1
|
Guo M, Guo L, Li Y. Nonprofit behavior altered by monetary donations: evidence from the U.S. hospice industry. Eur J Health Econ 2024; 25:207-220. [PMID: 36913132 DOI: 10.1007/s10198-023-01571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
This study investigates whether reliance on monetary donations alters nonprofit firms' behaviors. Specifically, in the hospice industry, a shorter patients' length of stay (LOS) speeds up overall patient turnover, allowing a hospice to serve more patients and expand its donation network. We measure hospices' donation reliance using the donation-revenue ratio, which indicates the importance of donations for revenue structure. By exploiting the supply shifter of donation, we adopt the number of donors as an instrument to control for the potential endogeneity issue. Our result suggests that a one-percentage-point increase in the donation-revenue ratio decreases patient LOS by 8%. Hospices that are more reliant on donations serve patients diagnosed with diseases that have shorter life expectancies to achieve a lower average LOS of all patients' stay. Overall, we find that monetary donations alter the behavior of nonprofit organizations.
Collapse
Affiliation(s)
- Miao Guo
- College of Finance and Statistics, Hunan University, Changsha, China
| | - Lei Guo
- School of Government, University of Chinese Academy of Social Science, Beijing, China
| | - Yang Li
- School of Economics, Faculty of Humanities and Social Sciences, The University of Nottingham Ningbo China, Room 310-2 IEB, 199 Taikang East Road, Ningbo, 315100, China.
| |
Collapse
|
2
|
Shen Y, Wang J, Wang J, Nicholas S, Maitland E, Lv M, Yin T, Zhu D. Effectiveness of financial incentives on influenza vaccination among older adults in China: a randomized clinical trial. Clin Microbiol Infect 2024:S1198-743X(24)00062-4. [PMID: 38341143 DOI: 10.1016/j.cmi.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To investigate the short-term and long-term effectiveness of different levels of financial incentives on increasing the willingness to vaccinate and vaccine uptake. METHODS A randomized controlled trial was conducted to investigate the effectiveness of financial incentives of three groups with monetary incentives (CNY 20, CNY 40, and CNY 60; 1 CNY = 0.13 EUR) vs. a control group-CNY 0-on influenza vaccine uptake among 720 older adults (≥60 years) in Beijing, China. The primary outcome was vaccine uptake, and the secondary outcomes were intention to vaccinate and length of time to immunization. RESULTS Financial incentive significantly promoted higher intention to influenza vaccination (120/178 [67.42%] vs. 442/542 [81.55%]; Relative Risk [RR], 1.21; 95% CI, 1.02-1.42) and higher vaccination participation (74/178 [41.57%] vs. 316/542 [58.30%]; RR, 1.39; 95% CI, 1.10-1.75). CNY 60 had the largest impact on the intention to vaccinate (15.00% vs. 13.48% and 13.90%) and vaccination uptake (19.42% vs. 14.05% and 16.67%) compared with CNY 20 and CNY 40. Time to vaccination was significantly lower among participants receiving incentives than those without ([37.21 days; 95% CI, 34.33-39.99] vs. [48.27 days; 95% CI, 43.47-53.07]; Hazard Ratio [HR] 1.57, 95% CI 1.22-2.03). We found no long-term influence of financial incentives on vaccination decisions in the following year (217/542, 40.04% vs. 65/178, 36.52%; RR 1.08, 95% CI 0.82-1.42). DISCUSSION Our study suggests that modest financial incentives will boost short-term influenza vaccination rates and shorten the length of time to immunization in China. No one single-time financial incentive had a long-term effect on future vaccination behaviours or helped establish regular vaccination behaviours.
Collapse
Affiliation(s)
- Yang Shen
- School of Public Health, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Jingyu Wang
- School of Public Health, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China; Center for Health Economics and Management at School of Economics and Management, Wuhan University, Wuhan, China
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia; Australian National Institite of Management and Commerce, Eveleigh, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Min Lv
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China.
| | - Tao Yin
- Department of Technology, Capital Institute of Pediatrics, Beijing, China.
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China; International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing, China.
| |
Collapse
|
3
|
Bairavi J, Gardner DSL, Yeoh E, Tham KW, Gandhi M, Tan NC, Lee PC, Lim RSM, Adamjee T, Cheung YB, Bee YM, Finkelstein EA. Protocol update and baseline characteristics for the TRIal to slow the Progression of Diabetes (TRIPOD) randomized controlled trial. Trials 2023; 24:728. [PMID: 37964330 PMCID: PMC10647071 DOI: 10.1186/s13063-023-07770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D), a major risk factor for cardiovascular disease and other adverse health conditions, is on the rise in Singapore. TRIPOD is a randomized controlled trial aimed to determine whether complementing usual care with an evidence-based diabetes management package (DMP) -comprising access to an evidence-based app, health coaching, pedometer, glucometer and weighing scale, with or without a financial rewards scheme (M-POWER rewards), can improve mean HbA1c levels at months 6 and 12. METHODS The protocol was published in Trials, accessible via https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3749-x 1. This manuscript updates the protocol with changes to the study design due to challenges with recruitment and presents baseline characteristics. Key updates include changing the arm allocation ratio from 1:1:1 (Arm 1-Usual Care: Arm 2-DMP: Arm 3-DMP+M-POWER rewards) to 10:1:10, the sample size from 339 to 269, the intervention period from two to one year, and the primary hypothesis to focus solely on differences between Usual Care and DMP+M-POWER rewards. Recruitment for the study began on 19 October 2019 and ended on 4 June 2022. RESULTS The average age of participants was 55.0 (SD9.7) years old and 64.2% were male. The majority of participants (76.8%) were Chinese, 4.9% Malay and 18.3% Indian and of other ethnicities. 67.0% had a monthly household income of SGD$4000 or more. The mean baseline HbA1c was 8.10% (SD 0.95) and the mean body mass index was 26.8 kg/m2 (SD 5.3). DISCUSSION The final participant completed month 12 follow-up data collection on 8 June 2023. All pre-planned analyses will be conducted and final results reported. TRIAL REGISTRATION ClinicalTrials.gov NCT03800680 . Registered on 11 January 2019.
Collapse
Affiliation(s)
- Joann Bairavi
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Daphne Su-Lyn Gardner
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ester Yeoh
- Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, 730676, Singapore
| | - Kwang Wei Tham
- Endocrinology Services, Woodlands Health, 2 Yishun Central 2, Singapore, 768024, Singapore
| | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Biostatistics, Singapore Clinical Research Institute, 31 Biopolis Way, Singapore, 138669, Singapore
| | - Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, 167 Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Robyn Su May Lim
- Health Promotion Board, 3 Second Hospital Avenue, Singapore, 168937, Singapore
| | - Thofique Adamjee
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore, 768828, Singapore
| | - Yin Bun Cheung
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Eric Andrew Finkelstein
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| |
Collapse
|
4
|
Kerman N, Nisenbaum R, Durbin A, Wang R, Kozloff N, Hwang SW, Stergiopoulos V. A Pragmatic Randomized Controlled Trial of Financial Incentives in Case Management for Homeless Adults With Mental Illness. Psychiatr Serv 2023; 74:823-829. [PMID: 36820517 DOI: 10.1176/appi.ps.20220392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Financial incentives can facilitate behavior change and service engagement in health care settings, but research on their use with adults experiencing homelessness is limited. This study examined the effectiveness of financial incentives in improving service engagement and health outcomes among homeless adults with mental illness in Toronto. METHODS The authors of this randomized controlled trial recruited 176 participants receiving brief multidisciplinary case management services for homeless adults with mental illness after hospital discharge. In a 1:1 randomization design, 87 participants received a financial incentive of CAN$20 for every week they remained engaged with the service for up to 6 months. The remaining 89 participants received treatment as usual. The primary outcome was service contact rates for up to 6 months of follow-up. Secondary outcomes included self-reported health status, mental health symptoms, substance use, quality of life, housing stability, acute health service use, and working alliance. Negative binomial regression models, analyses of covariance, generalized estimating equations models, and Wilcoxon rank sum tests were used to examine differences between the financial incentive and treatment-as-usual groups across outcomes of interest. RESULTS No significant differences were found between the financial incentive and treatment-as-usual groups in service contact rates or any of the secondary outcomes examined over the 6-month period. CONCLUSIONS In low-barrier, brief case management programs tailored to the needs of adults experiencing homelessness, financial incentives may not affect service engagement or health outcomes. Further research is needed to identify the effect of financial incentives on engagement in other services, including housing-based interventions.
Collapse
Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Rosane Nisenbaum
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Anna Durbin
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Ri Wang
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Stephen W Hwang
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| |
Collapse
|
5
|
Okubo Y, Nishi A, Uda K, Miyairi I, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yasunaga H. Financial incentives for infection prevention and antimicrobial stewardship to reduce antibiotic use: Japan's nationwide observational study. J Hosp Infect 2023; 131:89-98. [PMID: 36424696 DOI: 10.1016/j.jhin.2022.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Japanese government introduced financial incentives to reduce nationwide antibiotic use in hospital settings. AIM This study aimed to determine whether the nationwide financial incentives for creating infection prevention and control (IPC) teams introduced in 2012 and antimicrobial stewardship (ASP) teams introduced in 2018 were associated with changes in antibiotic use and health resource utilization at a national level. METHODS We conducted time-series analyses and a difference-in-differences study consisting of 3,057,517 inpatients with infectious diseases from 472 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. The primary outcome was the days of therapy (DOT) of antibiotic use per 100 patient-days (PDs). The secondary outcomes consisted of types of antibiotic used, health resource utilization, and mortality. RESULTS A total of 5,201,304 financial incentives were observed during 2012-2018, which resulted in a total of 12.1 billion JPY (≈110 million USD). Time-series analyses found decreasing trends in total antibiotic use (79.3-72.5 DOTs/100 PDs (8.6% reduction)) and carbapenem use (9.0-7.0 DOTs/100 PDs (7.8% reduction)) from 2011 to 2018 without adversely affecting other healthcare outcomes (e.g., mortality). In the difference-in-differences analyses, we did not observe meaningful changes in total antibiotic use between the incentivized and unincentivized hospitals for ASP teams, except for the northern part of Japan. No dose-response relationships were observed between the amount of financial incentives and reductions in antibiotic use during 2011-2019. CONCLUSIONS Further research and efforts are needed to accelerate antimicrobial stewardship in hospital settings in Japan.
Collapse
Affiliation(s)
- Y Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - A Nishi
- Department of Epidemiology, UCLA Fielding School of Public Health, CA, USA
| | - K Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - I Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, TN, USA; Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - N Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - R Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
6
|
Singh SP, Khokhar A, Gupta NK. Enrolment under of Nikshay Poshan Yojana among tuberculosis patients in a tertiary care hospital of Delhi. Indian J Tuberc 2022; 69:546-551. [PMID: 36460387 DOI: 10.1016/j.ijtb.2021.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 06/17/2023]
Abstract
UNLABELLED To mitigate malnutrition among tuberculosis burden, Government of India launched Nikshay Poshan Yojana in 2018, providing incentive of INR500 per month to each enrolled patient. Our study tried to find out the status of the scheme and its target benefits amongst the beneficiaries in a tertiary care hospital in Delhi, and also the facilitating factors and barriers towards enrolment, and their knowledge, attitude and practice towards nutrition in TB. METHODS A cross-sectional study was undertaken at a tertiary care hospital involving a calculated sample of 188 patients. The subjects were interviewed on a pre-designed, semi-structured, validated questionnaire and data was analysed on SPSS v.21. RESULTS Enrolment rate for the scheme was 81.4%, of which only 10% of the participants received any benefit. Of the 35 participants who were not enrolled or were not aware of their enrolment status, 22 were interested in enrolment. The reason for non-enrolment by the 21 participants who were not enrolled were lack of awareness, lack of time or lack of a bank account. CONCLUSION The study found that most of the patients attending DOTS treatment were enrolled under the scheme, but 90% were not receiving any incentive promised under it.
Collapse
Affiliation(s)
- Suraj Prakash Singh
- Department of Community Medicine, VMMC & Safdarjung Hospital, New Delhi, India.
| | - Anita Khokhar
- Department of Community Medicine, VMMC & Safdarjung Hospital, New Delhi, India
| | - Neeraj Kumar Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, VMMC & Safdarjung Hospital, New Delhi, India
| |
Collapse
|
7
|
Zhang J, Atkins DL, Wagner AD, Njuguna IN, Neary J, Omondi VO, Otieno VA, Atieno WO, Odhiambo M, Wamalwa DC, John-Stewart G, Slyker JA, Weiner BJ, Beima-Sofie K. Financial Incentives for Pediatric HIV Testing (FIT): Caregiver Insights on Incentive Mechanisms, Focus Populations, and Acceptability for Programmatic Scale Up. AIDS Behav 2021; 25:2661-2668. [PMID: 34170433 DOI: 10.1007/s10461-021-03356-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
Children living with HIV experience gaps in HIV testing globally; scaling up evidence-based testing strategies is critical for preventing HIV-related mortality. Financial incentives (FI) were recently demonstrated to increase uptake of pediatric HIV testing. As part of this qualitative follow-up study to the FIT trial (NCT03049917) conducted in Kenya, 54 caregivers participated in individual interviews. Interview transcripts were analyzed to identify considerations for scaling up FI for pediatric testing. Caregivers reported that FI function by directly offsetting costs or nudging caregivers to take action sooner. Caregivers found FI to be feasible and acceptable for broader programmatic implementation, and supported use for a variety of populations. Some concerns were raised about unintended consequences of FI, including caregivers bringing ineligible children to collect incentives and fears about the impact on linkage to care and retention if caregivers become dependent on FI.
Collapse
Affiliation(s)
- Junyi Zhang
- Department of Health Services, University of Washington, Seattle, WA, 98195, USA.
| | - Dana L Atkins
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA, 98195, USA
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA, 98195, USA
| | - Irene N Njuguna
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA, 98195, USA
- Research and Programs, Kenyatta National Hospital, Ngong Road, Nairobi, 00202, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
| | - Vincent O Omondi
- Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Verlinda A Otieno
- Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Winnie O Atieno
- Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Merceline Odhiambo
- Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Dalton C Wamalwa
- Department of Pediatrics, University of Nairobi, Nairobi, 00202, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
- Department of Medicine, University of Washington, Seattle, WA, 98104, USA
- Department of Pediatrics, University of Washington, Seattle, WA, 98104, USA
| | - Jennifer A Slyker
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
| | - Bryan J Weiner
- Department of Health Services, University of Washington, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA, 98195, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA, 98195, USA
| |
Collapse
|
8
|
Lian JX, McGhee SM, So C, Kwong ASK, Sum R, Tsui WWS, Chao DVK, Chan JCH. Screening for diabetic retinopathy with different levels of financial incentive in a randomized controlled trial. J Diabetes Investig 2021; 12:1632-1641. [PMID: 33484625 PMCID: PMC8409893 DOI: 10.1111/jdi.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION To examine the impact of different levels of financial incentive in terms of fee subsidization on diabetic retinopathy screening in the private primary care setting in Hong Kong. MATERIALS AND METHODS All general practitioners working in the private sector and registered in two electronic public databases were invited to participate. Consecutive patients with diabetes mellitus were then recruited by the participating practitioners. The recruited participants were randomly allocated to one of three screening groups with different fee levels (HK$0, HK$150 [US$19], HK$300 [US$39]) in a randomized controlled trial. Screening uptake and severity of diabetic retinopathy detected were compared. RESULTS Out of 1,688 eligible practitioners, 105 participated and invited 402 patients, with 239 initially agreeing to participate (59.5%). After randomization, 78, 75 and 76 participants in the HK$0, HK$150 and HK$300 fee groups, respectively, reconfirmed their participation and were offered screening at the relevant fee. The uptake of screening was 79.5% (62/78), 81.3% (61/75) and 63.2% (48/76), in the HK$0, HK$150 and HK$300 groups, respectively (P < 0.018). Being in the HK$150 fee group was associated with higher uptake of screening than being in the HK$300 fee group (odds ratio 2.31, P = 0.039). No significant difference was found in the prevalence of any diabetic retinopathy (33.9%, 27.9% and 37.5%, P = 0.378) or sight-threatening diabetic retinopathy (4.8%, 8.2% and 16.7%; P = 0.092) among the groups. CONCLUSION A screening fee of HK$150, representing approximately a half subsidy, appears to be as effective in maximizing uptake as a full subsidy (HK$0) and without deterring those at high risk of diabetic retinopathy from screening.
Collapse
Affiliation(s)
- Jin Xiao Lian
- School of OptometryThe Hong Kong Polytechnic UniversityKowloonHong Kong
| | | | - Ching So
- Department of OphthalmologyThe University of Hong KongHong KongHong Kong
| | - Alfred Siu Kei Kwong
- Department of Family Medicine and Primary Health CareHong Kong West ClusterHong Kong Hospital AuthorityHong Kong IslandHong Kong
| | - Rita Sum
- School of OptometryThe Hong Kong Polytechnic UniversityKowloonHong Kong
| | - Wendy Wing Sze Tsui
- Department of Family Medicine and Primary Health CareHong Kong West ClusterHong Kong Hospital AuthorityHong Kong IslandHong Kong
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Health CareKowloon East ClusterHong Kong Hospital AuthorityHong Kong IslandHong Kong
| | | |
Collapse
|
9
|
Strother M, Koepsell K, Song L, Faerber J, Bernard J, Malkowicz SB, Guzzo T, Tasian G. Financial incentives and wearable activity monitors to increase ambulation after cystectomy: A randomized controlled trial. Urol Oncol 2021; 39:434.e31-434.e38. [PMID: 33308975 PMCID: PMC8184881 DOI: 10.1016/j.urolonc.2020.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/05/2020] [Accepted: 11/22/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Financial incentive programs are effective in increasing physical activity for overweight, ambulatory adults. We sought to determine the potential effect size and direction of financial incentives on ambulation after radical cystectomy. MATERIALS AND METHODS We performed a pilot randomized controlled trial of daily financial incentives to meet postoperative step goals among adults with Eastern Cooperative Oncology Group performance status ≤2 who underwent radical cystectomy for bladder cancer at a single center. Step counts were measured over a 3- to 14-day preoperative period and 30-day postoperative period using a wearable activity monitor. Postoperative daily step goals of 10%, 25%, 40%, and 55% of mean preoperative daily step counts were set for postoperative weeks 1 through 4, respectively. The primary outcome was the number of postoperative days on which the step goals were met. Secondary outcomes included the number of daily postoperative steps taken and the length of stay. Participants randomized to the intervention arm received $1.50 for every day the goal was met with a 20% chance of a $100 reward if the step goal was met on >75% of the first 30 postoperative days. Questionnaires assessing self-reported physical activity, disability, and social support were administered preoperatively at 30 days postoperatively. RESULTS Thirty-three patients were analyzed, 11 in the control and 22 in the intervention arms. There were no statistically significant differences between incentive and control arms for the primary outcome (4.5/30 days vs. 9/30 days, P = 0.53). Results after adjusting for differences in baseline characteristics were similar (RR 1.00, 95% CI 0.24-4.19, P = 1.00). There were also no differences in average daily postoperative steps (median 979 vs. 1191, 95% CI -810 to 1,400, P = 0.59), length of stay (7.5 vs. 7, 95% CI -2.7 to 5.1, P = 0.56), or self-reported measures of disability, activity, and social support. CONCLUSIONS While this trial was a pilot study and not powered to detect a difference between groups, there was no suggestion of any clinically important impact of this financial incentive on postoperative ambulation. While a fully-powered trial is feasible, given the small range of plausible benefit, such a trial would be unlikely to influence clinical practice.
Collapse
Affiliation(s)
- Marshall Strother
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
| | - Kristen Koepsell
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lihai Song
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jennifer Faerber
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joshua Bernard
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - S Bruce Malkowicz
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Thomas Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Gregory Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
10
|
Chong KC, Fung H, Yam CHK, Chau PYK, Chow TY, Zee BCY, Wong ELY, Wang MH, Yeoh EK. Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis. BMC Public Health 2021; 21:1235. [PMID: 34174858 PMCID: PMC8236172 DOI: 10.1186/s12889-021-11280-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11280-z.
Collapse
Affiliation(s)
- Ka Chun Chong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China. .,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.
| | - Hong Fung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Carrie Ho Kwan Yam
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Patsy Yuen Kwan Chau
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Tsz Yu Chow
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Benny Chung Ying Zee
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Eliza Lai Yi Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Maggie Haitian Wang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Eng Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| |
Collapse
|
11
|
Katare B. Do low-cost economic incentives motivate healthy behavior? Econ Hum Biol 2021; 41:100982. [PMID: 33611235 DOI: 10.1016/j.ehb.2021.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
We conducted a field experiment to test the effectiveness of a conditional, low-cost, and recurring financial incentive in motivating recreation center visits. Results indicate that the financial incentive did not motivate students' recreation center visits. However, it was successful in increasing the frequency of recreation center visits for female students who had an established exercise habit. For a payout of $0.50, we estimate an increase of 0.4 visits per week for female students with established exercise habits. This provides modest evidence that the financial incentive structure was able to increase the behavioral response at the intensive margin. Our results show that the design of our financial incentive was not effective on the extensive margin. There was also no effect of the financial incentive on the recreation center visits for male students.
Collapse
|
12
|
PASDAR YAHYA, NAJAFI FARID, DARBANDI MITRA, REZAEIAN SHAHAB, NIAZI PARISA, HAMZEH BEHROOZ. Financial incentive strategy for weight loss and maintenance of weight loss. J Prev Med Hyg 2021; 62:E206-E212. [PMID: 34322638 PMCID: PMC8283650 DOI: 10.15167/2421-4248/jpmh2021.62.1.1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Abstract
Introduction The aim of this study was to investigate the effect of financial incentives on weight loss, maintain in obese women and biochemical factors. Methods This quasi-experimental study was conducted on 103 women with body mass index (BMI) ≥ 30 kg/m2. The participants were assessed over a 12-month follow-up in eight phases. Money payment for losing weight was incentive intervention in this study. The participants were given diet and physical activity. Results Mean of BMI was 34.78 ± 4.29 kg/m2 in baseline, that reduced to 32.41 ± 3.51 kg/m2 in the sixth phase, and 31.64 ± 3.71 kg/m2 in the final phase (P < 0.001). At baseline, mean of percentage of body fat (PBF) was 40.77 ± 2.81 that reduced to 37.34±4.02 at the end of the study (P < 0.001). Waist to hip ratio (WHR) and lean body mass (LBM) decreased significantly over the 12-month (P < 0.001). At the end of each phase, the mean of BMI reduction of 0.39 units was observed in the subjects, and 9 units of change were achieved by the end of the study compared to the baseline. The mean of triglyceride in the first, fourth and seventh phases were 128.57 ± 13.33, 101.43 ± 57.99 and 87.40 ± 57.59 mg/dl, respectively (P = 0.003). The mean of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate-pyruvate transaminase (SGPT) decreased significantly over the 12-month, P = 0.052 and P = 0.005, respectively. Conclusions Financial incentives can effectively help to weight loss and maintenance of weight, and improve lipid profiles; blood sugar and liver enzymes. The use of motivational factors with proper training (diet and physical activity) will have a better result.
Collapse
Affiliation(s)
- YAHYA PASDAR
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - FARID NAJAFI
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Cardiovascular Research center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - MITRA DARBANDI
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Correspondence: Darbandi M, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Isar Square, School of Public Health, Department of Epidemiology, Kermanshah, Iran - Tel.: +98 83 37102015 - Fax: +98 83 38263048 - E.mail: ,
| | - SHAHAB REZAEIAN
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - PARISA NIAZI
- Department of Nutrition, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - BEHROOZ HAMZEH
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
13
|
Reilly K, Bauman A, Reece L, Lecathelinais C, Sutherland R, Wolfenden L. Evaluation of a voucher scheme to increase child physical activity in participants of a school physical activity trial in the Hunter region of Australia. BMC Public Health 2021; 21:570. [PMID: 33757472 PMCID: PMC7986265 DOI: 10.1186/s12889-021-10588-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global population data suggest that physical activity levels in children remain unacceptably low. Improved participation in organised sport has been recommended by the WHO as one strategy to improve population levels of physical activity. In 2018, in the state of New South Wales, Australia, the government introduced the Active Kids scheme, to help families meet the cost of getting children into organized sport. The aim of this study is to describe the uptake of Active Kids and assess the impact of the scheme on organized sport participation and child physical activity in a region of New South Wales. METHODS A pragmatic longitudinal study was undertaken of parents/carers from primary school aged children (5-12 years) in the Hunter region of NSW, Australia. Baseline data were collected between Oct-Dec 2017, with follow-up 12 months later. A telephone survey occurred at both time points, asking questions regarding registration and redemption of an Active Kids voucher for their child, child participation in organised sports and child physical activity levels. RESULTS Of the 974 parents/carers who consented to participate, 511 (52.5%) completed the telephone surveys at both time points. A very large proportion of children (n = 454, 89.0%) were reported by their parents/carers at baseline as meeting the minimum physical activity guideline of 60 min per day. Of participating parents/carers in this study, 407 (96.0%) reported redeeming an Active Kids voucher. Children who redeemed a voucher had three times the odds to participate in organized team sports from baseline to follow-up (p = 0.009). Sub group analyses identified that females who redeemed a voucher had four times the odds to participate in organized team sports (p = 0.012). CONCLUSIONS Given the already active nature of this sample, no significant improvements in physical activity levels were noted, but the positive contribution community sport can have on health and wellbeing amongst children is reinforced. Whilst voucher schemes can address financial burdens across all socio-economic groups, more population targeting is needed to deliver voucher schemes to the most disadvantaged and inactive segments of the population in order to increase physical activity.
Collapse
Affiliation(s)
- Kathryn Reilly
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia.
- Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia.
| | - Adrian Bauman
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Lindsey Reece
- SPRINTER research group, Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | | | - Rachel Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia
| |
Collapse
|
14
|
Krishnamoorthy Y, Rehman T, Sakthivel M. Effectiveness of Financial Incentives in Achieving UNAID Fast-Track 90-90-90 and 95-95-95 Target of HIV Care Continuum: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. AIDS Behav 2021; 25:814-825. [PMID: 32968885 DOI: 10.1007/s10461-020-03038-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
Financial incentives influence behavioural changes and the current review was done to assess the effectiveness of this intervention in improving HIV care continuum. We conducted systematic searches in MEDLINE, Cochrane library, ScienceDirect and Google Scholar from inception until July 2019. We carried out a meta-analysis with random-effects model quantifying inconsistency (I2) for heterogeneity and reported pooled Risk Ratios (RR) with 95% confidence intervals (CIs). A total of 22 studies with 38,119 participants were included. All the six outcomes showed better results in financial incentive arm compared to standard care with statistical significance in three outcomes-HIV testing uptake (pooled RR: 2.42; 95%CI 1.06-5.54; I2 = 100%), antiretroviral therapy (ART) adherence (pooled RR: 1.30; 95%CI 1.13-1.50; I2 = 44%), and continuity in care (pooled RR: 1.24; 95%CI 1.09-1.41; I2 = 86%). To summarize, financial incentives can be helpful in improving the uptake of HIV testing, ART adherence and continuity of care while it was better for achieving viral load suppression among studies conducted in high-income countries.
Collapse
Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Tanveer Rehman
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Manikandanesan Sakthivel
- State Program and Technical Manager, Cap TB project, AP/TS Unit, Solidarity and Action against The HIV Infection in India (SAATHII), Hyderabad, India
| |
Collapse
|
15
|
Hohmann NS, Hastings TJ, Jeminiwa RN, Qian J, Hansen RA, Ngorsuraches S, Garza KB. Patient preferences for medication adherence financial incentive structures: A discrete choice experiment. Res Social Adm Pharm 2021; 17:1800-1809. [PMID: 33608244 DOI: 10.1016/j.sapharm.2021.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/24/2020] [Accepted: 01/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medication adherence for chronic conditions continues to be a challenge for patients. Patient incentives for medication adherence may help. Financial incentives delivered at the point of care may act as cues for medication-taking behavior. OBJECTIVES The purpose of this study was to investigate patient preferences for specific structures of financial medication adherence incentives that could feasibly be delivered at the point of care. METHODS A discrete choice experiment (DCE) was performed using a national online survey. Study participants were adults who self-reported taking at least one prescription medication for one or more chronic conditions. Following an orthogonal design generated in SAS, the DCE included 32 paired-choice tasks. Data were analyzed using mixed logit models and stratified on participants' income level. RESULTS In the full cohort (n = 933), form of financial reward (such as gift-card or cash) was 1.02 times as important to participants as the probability of incentive receipt, 1.58 times as important as monetary value, and 1.93 times as important as timing of receipt. Participants were willing to give up $31.04 of an incentive's monetary value (95% CI = $27.11-$34.98) to receive the incentive 5 months sooner (1-month vs. 6-month time-lag); $60.79 (95% CI = $53.19-$68.39) for probability of receipt to increase from a 1 out of 100 chance to a 1 out of 20 chance; and $10.52 (95% CI = $6.46-$14.58) to receive an incentive in the form of a Visa® gift-card instead of grocery store voucher. These patterns of trade-offs between attributes were generally consistent among participants with lower and higher income. CONCLUSIONS Regardless of socioeconomic status, patient preferences for financial medication adherence incentives delivered at the point of care may be most heavily influenced by incentive form and probability of receipt. This has implications for designing medication adherence programs in terms of incentive sustainability, patient engagement, plan star ratings, and patient outcomes.
Collapse
Affiliation(s)
- Natalie S Hohmann
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, 1202F Walker Building, Auburn, AL, USA.
| | - Tessa J Hastings
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, 715 Sumter St, CLS 311E, Columbia, SC, USA.
| | - Ruth N Jeminiwa
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Richard A Hansen
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Kimberly B Garza
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA.
| |
Collapse
|
16
|
Yamashita R, Sato S, Akase R, Doi T, Tsuzuku S, Yokoi T, Otsuki S, Harada E. Effects of social network incentives and financial incentives on physical activity and social capital among older women: a randomized controlled trial. BMC Public Health 2021; 21:188. [PMID: 33478465 PMCID: PMC7819206 DOI: 10.1186/s12889-021-10175-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/05/2021] [Indexed: 12/04/2022] Open
Abstract
Background Financial incentives have been used to increase physical activity. However, the benefit of financial incentives is lost when an intervention ends. Thus, for this study, we combined social network incentives that leverage the power of peer pressure with financial incentives. Few reports have examined the impact of physical activity on social capital. Therefore, the main goal of this study was to ascertain whether a combination of two incentives could lead to more significant changes in physical activity and social capital during and after an intervention. Methods The participants were 39 older women over 65 years of age in Kumamoto, Japan. The participants were randomly divided into a financial incentive group (FI group) and a social network incentive plus financial incentive group (SNI + FI group). Both groups underwent a three-month intervention. Measurements of physical activity and social capital were performed before and after the intervention. Additionally, the effects of the incentives on physical activity and social capital maintenance were measured 6 months postintervention. The financial incentive group received a payment ranging from US$4.40 to US$6.20 per month, depending on the number of steps taken during the intervention. For the other group, we provided a social network incentive in addition to the financial incentive. The SNI + FI group walked in groups of three people to use the power of peer pressure. Results A two-way ANOVA revealed that in terms of physical activity, there was a statistically significant interaction between group and time (p = 0.017). The FI group showed no statistically significant improvement in physical activity during the observation period. In terms of the value of social capital, there was no significant interaction between group and time. Conclusion Our results suggest that social network incentives, in combination with financial incentives, are more effective for promoting physical activity than financial incentives alone among older women and that these effects can continue after an intervention. In the meantime, further studies should be conducted on the effect of physical activity on social capital. Trial registration UMIN000038080, registered on 09/22/2019 (Retrospectively registered).
Collapse
Affiliation(s)
- Ryo Yamashita
- Kumamoto Institute of Total Fitness, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan.
| | - Shinji Sato
- Teikyo Heisei University, 2-51-4 Higashiikebukuro, Toyosima-ku, Tokyo, 170-8445, Japan
| | - Ryoichi Akase
- Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan
| | - Tatsuo Doi
- Dynamic Sports Medicine Institute, 1-10-28 Nishishinsaibashi, Chuo-ku, Osaka, 542-0086, Japan
| | - Shigeki Tsuzuku
- Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto, 860-8555, Japan
| | - Toyohiko Yokoi
- Osaka Sangyo University, 3-1-1 Nakagaito, Dito-city, Osaka, 574-8530, Japan
| | - Shingo Otsuki
- Osaka Sangyo University, 3-1-1 Nakagaito, Dito-city, Osaka, 574-8530, Japan
| | - Eisaku Harada
- Kumamoto Institute of Total Fitness, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan.,Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan
| |
Collapse
|
17
|
Foley BC, Owen KB, Bauman AE, Bellew W, Reece LJ. Effects of the Active Kids voucher program on children and adolescents' physical activity: a natural experiment evaluating a state-wide intervention. BMC Public Health 2021; 21:22. [PMID: 33423663 PMCID: PMC7798231 DOI: 10.1186/s12889-020-10060-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is an urgent need for scaled-up effective interventions which overcome barriers to health-enhancing physical activity for children and adolescents. In New South Wales (NSW), Australia, the state government implemented a universal voucher program, 'Active Kids' to support the cost of structured physical activity registration for school-enrolled children aged 4.5-18 years old. The objective of this study was to understand the effects a financial incentive intervention delivered in a real-world setting has on children and adolescent's physical activity participation. METHOD In 2018, all children and adolescents registered for an Active Kids voucher provided sociodemographic characteristics, physical activity and research consent. This prospective cohort study used an online survey with validated items to measure physical activity and other personal and social factors in children and adolescents who used an Active Kids voucher. Generalized linear mixed models were used to examine changes from registration to after voucher use at ≤8 weeks, 9-26 weeks and ≥ 6 months. RESULTS Study participants reported increasing their days achieving physical activity guidelines from 4.0 days per week (95%CI 3.8, 4.2) at registration (n = 37,626 children) to 4.9 days per week (95%CI 4.7, 5.1) after 6 months (n = 14,118 children). Increased physical activity was observed for all sociodemographic population groups. The voucher-specific activity contributed 42.4% (95%CI 39.3, 45.5) to the total time children participated in structured physical activities outside of school. Children and adolescents who increased to, or maintained, high levels of activity were socially supported to be active, had active parent/caregivers, had better concentration and were overall happier than their low-active counterparts. CONCLUSION The Active Kids program significantly increased children's physical activity levels and these increases continued over a six-month period. The Active Kids voucher program shows promise as a scaled-up intervention to increase children and adolescents' physical activity participation. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12618000897268 , approved May 29th, 2018 - Retrospectively registered.
Collapse
Affiliation(s)
- Bridget C Foley
- SPRINTER (Sport and Active Recreation Intervention & Epidemiology Research Group), Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, D17 Charles Perkins Centre, The University of Sydney, Level 6, the Hub, Camperdown, NSW, 2006, Australia.
| | - Katherine B Owen
- SPRINTER (Sport and Active Recreation Intervention & Epidemiology Research Group), Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, D17 Charles Perkins Centre, The University of Sydney, Level 6, the Hub, Camperdown, NSW, 2006, Australia
| | - Adrian E Bauman
- SPRINTER (Sport and Active Recreation Intervention & Epidemiology Research Group), Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, D17 Charles Perkins Centre, The University of Sydney, Level 6, the Hub, Camperdown, NSW, 2006, Australia
| | - William Bellew
- SPRINTER (Sport and Active Recreation Intervention & Epidemiology Research Group), Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, D17 Charles Perkins Centre, The University of Sydney, Level 6, the Hub, Camperdown, NSW, 2006, Australia
| | - Lindsey J Reece
- SPRINTER (Sport and Active Recreation Intervention & Epidemiology Research Group), Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, D17 Charles Perkins Centre, The University of Sydney, Level 6, the Hub, Camperdown, NSW, 2006, Australia
| |
Collapse
|
18
|
Thavam T, Devlin RA, Thind A, Zaric GS, Sarma S. The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada. Eur J Health Econ 2020; 21:1279-1293. [PMID: 32676753 DOI: 10.1007/s10198-020-01216-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI for 3 years), and comparison group (patients affiliated with a family physician ineligible for DMI throughout the study period). Diabetes-related services was measured using the Diabetic Management Assessment (DMA) billing code claimed by patient's physician. The impact of DMI on diabetes-related services was assessed using difference-in-differences regression models. After adjusting for patient- and physician-level characteristics, patient fixed-effects and patient-specific time trend, we found that DMI increased the probability of having at least one DMA fee code claimed by patient's physician by 9.3% points, and the probability of having at least three DMA fee codes claimed by 2.1% points. Subgroup analyses revealed the impact of DMI was slightly larger in males compared to females. We found that Ontario's DMI was effective in increasing the diabetes-related services provided to patients diagnosed with diabetes in Ontario. Financial incentives for physicians help improve the provision of targeted diabetes-related services.
Collapse
Affiliation(s)
- Thaksha Thavam
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, ON, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Gregory S Zaric
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
- Ivey School of Business, University of Western Ontario, London, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada.
- ICES, Toronto, ON, Canada.
| |
Collapse
|
19
|
Levan ML, Waldram MM, DiBrito SR, Thomas AG, Al Ammary F, Ottman S, Bannon J, Brennan DC, Massie AB, Scalea J, Barth RN, Segev DL, Garonzik-Wang JM. Financial incentives versus standard of care to improve patient compliance with live kidney donor follow-up: protocol for a multi-center, parallel-group randomized controlled trial. BMC Nephrol 2020; 21:465. [PMID: 33167882 PMCID: PMC7654057 DOI: 10.1186/s12882-020-02117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Live kidney donors (LKDs) account for nearly a third of kidney transplants in the United States. While donor nephrectomy poses minimal post-surgical risk, LKDs face an elevated adjusted risk of developing chronic diseases such as hypertension, diabetes, and end-stage renal disease. Routine screening presents an opportunity for the early detection and management of chronic conditions. Transplant hospital reporting requirements mandate the submission of laboratory and clinical data at 6-months, 1-year, and 2-years after kidney donation, but less than 50% of hospitals are able to comply. Strategies to increase patient engagement in follow-up efforts while minimizing administrative burden are needed. We seek to evaluate the effectiveness of using small financial incentives to promote patient compliance with LKD follow-up. METHODS/DESIGN We are conducting a two-arm randomized controlled trial (RCT) of patients who undergo live donor nephrectomy at The Johns Hopkins Hospital Comprehensive Transplant Center (MDJH) and the University of Maryland Medical Center Transplant Center (MDUM). Eligible donors will be recruited in-person at their first post-surgical clinic visit or over the phone. We will use block randomization to assign LKDs to the intervention ($25 gift card at each follow-up visit) or control arm (current standard of care). Follow-up compliance will be tracked over time. The primary outcome will be complete (all components addressed) and timely (60 days before or after expected visit date), submission of LKD follow-up data at required 6-month, 1-year, and 2-year time points. The secondary outcome will be transplant hospital-level compliance with federal reporting requirements at each visit. Rates will be compared between the two arms following the intention-to-treat principle. DISCUSSION Small financial incentivization might increase patient compliance in the context of LKD follow-up, without placing undue administrative burden on transplant providers. The findings of this RCT will inform potential center- and national-level initiatives to provide all LKDs with small financial incentives to promote engagement with post-donation monitoring efforts. TRIAL REGISTRATION ClinicalTrials.gov number: NCT03090646 Date of registration: March 2, 2017 Sponsors: Johns Hopkins University, University of Maryland Medical Center Funding: The Living Legacy Foundation of Maryland.
Collapse
Affiliation(s)
- Macey L. Levan
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD USA
| | - Madeleine M. Waldram
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Sandra R. DiBrito
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Alvin G. Thomas
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC USA
| | - Fawaz Al Ammary
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Shane Ottman
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Jaclyn Bannon
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Daniel C. Brennan
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Allan B. Massie
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Joseph Scalea
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD USA
| | - Rolf N. Barth
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD USA
| | - Dorry L. Segev
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Jacqueline M. Garonzik-Wang
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| |
Collapse
|
20
|
Latan H, Chiappetta Jabbour CJ, Lopes de Sousa Jabbour AB. Social Media as a Form of Virtual Whistleblowing: Empirical Evidence for Elements of the Diamond Model. J Bus Ethics 2020; 174:529-548. [PMID: 32836583 PMCID: PMC7430546 DOI: 10.1007/s10551-020-04598-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
This article originally advances the field of organizational whistleblowing by empirically investigating the suitability of the four elements of the fraud diamond as a means to understand the intention to disclose wrongdoing through virtual channels. This article also makes a contribution on the theme of whistleblowing as it relates to customers, an under-studied, however, relevant stakeholder in this field. The main findings of the article are as follows: (a) the four elements of the fraud diamond as they relate to whistleblowing-a combination of pressure, financial incentive, opportunity and rationalization, and capability-can explain the intentions behind customer reports of wrongdoing; (b) online social media channels are customers' preferred means of whistleblowing; (c) the elements of opportunity and capability are strongly correlated with the use of social media as a method of disclosing wrongdoing; and (d) virtual channels can be useful for whistleblowers in order to avoid potential retaliation. Unique managerial and academic implications of these research findings are also discussed, extending the layers of knowledge on whistleblowing in organizations.
Collapse
Affiliation(s)
- Hengky Latan
- HLC Consulting, Jl. Kertanegara Selatan V No 5B, Semarang, 50241 Indonesia
| | - Charbel Jose Chiappetta Jabbour
- Lincoln International Business School, University of Lincoln, Lincoln, LN6 7TS Lincolnshire UK
- Montpellier Business School, 2300, avenue des Moulins, 34185 Montpellier, Cédex4, France
| | - Ana Beatriz Lopes de Sousa Jabbour
- Lincoln International Business School, University of Lincoln, Lincoln, LN6 7TS Lincolnshire UK
- Montpellier Business School, 2300, avenue des Moulins, 34185 Montpellier, Cédex4, France
| |
Collapse
|
21
|
Kumar R, Khayyam KU, Singla N, Anand T, Nagaraja SB, Sagili KD, Sarin R. Nikshay Poshan Yojana (NPY) for tuberculosis patients: Early implementation challenges in Delhi, India. Indian J Tuberc 2020; 67:231-7. [PMID: 32553317 DOI: 10.1016/j.ijtb.2020.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/18/2019] [Accepted: 02/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nutrition support is one of the essential factors for envisioning Tuberculosis (TB) elimination in India by 2025. In this regard, Government of India introduced Nikshay Poshan Yojana (NPY) through Direct Benefit Transfer (DBT) as monthly financial assistance towards nutrition for TB patients in April, 2018. Assessment of early implementation challenges of the scheme is essential. OBJECTIVE (a) To determine the number (proportion) of TB patients who received the benefits (b) to explore the challenges encountered by the health care providers in delivering the NPY through DBT (c) to explore the ways the incentives were utilised by the patients. MATERIAL AND METHODS It was a cross-sectional study conducted among patients registered for TB treatment at Ladosarai and Mehrauli DOTS centre between July-September, 2018.Health providers engaged in implementation of NPY at the study sites were also interviewed. The data were collected through structured questionnaires, double entered and analyzed in Epi Data. RESULTS Out of 119 patients registered, we interviewed 57 (47.9%) patients. Of which, 30 (52.6%) had received NPY for 2 months in the fourth and fifth month of treatment. The health providers reported increased workload, lack of training and complex reporting formats as main hurdles in implementation of the scheme. While, the patients cited non-availability of bank accounts and unlinked bank account with Aadhar card as difficulties to receive NPY through DBT. CONCLUSION Nearly half of the interviewed TB patients received nutritional incentives of NPY through DBT for 2 months. Non-availability of bank accounts and unlinked bank accounts were some challenges faced by both health providers and patient. It is recommended to address these implementation on time in order to reap the benefit of scheme in improving nutritional status of TB patients. Further studies are needed to determine the effect of nutrition support on TB patients.
Collapse
|
22
|
Chin JY, Matson J, McCauley S, Anarella J, Gesten F, Roohan P. The impact of financial incentives on utilization and outcomes of diabetes prevention programs among Medicaid managed care adults in New York state. Contemp Clin Trials 2020; 91:105960. [PMID: 32087338 DOI: 10.1016/j.cct.2020.105960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
Diabetes prevalence has risen rapidly and has become a global health challenge. The Diabetes Prevention Program (DPP) has been shown to prevent or delay the development of diabetes among individuals with prediabetes. Yet, diabetes prevention studies within the Medicaid population are limited and results are mixed. This study aimed to evaluate the impact of different financial incentive strategies on the utilization of the DPP for Medicaid managed care adults in New York State. A four-arm randomized controlled trial was conducted among Medicaid managed care adult enrollees diagnosed with prediabetes and/or obesity. Study participants were offered a 16-week DPP with various incentive strategies based on class attendance and weight loss as follows: Attendance-Only, Weight-Loss Only, and both Attendance and Weight-Loss. A control group was offered DPP with no incentives for attendance or weight loss. We evaluated the impact of incentives on achievement of the program completion and weight-loss milestone. Participants who received incentives for the Attendance-Only class were least likely to be lost to follow-up, more likely to complete the program, and had two times higher percentage of meeting the weight-loss milestone compared to the control group. Results for the other incentive cohorts were mixed. A strong positive association was observed for participants who attended 9 or more classes and weight-loss regardless of incentive strategies. Providing monetary incentives for DPP class attendance had a positive impact on program completion and achieving the weight-loss milestone. However, the results from this study indicate that participant enrollment and retention remained challenges despite the incentives.
Collapse
Affiliation(s)
- Jo-Yu Chin
- New York State Department of Health, Albany, NY, USA.
| | | | | | | | - Foster Gesten
- New York State Department of Health, Albany, NY, USA.
| | | |
Collapse
|
23
|
Lim RSM, Gardner DSL, Bee YM, Cheung YB, Bairavi J, Gandhi M, Goh SY, Ho ETL, Lin X, Tan NC, Tay TL, Finkelstein EA. TRIal to slow the Progression Of Diabetes (TRIPOD): study protocol for a randomized controlled trial using wireless technology and incentives. Trials 2019; 20:650. [PMID: 31779678 PMCID: PMC6883710 DOI: 10.1186/s13063-019-3749-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/23/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The outcomes for those with type 2 diabetes mellitus (T2DM) in Singapore are poor. In this TRIal to slow the Progression Of Diabetes (TRIPOD), we will evaluate the effectiveness and cost-effectiveness of a comprehensive diabetes management package (DMP), with or without a financial incentives program, M-POWER Rewards, in efforts to improve HbA1c levels for individuals with T2DM. METHODS/DESIGN TRIPOD is a randomized, open-label, controlled, multi-center, superiority trial with three parallel arms: (1) usual care only, (2) usual care with DMP, and (3) usual care with DMP plus M-POWER Rewards. A total of 339 adults with sub-optimally controlled T2DM (self-reported HbA1c 7.5-11.0%) will be block randomized according to a 1:1:1 allocation ratio to the three arms. The primary outcome is mean change in HbA1c level at Month 12 from baseline. Secondary outcomes include mean change in HbA1c level at Months 6, 18, and 24; mean changes at Months 6, 12, 18, and 24 in weight, blood pressure, and self-reported physical activity, weight monitoring, blood glucose monitoring, medication adherence, diabetes self-management, sleep quality, work productivity and daily activity impairment, and health utility index; and proportion of participants initiating insulin treatment by Months 6, 12, 18, and 24. Incremental cost-effectiveness ratios will be computed based on costs per improvement in HbA1c at Month 12 and converted to cost per quality-adjusted life year gained. DISCUSSION The TRIPOD study will present insights about the long-term cost-effectiveness and financial viability of the interventions and the potential for integrating within usual care. TRIAL REGISTRATION ClinicalTrials.gov, NCT03800680. Registered on 11 January 2019.
Collapse
Affiliation(s)
- Robyn Su May Lim
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Daphne Su Lyn Gardner
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Yin Bun Cheung
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Joann Bairavi
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Biostatistics, Singapore Clinical Research Institute, 31 Biopolis Way, Singapore, 138669 Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Emily Tse Lin Ho
- Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Xinyi Lin
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609 Singapore
| | - Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, 167 Jalan Bukit Merah, Singapore, 150167 Singapore
| | - Tunn Lin Tay
- Department of Endocrinology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
| | - Eric Andrew Finkelstein
- Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| |
Collapse
|
24
|
Hoskins K, Ulrich CM, Shinnick J, Buttenheim AM. Acceptability of financial incentives for health-related behavior change: An updated systematic review. Prev Med 2019; 126:105762. [PMID: 31271816 DOI: 10.1016/j.ypmed.2019.105762] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/03/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
Despite the successes of financial incentives in increasing uptake of evidence-based interventions, acceptability is polarized. Given widespread interest in the use of financial incentives, we update findings from Giles and colleagues' 2015 systematic review (n = 81). The objectives of this systematic review are to identify what is known about financial incentives directed to patients for health-related behavior change, assess how acceptability varies, and address which aspects and features of financial incentives are potentially acceptable and not acceptable, and why. PRISMA guidelines were used for searching peer-reviewed journals across 10 electronic databases. We included empirical and non-empirical papers published between 1/1/14 and 6/1/18. After removal of duplicates, abstract screening, and full-text reviews, 47 papers (n = 31 empirical, n = 16 scholarly) met inclusion criteria. We assessed empirical papers for risk of bias and conducted a content analysis of extracted data to synthesize key findings. Five themes related to acceptability emerged from the data: fairness, messaging, character, liberty, and tradeoffs. The wide range of stakeholders generally preferred rewards over penalties, vouchers over cash, smaller values over large, and certain rewards over lotteries. Deposits were viewed unfavorably. Findings were mixed on acceptability of targeting specific populations. Breastfeeding, medication adherence, smoking cessation, and vaccination presented as more complicated incentive targets than physical activity, weight loss, and self-management. As researchers, clinicians, and policymakers explore the use of financial incentives for challenging health behaviors, additional research is needed to understand how acceptability influences uptake and ultimately health outcomes.
Collapse
Affiliation(s)
- Katelin Hoskins
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America.
| | - Connie M Ulrich
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America; University of Pennsylvania, School of Nursing, Department of Biobehavioral Health Sciences, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America
| | - Julianna Shinnick
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America
| | - Alison M Buttenheim
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America
| |
Collapse
|
25
|
Khan MS, Mehboob N, Rahman-Shepherd A, Naureen F, Rashid A, Buzdar N, Ishaq M. What can motivate Lady Health Workers in Pakistan to engage more actively in tuberculosis case-finding? BMC Public Health 2019; 19:999. [PMID: 31345194 PMCID: PMC6657372 DOI: 10.1186/s12889-019-7326-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background Many interventions to motivate community health workers to perform better rely on financial incentives, even though it is not clear that monetary gain is the main motivational driver. In Pakistan, Lady Health Workers (LHW) are responsible for delivering community level primary healthcare, focusing on rural and urban slum populations. There is interest in introducing large-scale interventions to motivate LHW to be more actively involved in improving tuberculosis case-finding, which is low in Pakistan. Methods Our study investigated how to most effectively motivate LHW to engage more actively in tuberculosis case-finding. The study was embedded within a pilot intervention that provided financial and other incentives to LHW who refer the highest number of tuberculosis cases in three districts in Sindh province. We conducted semi-structured interviews with 20 LHW and 12 health programme managers and analysed these using a framework categorising internal and external sources of motivation. Results Internal drivers of motivation, such as religious rewards and social recognition, were salient in our study setting. While monetary gain was identified as a motivator by all interviewees, programme managers expressed concerns about financial sustainability, and LHW indicated that financial incentives were less important than other sources of motivation. LHW emphasised that they typically used financial incentives provided to cover patient transport costs to health facilities, and therefore financial incentives were usually not perceived as rewards for their performance. Conclusions This study indicated that interventions in addition to, or instead of, financial incentives could be used to increase LHW engagement in tuberculosis case-finding. Our finding about the strong role of internal motivation (intrinsic, religious) in Pakistan suggests that developing context-specific strategies that tap into internal motivation could allow infectious disease control programmes to improve engagement of community health workers without being dependent on funding for financial incentives.
Collapse
Affiliation(s)
- Mishal S Khan
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | | | - Afifah Rahman-Shepherd
- Centre on Global Health Security, Chatham House, 10 St James's Square, London, SW1Y 4LE, UK
| | | | | | | | | |
Collapse
|
26
|
Alade O, Lawal F. A PILOT TRIAL OF THE IMPACT OF FINANCIAL INCENTIVE ON THE UTILIZATION OF DENTAL SERVICES AMONG CIVIL SERVANTS IN IBADAN, NIGERIA. Ann Ib Postgrad Med 2019; 17:81-94. [PMID: 31768162 PMCID: PMC6871207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Financial constraints have been reported as major barriers to utilization of dental services in developing countries. It is however unknown if financial incentives will improve dental service utilization among civil servants in Nigeria. OBJECTIVE To evaluate the effect of financial incentive on the utilization of dental services among civil servants in Ibadan, Nigeria. METHODS This was a pilot trial among two clusters of civil servants in Ibadan, Nigeria. In both groups, the civil servants participated in an oral health education programme, a dental screening exercise and referral for dental treatment. In addition to this, the experimental group got a financial incentive to present for treatment. The two groups were followed up for a period of twelve weeks. Data were analysed using SPSS. RESULTS A total of 109 civil servants participated in the study. There were 62 in the control group and 47 in the experimental group. The mean age of the study participants in the control group was 42.1 ± 8.75 years, mean DMFT was 0.95 ± 1.87 and 94% of them had an unmet dental need. Similarly, in the experimental group the mean age was 44.7 ± 11.68 years, mean DMFT was 0.45 ± 0.95 and 98% of them had an unmet need. There was no significant difference between the two groups at baseline. At twelve weeks, none of those referred for treatment in the control group presented for treatment while only 3 (6.4%) experimental group presented for dental treatment. No statistical difference was observed (p=0.077). CONCLUSION In this study financial incentive did not result in significant increased utilization of dental care services among adults.
Collapse
Affiliation(s)
- O.T. Alade
- Department of Preventive Dentistry, College of Medicine University of Lagos, Lagos
| | - F.B. Lawal
- Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan
| |
Collapse
|
27
|
Salazar M, Vora K, Sidney Annerstedt K, De Costa A. Caesarean sections in the in the context of the Chiranjeevi Yojana public private partnership program to promote institutional birth in Gujarat, India; does the embedded disincentive for caesarean section work? Int J Equity Health 2019; 18:17. [PMID: 30678731 PMCID: PMC6345034 DOI: 10.1186/s12939-019-0922-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background The government of Gujarat, India runs a large public private partnership program to widen access to emergency obstetric care (EmOC). The program include a disincentive for Cesareans section (CS) which are capped at seven per 100 women. In this paper, we study if the disincentive works by comparing CS rates among similar groups of women who deliver within and outside the program. Methods Community-based panel study in three districts of Gujarat, India. Sample size: 2123 women. Data was analyzed using multivariable logistic regression. Results Overall seven point seven % (164/2123) of the all women in the study had a CS. After adjusting for confounding factors women within the program had 62% (AOR 0.38, 95% CI 0.22–0.44) lower odds of having a CS than to non-beneficiaries. In a separate model of predictors of CS among women giving birth only in program accredited hospitals, we found that CY program beneficiaries had lower odds of having a CS birth than non-beneficiary women (paying clients) (AOR 0.40, 95% CI 0.24–0.67). Conclusions The Gujarat government is trying to ensure access to EmOC (including CS) for its vulnerable population through CY. The embedded disincentive to prevent unnecessary cesareans by private obstetricians is a novel one, and appears to work, though one could argue it works ‘over-efficiently’ by depriving some women who need CS from receiving one under the program. The state needs to revisit and review what is happening in the program periodically, and have oversight over whether women who need CS under the program actually receive the care that they need. Electronic supplementary material The online version of this article (10.1186/s12939-019-0922-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mariano Salazar
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden.
| | - Kranti Vora
- Department of Reproductive and Child Health, Indian Institute of Public Health, Gandhinagar, Ahmedabad, Gujarat, India
| | - Kristi Sidney Annerstedt
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden.,Department of Reproductive and Child Health, Indian Institute of Public Health, Gandhinagar, Ahmedabad, Gujarat, India
| |
Collapse
|
28
|
Beatty TKM, Katare B. Low-cost approaches to increasing gym attendance. J Health Econ 2018; 61:63-76. [PMID: 30053711 DOI: 10.1016/j.jhealeco.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
We investigate the effect of two low-cost experimental interventions designed to increase physical exercise: a lottery based financial incentive and a social norming treatment. The lottery intervention provides a financial incentive to increase physical activity whereas the social norming intervention attempts to increase physical activity by providing feedback to individuals on their own and their peers' physical exercise activity. We find the larger of our two lottery treatments yields a positive and statistically significant effect on physical activity at modest cost, whereas our social norming treatment has no detectable effect.
Collapse
Affiliation(s)
- Timothy K M Beatty
- Department of Agricultural and Resource Economics, University of California, One Shields Ave, Davis, CA 95616, United States.
| | - Bhagyashree Katare
- Department of Agricultural Economics, Purdue University, 403 W. State St., West Lafayette, IN 47907, United States.
| |
Collapse
|
29
|
Gnich W, Sherriff A, Bonetti D, Conway DI, Macpherson LMD. The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland: a natural experiment. Implement Sci 2018; 13:95. [PMID: 29996868 PMCID: PMC6042272 DOI: 10.1186/s13012-018-0775-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/05/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Financial incentives are often used to influence professional practice, yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood. In keeping with clinical guidelines, Childsmile (Scotland's oral health improvement programme) advocates twice yearly fluoride varnish application (FVA) for children in dental practice. To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2-5-year-olds' teeth through a pilot. In October 2011 payment was extended to all dental practitioners. This paper compares FVA pre- and post-roll-out and explores the financial incentive's behavioural mechanisms. METHODS A natural experimental approach using a longitudinal cohort of dental practitioners (n = 1090) compared FVA pre- (time 1) and post- (time 2) financial incentive. Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2-5-year-old patients (novel incentive group) were compared with all other responses (continuous incentive group). The Theoretical Domains Framework (TDF) was used to measure change in behavioural mechanisms associated with the incentive. Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups. RESULTS At time 2, 709 74%, of eligible responders, were followed up. In general, FVA rates increased over time for both groups; however, the novel incentive group experienced a greater increase (β [95% CI] = 0.82 [0.72 to 0.92]) than the continuous incentive group. Despite this, only 33% of practitioners reported 'always' varnishing increased risk 2-5-year-olds' teeth following introduction of the financial incentive, 19% for standard risk children. Domain scores at time 2 (adjusting for time 1) increased more for the novel incentive group (compared to the continuous incentive group) for five domains: knowledge, social/professional role and identity, beliefs about consequences, social influences and emotion. CONCLUSIONS In this large, prospective, population-wide study, a financial incentive moderately increased FVA in dental practice. Novel longitudinal use of a validated theoretical framework to understand behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems. While financial incentives are useful in narrowing the gap between clinical guidelines and FVA, multiple intervention approaches are required.
Collapse
Affiliation(s)
- Wendy Gnich
- Community Oral Health Section, School of Medicine, Dentistry and Nursing, College of Medicine, Veterinary and Life Sciences (MVLS), University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - Andrea Sherriff
- Community Oral Health Section, School of Medicine, Dentistry and Nursing, College of Medicine, Veterinary and Life Sciences (MVLS), University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK
| | - Debbie Bonetti
- Dental Health Services Research Unit, Dundee Dental Education Centre, Frankland Building, Small's Wynd, Dundee, DD1 4HN, UK
| | - David I Conway
- Community Oral Health Section, School of Medicine, Dentistry and Nursing, College of Medicine, Veterinary and Life Sciences (MVLS), University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK
| | - Lorna M D Macpherson
- Community Oral Health Section, School of Medicine, Dentistry and Nursing, College of Medicine, Veterinary and Life Sciences (MVLS), University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK
| |
Collapse
|
30
|
Luong MLN, Bennell KL, Hall M, Harris A, Hinman RS. The impact of financial incentives on physical activity in adults: a systematic review protocol. Syst Rev 2018; 7:21. [PMID: 29370831 PMCID: PMC5785811 DOI: 10.1186/s13643-018-0687-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/15/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Most adults fail to meet global physical activity guidelines set out by the World Health Organization. In recent years, behavioural economic principles have been used to design novel interventions that increase physical activity. Immediate financial rewards, for instance, can motivate an individual to change physical activity behaviour by lowering the opportunity costs of exercise. This systematic review will summarise the evidence about the effectiveness of financial incentive interventions for improving physical activity in adults. METHODS We will search MEDLINE, Embase, Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, PsycINFO, EconLit, SPORTDiscus, the National Health Service Economic Evaluation Database, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform from inception using a comprehensive, electronic search strategy. The search strategy will include terms related to 'financial incentive' and 'physical activity'. Only randomised controlled trials that investigate the effect of financial incentives on physical activity in adult populations and that are written in the English language will be included. Two review authors will independently screen abstracts and titles, complete full text reviews and extract data on objective and self-reported physical activity outcomes. The authors will also assess the study quality using the Cochrane risk of bias tool and provide a systematic presentation and synthesis of the included studies' characteristics and results. If more than two studies are sufficiently similar in population, settings and interventions, we will pool the data to conduct a meta-analysis. If we are unable to perform a meta-analysis, we will conduct a narrative synthesis of the results and produce forest plots for individual studies. Our subgroup analyses will examine the differential effects of an intervention in healthy populations compared to populations with disease pathology and compare the effects of interventions using financial rewards to interventions using financial penalties. DISCUSSION This systematic review will determine the effectiveness of positive and negative financial incentives on physical activity in adults. Findings will help inform the development of public health interventions and research in this field. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2017: CRD42017068263.
Collapse
Affiliation(s)
- My-Linh Nguyen Luong
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Level 7, Alan Gilbert Building, Building 104, 161 Barry St, Melbourne, VIC 3010 Australia
| | - Kim L. Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Level 7, Alan Gilbert Building, Building 104, 161 Barry St, Melbourne, VIC 3010 Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Level 7, Alan Gilbert Building, Building 104, 161 Barry St, Melbourne, VIC 3010 Australia
| | - Anthony Harris
- Centre for Health Economics, Monash Business School, Monash University, 15 Innovation Walk, Level 2, Clayton, VIC 3800 Australia
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Level 7, Alan Gilbert Building, Building 104, 161 Barry St, Melbourne, VIC 3010 Australia
| |
Collapse
|
31
|
Bilger M, Shah M, Tan NC, Howard KL, Xu HY, Lamoureux EL, Finkelstein EA. Trial to Incentivise Adherence for Diabetes (TRIAD): study protocol for a randomised controlled trial. Trials 2017; 18:551. [PMID: 29149912 PMCID: PMC5693491 DOI: 10.1186/s13063-017-2288-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Many people with diabetes have suboptimal glycaemic control due to not being adherent to their treatment regimen. Behavioural economic theory suggests that the lack of adherence results from the disconnect between the timing of when costs and benefits accrue. One strategy to address this discontinuity is to offer patients a near-term benefit, such as a financial reward. Whereas there is evidence that rewards can improve treatment adherence and sometimes health outcomes, further research is needed to determine whether rewards are more effective when targeting processes or intermediary health outcomes. In the Trial to Incentivise Adherence for Diabetes (TRIAD) we test whether adding financial incentives to usual care can improve HbA1c levels among people with diabetes and whether the financial incentives work better when targeting processes (adherence to blood glucose testing, medication, and daily physical activity) or the primary intermediary health outcome of self-monitored blood glucose within an acceptable range. Methods/design TRIAD is a randomised, controlled, open-label, single-centre superiority trial with three parallel arms. A total of 240 patients with suboptimally controlled diabetes (HbA1c ≥ 8%) from a polyclinic in Singapore are block-randomised (blocking factor: current vs. new glucometer users) into three arms, namely (1) usual care (UC) only, (2) UC with process incentive and (3) UC with outcome incentive, in a 2:3:3 ratio. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome (change in HbA1c level at month 6) will be measured by a laboratory that is independent from the study team. Secondary outcomes (at month 6) include the number of blood glucose testing days, glucose readings within the normal range (between 4 to 7 mmol/L), medication-adherent days, physically active days, and average incentives earned and time spent administrating the incentives. Discussion This study will provide evidence on whether financial incentives can cost-effectively improve glycaemic control. It will also provide evidence on the benefit incidence of interventions involving financial incentives. By comparing process to outcome incentives, this study will inform the design of future incentive strategies in chronic disease management and beyond. Trial registration ClinicalTrials.gov registry, ID: NCT02224417. Registered on 22 August 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2288-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marcel Bilger
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore, Singapore.
| | - Mitesh Shah
- SingHealth Polyclinics, Singapore, Singapore
| | | | - Kaye Louise Howard
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore, Singapore
| | - Hui Yan Xu
- SingHealth Polyclinics, Singapore, Singapore
| | - Ecosse Luc Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Eric Andrew Finkelstein
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, USA
| |
Collapse
|
32
|
Bilger M, Wong TT, Howard KL, Lee JY, Toh AN, John G, Lamoureux EL, Finkelstein EA. Study on Incentives for Glaucoma Medication Adherence (SIGMA): study protocol for a randomized controlled trial to increase glaucoma medication adherence using value pricing. Trials 2016; 17:316. [PMID: 27422389 DOI: 10.1186/s13063-016-1459-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Many glaucoma patients do not adhere to their medication regimens because they fail to internalize the (health) costs of non-adherence, which may not occur until years or decades later. Behavioural economic theory suggests that adherence rates can be improved by offering patients a near-term benefit. Our proposed strategy is to offer adherence-contingent rebates on medication and check-up costs. This form of value pricing (VP) ensures that rebates are granted only to those most likely to benefit. Moreover, by leveraging loss aversion, rebates are expected to generate a stronger behavioural response than equivalent financial rewards. Methods/Design The main objective of the Study on Incentives for Glaucoma Medication Adherence (SIGMA) is to test the VP approach relative to usual care (UC) in improving medication adherence. SIGMA is a randomized, controlled, open-label, single-centre superiority trial with two parallel arms. A total of 100 non-adherent (Morisky Medication Adherence Scale ≤6) glaucoma patients from the Singapore National Eye Centre are block-randomized (blocking factor: single versus multiple medications users) into the VP and UC arms in a 1:1 ratio. The treatment received by VP patients will be strictly identical to that received by UC patients, with the only exception being that VP patients can earn either a 50 % or 25 % rebate on their glaucoma-related healthcare costs conditional on being adherent on at least 90 % or 75 % of days as measured by a medication event monitoring system. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome is the mean change from baseline in percentage of adherent days at month 6. A day will be counted as adherent when the patients take all their medication(s) within the appropriate dosing windows. Discussion This trial will provide evidence on whether adherence-contingent rebates can improve medication adherence among non-adherent glaucoma patients, and more generally whether this approach represents a promising strategy to cost-effectively improve chronic disease management. Trial registration NCT02271269. Registered on 19 October 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1459-1) contains supplementary material, which is available to authorized users.
Collapse
|
33
|
Molema CCM, Wendel-Vos GCW, Puijk L, Jensen JD, Schuit AJ, de Wit GA. A systematic review of financial incentives given in the healthcare setting; do they effectively improve physical activity levels? BMC Sports Sci Med Rehabil 2016; 8:15. [PMID: 27274847 PMCID: PMC4893256 DOI: 10.1186/s13102-016-0041-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/28/2016] [Indexed: 12/14/2022]
Abstract
Background According to current physical activity guidelines, a substantial percentage of the population in high-income countries is inactive, and inactivity is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The objective of this review was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting. Methods A systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven of them were screened on in- and exclusion criteria based on the full-text publication. Results Three studies were included in the review. Two studies combined a financial incentive with nutrition classes or motivational interviewing. One of these provided a free membership to a sports facility and the other one provided vouchers for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short-term effects, neither of the studies showed significant long-term effects of the financial incentive. Conclusions Based on the limited number of studies and the diversity in findings, no solid conclusion can be drawn regarding the effectiveness of financial incentives on physical activity in the healthcare setting. Therefore, there is a need for more research on the effectiveness of financial incentives in changing physical activity behavior in this setting. There is possibly something to be gained by studying the preferred type and size of the financial incentive.
Collapse
Affiliation(s)
- Claudia C M Molema
- Department of Tranzo, Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000LE Tilburg, The Netherlands ; National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands
| | - G C Wanda Wendel-Vos
- National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands
| | - Lisanne Puijk
- National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands
| | | | - A Jantine Schuit
- National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands ; Institute of Resource Economics and Food Policy, University of Copenhagen, Copenhagen, Denmark
| | - G Ardine de Wit
- National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
34
|
Slater JS, Nelson CL, Parks MJ, Ebbert JO. Connecting low-income smokers to tobacco treatment services. Addict Behav 2016; 52:108-14. [PMID: 26489597 DOI: 10.1016/j.addbeh.2015.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/02/2015] [Accepted: 10/11/2015] [Indexed: 11/17/2022]
Abstract
The Affordable Care Act calls for using population-level incentive-based interventions, and cigarette smoking is one of the most significant health behaviors driving costs and adverse health in low-income populations. Telehealth offers an opportunity to facilitate delivery of evidence-based smoking cessation services as well as incentive-based interventions to low-income populations. However, research is needed on effective strategies for linking smokers to services, how to couple financial incentives with telehealth, and on how to scale this to population-level practice. The current paper evaluates primary implementation and follow-up results of two strategies for connecting low-income, predominantly female smokers to a telephone tobacco quitline (QL). The population-based program consisted of participant-initiated phone contact and two recruitment strategies: (1) direct mail (DM) and (2) opportunistic telephone referrals with connection (ORC). Both strategies offered financial incentives for being connected to the QL, and all QL connections were made by trained patient navigators through a central call center. QL connections occurred for 97% of DM callers (N=870) and 33% of ORC callers (N=4550). Self-reported continuous smoking abstinence (i.e., 30 smoke-free days at seven-month follow-up) was 20% for the DM group and 16% for ORC. These differences between intervention groups remained in ordered logistic regressions adjusting for smoking history and demographic characteristics. Each recruitment strategy had distinct advantages; both successfully connected low-income smokers to cessation services and encouraged quit attempts and continuous smoking abstinence. Future research and population-based programs can utilize financial incentives and both recruitment strategies, building on their relative strengths.
Collapse
Affiliation(s)
- Jonathan S Slater
- Minnesota Department of Health, 85 East 7th Place, Saint Paul, MN 55164, USA; Masonic Cancer Center, 424 Harvard St SE, University of Minnesota, Minneapolis, MN, USA
| | - Christina L Nelson
- Minnesota Department of Health, 85 East 7th Place, Saint Paul, MN 55164, USA
| | - Michael J Parks
- Minnesota Department of Health, 85 East 7th Place, Saint Paul, MN 55164, USA.
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, 221 Fourth Avenue SW, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
35
|
An R. Nationwide expansion of a financial incentive program on fruit and vegetable purchases among Supplemental Nutrition Assistance Program participants: A cost-effectiveness analysis. Soc Sci Med 2015; 147:80-8. [PMID: 26547363 DOI: 10.1016/j.socscimed.2015.09.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/14/2015] [Accepted: 09/25/2015] [Indexed: 10/23/2022]
Abstract
High prices remain a formidable barrier for many people, especially those of low socioeconomic status, to adopt a healthier diet. The Food, Conservation, and Energy Act of 2008 mandated the U.S. Department of Agriculture (USDA) to conduct a pilot study to assess the impact of making fruits and vegetables more affordable for households in the Supplemental Nutrition Assistance Program (SNAP). Based on the USDA final report of the Healthy Incentives Pilot (HIP), a large-scale randomized trial in 2011-2012 that provided 30% rebate on targeted fruits and vegetables to 7500 study participants enrolled in the SNAP, we constructed a decision model to evaluate the cost-effectiveness of an expansion of the HIP to all SNAP households nationwide. The estimated life-time per capita costs of the HIP to the Federal government is $1323 in 2012 U.S. dollars, and the average gains in quality-adjusted life expectancy to a SNAP participant is 0.082 quality-adjusted life year (QALY), resulting in an incremental cost-effectiveness ratio (ICER) of $16,172 per QALY gained. Sensitivity analysis using Monte Carlo simulations indicates a 94.4% and 99.6% probability that the estimated ICER would be lower than the cost-effective threshold of $50,000 and $100,000 per QALY gained, respectively. Moreover, the estimated ICER of the HIP expansion tends to be competitive in comparison to other interventions that aimed at promoting fruit/vegetable intake among adult population. Findings from this study suggest that a nationwide expansion of the HIP is likely to nudge SNAP households towards purchasing and consuming more targeted fruits and vegetables. However, diet behavior modification is proportional to price change. When people's actual eating behaviors and what dietary guidelines recommend differ by several folds, even a 30% rebate closes just a small fraction of that gap and has limited beneficial impact on participants' weight management, disease prevention, and health-related quality of life.
Collapse
Affiliation(s)
- Ruopeng An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, USA.
| |
Collapse
|
36
|
Chen CS, Liu TC, Chen B, Lin CL. The failure of financial incentive? The seemingly inexorable rise of cesarean section. Soc Sci Med 2013; 101:47-51. [PMID: 24560223 DOI: 10.1016/j.socscimed.2013.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 10/13/2013] [Accepted: 11/08/2013] [Indexed: 11/25/2022]
Abstract
Two policy interventions in Taiwan aiming to slow the growth of cesarean delivery utilization were respectively implemented in 2005 and 2006. The first policy provided financial incentives to encourage vaginal delivery by setting a global fee for obstetric services and in essence increasing the reimbursement for vaginal delivery up to the same level of cesarean section. The second policy aimed to reduce the demand for elective cesarean procedure by employing a copayment when cesarean section is not medically indicated. This paper examines the impact of financial incentives of both the supply and the demand side on the use of utilization of cesarean section using data from the 2003-2008 National Health Insurance Research Database. We found that while the overall trend of cesarean utilization did not seem to respond to the interventions, the policies did have significant impact on its elective use. Financial incentives for the providers do matter, and policy interventions, such as a fee change, are still important strategies to consider in reducing the over-utilization of cesarean section.
Collapse
Affiliation(s)
| | - Tsai-Ching Liu
- Department of Public Finance, National Taipei University, 151, University Rd., San Shia, New Taipei City 237, Taiwan.
| | - Bradley Chen
- Program in Health Care Financing, Harvard School of Public Health, USA
| | - Chung-Liang Lin
- Department of Economics, National Dong Hwa University, Taiwan
| |
Collapse
|