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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

AbstractImproving 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.

Topics: Incentive (65%), Incentive program (62%), Behavior change (52%)

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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...

232 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.
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66 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.
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17 citations


Journal ArticleDOI
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13 citations


References
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Journal ArticleDOI
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...

1,457 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.

531 citations


Book Chapter
01 Jan 2003
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)

89 citations


Journal ArticleDOI
Abstract: This paper develops a framework to analyze the value of information in the context of health plan choice. We 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. We estimate the parameters of the model with simulated maximum likelihood, and use the estimates to quantify the value of the report card information. We model both continuous specifications with Gaussian priors and signals, and discrete specifications with Beta priors and Binomial signals. We find that the release of information had a statistically significant effect on health plan choices. Consumers were willing to pay about $330 per year per below expected performance rating avoided, and the average value of the report card per employee was about $20 per year. We find large variation in valuations across different performance domains, but no significant evidence of heterogeneity based on observable employee characteristics or unobservable dimensions.

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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.

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