence on publicly funded legal services. Bureaucratic rules mix with professional and economic incentives to articulate entitlement to public money in a predominantly private forum. Drawing on research in the field of rationing health care, sociological and economic work on legal services, and organizational theories, it will be demonstrated that conceptual, policy, and research tools need to play closer attention to this competition of values.

Towards general practice-led integrated healthcare in New Zealand.

New Zealand's recent painful experience of health system reforms has shown that professional incentives are more powerful than market incentives, and that medical leadership, with accountability for both cost and quality, may be the key to success.

Is the System Dynamics Society ready for virtual proceedings: some empirical findings and recommendations for action

As methods of publishing documents have moved from paper to a wide variety of electronic formats, the publication policies of the System Dynamics Society have also changed from full-text paper proceedings to a mix of paper abstracts, and CD-ROM and Web-based full-text documents. These changes have been instituted not only to facilitate access to documents, but also to save the considerable cost of publishing full-text volumes for conferences. Interview research at the 1997 System Dynamics Conference in Istanbul, Turkey looked at participants' access to and use of electronic information technologies for full-text conference articles. Interviewees reported lack of technology, insufficient knowledge about technologies, lack of professional incentives, and institutional demands as barriers to the use of strictly paperless dissemination of information. The Society will need to consider a multi-step transition to electronic proceedings, serving as an educator as well as clarifying the roles of the proceedings and the journal for dissemination of differing sorts of information about research in this field. Although it seems clear that the future lies in electronic communication, the speed and method of getting there need careful consideration. © 1998 John Wiley & Sons, Ltd.

Beyond guidelines: promoting clinical change in the real world

There is widespread recognition that simply publishing research findings is not enough to ensure that they are carried into clinical practice. One response to this has been the burgeoning "guidelines movement" of recent years, which has now reached the stage of generating guidelines for the production of guidelines. Argues that guidelines, and other forms of intervention to change clinical practice in an evidence-based direction, will succeed only to the extent that they engage actively with the real world of clinical decision making. This world is more complex than guidelines writers acknowledge, and includes economic, administrative, professional and personal incentives as well as those provided by research evidence. Engaging with this real world may be difficult, but it opens up new possibilities for understanding how clinicians act and how evidence may be used to inform clinical practice. Such possibilities include social influences, educational outreach, providing information to patients, negotiating local coalitions on specific issues and changing the administrative environment.

Making alternative agriculture research policy

AbstractThe policies influencing the American agricultural research agenda are developed by Congress, the U.S. Department of Agriculture, and the 58 state agricultural experiment stations of the land-grant university system, with input from various advisory groups. Despite the slow pace of change in the agricultural research agenda, there are no special barriers keeping the research system from adapting to contemporary and alternative agriculture issues. Rather, agricultural researchers have neither appropriate professional incentives nor sufficient financial incentives to shift toward alternative agriculture. Public intervention to alter these incentives has been thwarted because agricultural research institutions set their agendas through obscure processes. Five areas of policy change that could improve the prospects for evolution of a significant alternative agriculture research agenda are: 1) imposing a means test for formula fund payment limitations to states, with saved funds directed toward alternative agriculture research; 2) making priority setting a condition for receiving federalfunds for agricultural research to make the research agenda-setting process clearer to all interested parties; 3) requiring that federally funded research programs be categorized by the specific social goals toward which they are directed, to aid in judgments about the relevance of specific public agricultural research programs; 4) requiring information on research programs to be reported in a way that is specifically relevant to the alternative agriculture agenda; 5) formally involving public citizens and farmers in reviewing agricultural research grants to assure that the usefulness of proposed research is weighed along with scientific merit. These proposals complement current interest in making science generally more responsive to national priorities, and are entirely feasible within current agricultural research policy processes. Their effectiveness, however, is limited by the shrinking influence of federal funding in the state agricultural experiment station system, and they are only incremental changes within the existing system rather than radical reforms toward an alternative research system.

The Economics of Law Firms: A Study in the Legal Organization of the Firm

Previous articleNext article No AccessThe Economics of Law Firms: A Study in the Legal Organization of the FirmJack Carr and Frank MathewsonJack Carr Search for more articles by this author and Frank Mathewson Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by The Journal of Law and Economics Volume 33, Number 2Oct., 1990 Sponsored by The University of Chicago Booth School of Business and The University of Chicago Law School Article DOIhttps://doi.org/10.1086/467207 Views: 23Total views on this site Citations: 25Citations are reported from Crossref Copyright 1990 The University of ChicagoPDF download Crossref reports the following articles citing this article:Marie-Laure Vandenhaute, Kris Hardies, Diane Breesch Professional and Commercial Incentives in Audit Firms: Evidence on Partner Compensation, European Accounting Review 29, no.33 (Jul 2019): 521–554.https://doi.org/10.1080/09638180.2019.1642223Niels Philipsen, Qi Zhou Business Restrictions in the Legal Professions: Do We Need More Market Integration?, (Jan 2016): 211–238.https://doi.org/10.1007/978-3-662-48273-5_9Camille Chaserant, Sophie Harnay Self-regulation of the legal profession and quality in the market for legal services: an economic analysis of lawyers’ reputation, European Journal of Law and Economics 39, no.22 (Oct 2013): 431–449.https://doi.org/10.1007/s10657-013-9420-1Gregory K. Dow Partnership markets with adverse selection, Review of Economic Design 18, no.22 (Jun 2013): 105–126.https://doi.org/10.1007/s10058-013-0145-yCamille Chaserant, Sophie Harnay Déréglementer la profession d'avocat en France ?, Revue internationale de droit économique t.XXIV, no.22 (Jul 2010): 147–183.https://doi.org/10.3917/ride.242.0147Nuno Garoupa Providing a Framework for Reforming the Legal Profession: Insights from the European Experience, European Business Organization Law Review 9, no.33 (Feb 2015): 463–495.https://doi.org/10.1017/S1566752908004631N. Garoupa, F. Gomez-Pomar Cashing by the Hour: Why Large Law Firms Prefer Hourly Fees over Contingent Fees, Journal of Law, Economics, and Organization 24, no.22 (Nov 2007): 458–475.https://doi.org/10.1093/jleo/ewm063Nuno M. Garoupa Regulation of Professions in the US and Europe: A Comparative Analysis, SSRN Electronic Journal (Jan 2005).https://doi.org/10.2139/ssrn.640502Benito Arruñada Managing Competition in Professional Services and the Burden of Inertia, SSRN Electronic Journal (Jan 2005).https://doi.org/10.2139/ssrn.859245John Romley, Eric L. Talley Uncorporated Professionals, SSRN Electronic Journal (Jan 2004).https://doi.org/10.2139/ssrn.587982Mark Davies The Regulatory Crisis in the Solicitors' Profession, Legal Ethics 6, no.22 (May 2015): 185–216.https://doi.org/10.1080/1460728X.2003.11424190Nuno M. Garoupa, Fernando Gomez-Pomar Cashing by the Hour: Why Large Law Firms Prefer Hourly Fees Over Contingent Fees, SSRN Electronic Journal (Jan 2003).https://doi.org/10.2139/ssrn.394305Jack Carr, Frank Mathewson Law Firms, (Jan 2002): 1155–1158.https://doi.org/10.1007/978-1-349-74173-1_217Larry E. Ribstein Partnership, (Jan 2017): 1410–1413.https://doi.org/10.1007/978-1-349-74173-1_268Larry E. Ribstein, Bruce H. Kobayashi Joint Ventures, (Jan 2017): 1034–1038.https://doi.org/10.1007/978-1-349-74173-1_196Peter Bardsley, Katerina Sherstyuk Rat Races and Glass Ceilings: Career Paths in Organizations, SSRN Electronic Journal (Jan 2001).https://doi.org/10.2139/ssrn.292188Stanley B. Malos, Michael A. Campion Human Resource Strategy and Career Mobility in Professional Service Firms: A Test of an Options-Based Model, Academy of Management Journal 43, no.44 (Aug 2000): 749–760.https://doi.org/10.5465/1556365LAURENCE VAN LENT THE ECONOMICS OF AN AUDIT FIRM: THE BENEFITS OF PARTNERSHIP GOVERNANCE, The British Accounting Review 31, no.22 (Jun 1999): 225–254.https://doi.org/10.1006/bare.1998.0087Mark Davies Wither mutuality? A recent history of solicitors’ professional indemnity insurance, International Journal of the Legal Profession 5, no.11 (Mar 1998): 29–61.https://doi.org/10.1080/09695958.1998.9960441Peter Newman P, (Jan 1998): 1–198.https://doi.org/10.1007/978-1-349-14286-6_1Tadiboyina Venkateswarlu Law and Economics Course Readings: A Survey of North American Universities, The American Economist 41, no.11 (Mar 1997): 89–93.https://doi.org/10.1177/056943459704100110Benito Arru�ada The economics of notaries, European Journal of Law and Economics 3, no.11 (Mar 1996): 5–37.https://doi.org/10.1007/BF00149081Richard A. Posner The sociology of the sociology of law: A view from economics, European Journal of Law and Economics 2, no.44 (Dec 1995): 265–284.https://doi.org/10.1007/BF01541067Stanley B. Malos, Michael A. Campion An Options-Based Model Of Career Mobility in Professional Service Firms, Academy of Management Review 20, no.33 (Jul 1995): 611–644.https://doi.org/10.5465/amr.1995.9508080332Steven C. Hackett Heterogeneity and Share Contracting in Medical Group Practices, International Journal of the Economics of Business 2, no.11 (May 2011): 103–121.https://doi.org/10.1080/758521099

Quality and the use of time in general practice: widening the discussion.

To examine the association between different consulting styles in general practice (defined according to the average length of doctor-patient contact time in surgery consultations) and the process of care for those patients presenting with new episodes of respiratory illness, 1787 consultations conducted by 85 general practitioner principals in Lothian from November 1987 to May 1988 were analysed. Short as against long consultations resulted in less attention being given to psychosocial issues that the doctor recognised as relevant. When psychosocial problems were dealt with prescribing of antibiotics decreased. In this volunteer sample of doctors the process of care seemed to reflect decisions as to how time was allocated rather than inherently different patterns of clinical behavior. Organisational and contractual changes will shift the mix of financial and professional incentives for general practitioners in ways that could lead to doctors reallocating their time toward shorter consultations; such a reallocation could have important implications for patient care.

Cost Containment: Challenging Fidelity and Justice

Cost containment heralds a general tightening of health care funds, which subjects every health care intervention to scrutiny for its economic as well as its medical wisdom and imposes upon physicians a variety of controls and incentives. Fiduciary fidelity is challenged by the conflict between clinical authority and patient loyalty, by financial and professional incentives that pit the physician's own interests against those of his or her patients, by the stratification of resources which results in greater scarcity of funds for indigent care, and by standardization of care through the implementation of "efficiency protocols." Questions of clinical justice are analyzed in the areas of distribution of medical services and of contractual relations among patient, payer, physician, and institution.

Family doctors and innovation in general practice.

Family doctors have been presented with changes in government policies and incentives in a recent white paper on primary care. Little work has been done, however, to find out how general practitioners respond to such measures. The response of general practitioners to professional and economic incentives was examined in relation to the location of the practice and the characteristics of the practitioners in seven different areas of England. The areas represented urban, rural, affluent, and deprived communities. The overall response rate was 74%, but the response varied among the areas, being poorest (64%) in an inner city area. Practices were subdivided as innovative, traditional, or intermediate, according to whether they employed a nurse and participated in the cost rent scheme and the vocational training scheme. Innovative practices were defined as fulfilling two of these criteria and traditional practices as fulfilling none; the remainder were classed as intermediate. The results showed that these three types of practice had distinct strategies that were related to financial constraints and the local population. Innovative practices had more partners and were often located in rural or affluent suburban areas; traditional practices had fewer partners and were more common in urban and working class areas. Innovative practices seemed to be in the best position to increase their services, and hence their incomes, in response to the recent proposals in the white paper. Practices in areas of developmental difficulty (predominantly urban but not necessarily inner city areas) had been less able to respond to existing incentives and had a smaller margin available for developing their services. In view of the effect of local constraints of economics and population on the strategy of practices, concentrating resources for primary care in local budgets for working class and urban areas may be preferable to extending the system of charging fees for services provided by family doctors.

Family doctors: their choice of practice strategy.

The economic decisions taken by family doctors in one family practitioner area in the north of England were examined. There was evidence of a differential response to professional and economic incentives by a group of "high investing" practices. On five indicators of improvement in practice 32% of the practices accounted for 71% of the positive scores. Nearly all the high investing practices were in affluent areas; they were on average larger and had younger partners than the other practices. The high investing practices also faced more financial problems. There was evidence that older doctors with long lists of patients had a different strategy of income maximization. Innovation in primary care is not determined by attitude alone but also by objective factors such as age, location, and size of the practice.

Decentralised budgeting and care for the elderly

With the elderly, as with other client groups, financial and professional incentives have pushed towards institutional care ‐ in hospital or residential home. One experiment in decentralised budgeting shows that it is possible to reverse those incentives and achieve better, more cost‐effective care.

Science and the media: the boundaries of truth.

Prologue: In the fast-paced world of journalism, science writers are a special breed: well-trained, conversant in a wide range of health and medical subjects, and prepared at a moment's notice to translate for readers the meaning of the latest technological breakthrough. In the last year, their calls to action have been Barney Clark, Baby Fae, and, most recently, Bill Schroeder. At the same time, though, they often are viewed within their profession as the backbenchers of big-time journalism, experts in the scientific arcane whose subject matter only occasionally merits page-one attention or prime-time television coverage. What drives these journalists? What pressures are they subjected to as they strive to unravel the mysteries of science for an interested public and advance their own careers? In a landmark study, Jay Winsten, director of the Office of Health Policy Information at the Harvard School of Public Health, set out three years ago to answer these questions in an examination of how news judgments are shaped by organizational, economic, and professional incentives in the news business. He based his findings on interviews with science reporters and editors who are regarded as the best in the business. Winsten had impeccable credentials to undertake this project. He holds a Ph.D. in molecular biology from The Johns Hopkins University and has devoted considerable time to freelance writing for The Wall Street Journal, The Christian Science Monitor , and The New York Times . Winsten's Office of Health Policy Information serves as a resource center for federal and state policymakers and for journalists. The next project in his research on the impact of the mass media on public understanding of science and health policy involves the development of a primer to help scientists work more effectively with science writers.

The Conglomeration Syndrome in Medical Schools ‐‐ an acute example of leadership difficulties in universities and colleges

Tertiary education is a complex, expensive and socially important activity, and medical education is perhaps archetypal of that process. The complexity of the typical medical faculty probably exceeds most other tertiary schools and faculties, largely because the majority of medical educators are committed to patient care, in addition to the usual teaching, research and administrative tasks. Additional demands have been placed upon medical educators by the relatively recent information explosion in biology and medicine, which has increased further the scope and depth of modern medical education. Furthermore, newer concepts of health care and health maintenance, and rising public expectations concerning health services, have placed considerable pressure on medical educators to produce not only more graduates, but graduates who are better equipped to meet the current needs of society. In these circumstances, it soon became obvious that medical education had to be expanded, re-formed and re-organised in terms of style and content, if it was going to fulfil its obligations to society. This process is by no means complete, but the changes which have been introduced have met with some degree of resistance and conflict, and they have tended to complicate rather than simplify medical education. Consequently, additional stress has been placed upon the organisation and administration of medical faculties. Although medical education has grown in size, complexity and social and economic importance, until it now rivals large organisations in the government and private sectors, it seems to have been largely ignored by organisational researchers. It is unlikely that medical educators will themselves investigate the organisation and administration of medical education, for there are no significant professional, career or financial incentives in this area of research (Walton, 1981), and most medical educators have neither the aptitude, talent nor inclination to work in this area (Rogers & Blendon, 1978). It is for these reasons that the administration and organisation of medical education is not being studied adequately, and this is a cause of concern for at least a few medical educators (for example, Ingersoll, 1975; Maddison, 1978; Walton, 1981), but what areas are in need of immediate attention? If medical schools are to cope satisfactorily with the various challenges, demands and responsibilities which presently confront them, then effective leadership, which is believed to be critical to the success of a teaching establishment (Alty, Gorman & Baker, 1981), and indeed to the success of any organisation (Hersey & Blanchard, 1977; Rheinhart, 1981; Sinetar, 1981), will be a decisive factor in determining how

Policies To Influence the Spatial Distribution of Physicians: A Conceptual Review of Selected Programs and Empirical Evidence

To increase the usefulness of existing physician location literature for policy evaluation, literature is grouped into intraurban and urban-rural studies. A conceptual overview of physician location literature is presented. Consensus results, if any, are discussed. A list of hypotheses suggested by the literature is then utilized in a discussion of economic social, prior exposure, and professional development incentives embodied in selected public and private sector programs. Programs are evaluated by type of incentive mechanism and geographic target area to determine if present program structures are based on a solid empirical foundation. This assessment indicates that, in general, use of prevalent location incentive mechanisms is not justified by a consensus of empirical evidence.

Academic and Professional Incentives

Academic and Professional Incentives

The Determination of Interest Rates

Previous articleNext article No AccessThe Determination of Interest RatesCharles Frederick Roos, and Victor Von SzeliskiCharles Frederick Roos Search for more articles by this author , and Victor Von Szeliski Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Journal of Political Economy Volume 50, Number 4Aug., 1942 Article DOIhttps://doi.org/10.1086/255904 Views: 19Total views on this site Citations: 2Citations are reported from Crossref PDF download Crossref reports the following articles citing this article:Oddný Helgadóttir Seeing like a macroeconomist: varieties of formalisation, professional incentives and academic ideational change, New Political Economy 27, no.33 (Aug 2021): 426–440.https://doi.org/10.1080/13563467.2021.1967910Adrian C. Darnell BOWLEY, WICKSELL AND THE DEVELOPMENT OF MATHEMAATICAL ECONOMICS, Scottish Journal of Political Economy 29, no.22 (Jun 1982): 156–180.https://doi.org/10.1111/j.1467-9485.1982.tb00445.x