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Journal Article

Principles to Guide the Development of Population Health Incentives

15 Aug 2010-Preventing Chronic Disease (National Center for Chronic Disease Prevention and Health Promotion)-Vol. 7, Iss: 5
TL;DR: A wide range of financial and non-financial incentives are available to encourage efficient behaviors and discourage costly and unproductive ones as discussed by the authors, but evidence for the beneficial effects of incentive programs has not yet emerged, partly because such evidence must show how behaviors have changed because of the incentive.
Abstract: Improving population health is not simple. Many instruments are available for changing behavior and consequent outcomes. However, the following basic principles should guide development of any incentive arrangement: 1) identify the desired outcome, 2) identify the behavior change that will lead to this outcome, 3) determine the potential effectiveness of the incentive in achieving the behavior change, 4) link a financial incentive directly to this outcome or behavior, 5) identify the possible adverse effects of the incentive, and 6) evaluate and report changes in the behavior or outcome in response to the incentive. A wide range of financial and nonfinancial incentives is available to encourage efficient behaviors and discourage costly and unproductive ones. Evidence for the beneficial effects of incentive programs has been slow to emerge, partly because such evidence must show how behaviors have changed because of the incentive. Nevertheless, the potential for incentive programs in health care seems large, and research should support their design and assess their effect.

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Citations
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TL;DR: In this paper, an integration of views about social marketing is proposed that is focused on the core roles of audience benefits; analysis of behavioral determinants, context and consequences; the use of positioning, brand and personality in marketing strategy development; and use of the four elements of the marketing mix to tailor offerings, realign prices, increase access and opportunities; and communicate these in an evolving media environment.
Abstract: Purpose – Social marketing has evolved differently in the developing and developed worlds, at times leading to different emphases on what social marketing thought and practice entail. This paper aims to document what those differences have been and provide an integrative framework to guide social marketers in working with significant social and health issues.Design/methodology/approach – An integration of views about social marketing is proposed that is focused on the core roles of audience benefits; analysis of behavioral determinants, context and consequences; the use of positioning, brand and personality in marketing strategy development; and use of the four elements of the marketing mix to tailor offerings, realign prices, increase access and opportunities; and communicate these in an evolving media environment.Findings – Ideas about branding and positioning, core strategic social marketing concerns, have been better understood and practiced in developing country settings. Social marketing in developi...

266 citations

Journal ArticleDOI
TL;DR: A systematic review exploring acceptability of financial incentives for encouraging healthy behaviours found that financial incentives tend to be acceptable to the public when they are effective and cost-effective.

73 citations

Journal ArticleDOI
TL;DR: Incentives to help make healthy choices the easy choices for individuals, operating at the levels of the individual, producers and service providers, and governments are discussed.
Abstract: This article discusses incentives to help make healthy choices the easy choices for individuals, operating at the levels of the individual, producers and service providers, and governments. Whereas paying individuals directly to be healthier seems to have a limited effect, offering financial incentives through health insurance improves health. Changing the environment to make healthier choices more accessible acts as an incentive to improve health. Employers can provide incentives to improve the health of their employees. Producers and service providers can take voluntary action to make their products less harmful, and they can be nudged into marketing healthier products within a regulatory environment. International agreements and monitoring systems can incentivize governments to do more for health. Lessons from climate change adaptation suggest that multilevel governance and policy integration are greater obstacles to policy change and implementation than knowing what has to be done. Policy change and implementation are triggered by many drivers, many of which are side effects of other policy pressures rather than of the direct policy goal itself. Effective action to reduce noncommunicable diseases will require leveraging social networks into a new ways of thinking about health; making better health prestigious and aspirational, and giving health and wellness a brand that encourages positive behavior change.

28 citations

Journal Article
TL;DR: The essay analyses the role of mobile technology for public health by using 4 Ps of marketing mix-products and services, price, place, and promotion from social marketing perspective and also shows how it helps for democratizing public health programs in the developing world.
Abstract: Mobile technology is emerging as the first extensive form of electronic communication which is culturally and socially feasible and appropriate for strengthening health system. As a public health intervention, the world of mobile is just beginning. The essay analyses the role of mobile technology for public health by using 4 Ps of marketing mix-products and services, price, place, and promotion from social marketing perspective and also show how it helps for democratizing public health programs in the developing world.

18 citations

Journal ArticleDOI
TL;DR: Experimental evidence is offered on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.
Abstract: Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy. However, little is known about how to translate incentive-based strategies to public health practice geared toward improving population-level health, and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail. This study reports results of a population-based randomized controlled trial testing a direct mail, incentive-based intervention for promoting mammography uptake. The study population was composed of a random sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening. Participants ( N = 18,939) were randomized into three groups: (1) Direct Mail only, (2) Direct Mail plus Incentive, and (3) Control. Both direct mail groups received two mailers with a message about the importance of mammography; however, Mail plus Incentive mailers also offered a $25 incentive for getting a mammogram. Logistic regression analyses measured intervention effects. Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups. The use of incentives also proved to be cost-effective. Additionally, the Direct Mail only group was more likely to receive mammography than the Control group. Findings offer experimental evidence on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.

14 citations

References
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Journal ArticleDOI
TL;DR: In this paper, the authors present examples from society in general, and from organizations in particular, of reward systems that "pay off" for one behavior even though the rewarder hopes dearly for another.
Abstract: Illustrations are presented from society in general, and from organizations in particular, of reward systems that “pay off” for one behavior even though the rewarder hopes dearly for another. Porti...

1,496 citations

Journal ArticleDOI
TL;DR: This publication contains reprint articles for which IEEE does not hold copyright and which are likely to be copyrighted.
Abstract: Whether dealing with monkeys, rats, or human beings, it is hardly controversial to state that most organisms seek information concerning what activities are rewarded, and then seek to do (or at least pretend to do) those things, often to the virtual exclusion of activities not rewarded. The extent to which this occurs of course will depend on the perceived attractiveness of the rewards offered, but neither operant nor expectancy theorists would quarrel with the essence of this notion. Nevertheless, numerous examples exist of reward systems that are fouled up in that behaviors which are rewarded are those which the rewarder is trying to discourage, while the behavior he desires is not being rewarded at all. In an effort to understand and explain this phenomenon, this paper presents examples from society, from organizations in general, and from profit making firms in particular. Data from a manufacturing company and information from an insurance firm are examined to demonstrate the consequences of such reward systems for the organizations involved, and possible reasons why such reward systems continue to exist are considered.

579 citations

Book Chapter
01 Jan 2003
TL;DR: A review of the current evidence on the effect of pay and non-pay incentives on health workers' performance and motivation is presented in this paper, where the authors focus on the structural and organisational aspects of incentives.
Abstract: The World Health Report 2000, Health Systems: Improving Performance, defines incentives as “all the rewards and punishments that providers face as a consequence of the organisations in which they work, the institutions under which they operate and the specific interventions they provide” This definition suggests that the organisation, the work that is done and the setting in which work takes place will determine the incentive used and its resulting impact. Buchan et al add another dimension by defining an incentive in terms of its objective: “An incentive refers to one particular form of payment that is intended to achieve some specific change in behaviour” (2). This review is intended to provide an overview of the current evidence on the effect of pay and non-pay incentives on health workers’ performance and motivation. The literature on incentives is primarily focused on the impact of specific incentives on provider behaviour, especially physicians. There is much less work on the structural and organisational aspects of incentives. This paper primarily uses as its base two papers recently completed for WHO and in publication (2, 3). The first paper is based on a search of English language publications, using library and CD-ROM facilities. The review as reported by Buchan et al covered the following databases: Social Science Citation Index (SSCI), BIDS, CHNAHL, Psyc Lit, FirstSearch, Medline and Health Management Information Consortium (HMIC). A total of 352 articles and papers were identified. The paper by Hicks and Adams is based on ten country case studies using a common framework for analysis developed by WHO. The countries in the study (Bahrain, Bangladesh, Cote d’Ivoire, Estonia, Ghana, Islamic Republic of Iran, Kyrgyzstan, Mongolia, Nepal and New Zealand)

91 citations

Journal ArticleDOI
TL;DR: In this article, the authors use a Bayesian learning model to estimate the impact and value of information using data from a large employer, which started distributing health plan ratings to its employees in 1997.

70 citations

Journal ArticleDOI
TL;DR: It is argued that economists should take a more active role in shaping individuals’ health habits, and findings from psychology offer incentive-based approaches; specifically, contingency management (CM).
Abstract: New evidence suggests that individuals do not always make rational decisions, especially with regard to health habits. Smoking, misuse of alcohol, overeating and illicit drug use are leading causes of morbidity and mortality. Thus, influencing health habits is critical for improving overall health and well-being. This editorial argues that economists should take a more active role in shaping individuals’ health habits. Two recent innovations in economic theory pave the way. One change is that some economists now view rationality as bounded and willpower in short supply. Another, related to the first, is a more accepting perspective on paternalism, authorizing economists to help individuals make better choices when the neoclassical model breaks down. Findings from psychology offer incentive-based approaches; specifically, contingency management (CM). Economists could use this approach as a basis for developing public and private policies.

54 citations