Search results

Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work.

An interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjusted capitation payments, and the other a mainly risk-adjusted capitation system.

Findings suggested that both managers and salaried physicians were aware of and adapted to unit-level payment incentives, albeit the latter sometimes to a lesser extent. Respondents perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits and skimming of healthier patients. Results also suggested that differentiated rates for patient visits affected horizontal prioritisations between physician and nurse visits. Respondents perceived that risk-adjustments for diagnoses led to a focus on registering diagnosis codes, and to some extent, also up-coding of secondary diagnoses.

Policymakers and responsible authorities need to design payment systems carefully, balancing different incentives and considering how and from where data used to calculate payments are retrieved, not relying too heavily on data supplied by providers.

This study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.

The purpose of this paper is to investigate the effects of financial incentives on consumers’ intention to adopt near field communication (NFC) mobile payment.

An online experiment was conducted crossing two levels of incentive types (cash back and discount), two levels of incentive amounts (5 and 10 percent), and two levels of incentive promotion periods (one and three months). A total of eight treatment conditions plus one control group comprised the 2×2×2 factorial design. A sample of 463 subjects with no prior experience with NFC mobile payment was recruited using a Qualtrics panel.

This study found that: the availability of financial incentives had a positive effect on intention to adopt NFC mobile payment; financial incentives indirectly affected intention through perceived risk; and while different types, amounts or promotion periods did not seem to matter for those in the low perceived risk group, the main effect of promotion period and the interaction effect between amount and promotion period were significant for those in the high perceived risk group.

The study sample was limited from 18 to 35 age group, which could have affected the varied effect of the different attributes of incentives that were examined.

This study is the first to give some empirical evidence about the impact of financial incentives on NFC mobile payment adoption. The results provide insight to providers as well as retailers offering the incentive payment option.

There are longstanding concerns about the sustainability of the US health care system. Payment reform has been seen over the last decade as a key strategy to reorienting the US health care system around value. Alternative payment models (APMs) that seek to accomplish this goal have become increasingly prevalent in the US, yet there is a perception that physicians are resistant to their use and that organizations have been slow to adopt such models. The reasons for the limited effectiveness of APM programs are multifactorial and include aspects related to the design and implementation of these programs and lack of alignment and coordination across different payers and health care sectors. Most importantly, however, is that the current organizational structures in US health care serve to dampen the direct impact of these incentives, often because health care delivery organizations face conflicting incentives themselves. Organizations filter and refine the incentives from multiple external payment contracts and develop internal incentive systems that best reflect the amalgamation of the incentives embedded across their contracts, and thus the fragmented nature of the US health care system serves to undermine efforts to transform care under value-based contracts. In addition to organizations having conflicting incentives, there also are fundamental problems with the design and implementation of APMs that hinder their acceptance among physicians and the organizations in which they work. Moreover, much remains to be learned about how organizations can best adapt to succeed under these models, and how organizational culture can be leveraged to transform care.

The purpose of this paper is to propose a wage incentive plan for branch managers of multi‐branch firms. The incentive payment is calculated according to each branch's performance and its relative rank, taking into consideration common variables, regional variables and managerial skill variables.

The paper utilizes Andersen and Petersen's super‐efficiency model, which is based on the model of Charnes, Cooper and Rhodes, the most widely used and best known data envelopment analysis model. The regional variables and the managerial skill variables are considered as inputs (resources). The periodic measured efficiencies are then translated into a special wage incentive plan with promotive and contrient interdependence between the branch managers.

The regional variables and the managerial skill variables have a significant impact on the efficiency of each branch and on the ranking of the branches. These variables may increase or decrease the relative efficiency and the incentive payments of the branch managers.

The research provides tools for applying a wage incentive plan for branch managers of multi‐branch firms. The proposed incentive plan is more fair than most other incentive plans because it takes into account regional variables. Furthermore, it can increase the flexibility of the top management to switch branch managers, to send talented managers to problematic branches/regions/countries and to decrease the attractiveness of the profitable branches. The method also enables us to evaluate the performance of each branch over periods of time. The practicability of the proposed plan is demonstrated by a real‐life case study.

Beyond the common input and output variables that measure efficiency, the plan presented in the paper takes into consideration those regional variables which characterize each branch as well as the managerial skills of the branch managers. The total cost for the incentive payment is a given portion of the global corporate net profit.

The ability to measure and assess “quality” is essential in building and maintaining a safe and effective transportation system. Attaining acceptable quality outcomes in transportation projects has been a reoccurring problem at both the federal and state levels, at least partially, as a result of poorly developed, inefficient or nonexistent quality assurance/quality control (QA/QC) processes. The purpose of this paper is to develop and implement a new QA/QC process that focuses on a novel double-bounded performance-related specification (PRS) and corresponding pay factor policy that includes both lower and upper quality acceptance and payment reward boundaries for bridge concrete.

The authors use historical data to design different payment scenarios illustrating likely industry responses to the new PRS, and select the single scenario that best balances risk between the agency and industry. The authors then convert that payment scenario to a pay factor schedule using a search heuristic and determine statistical compliance with the PRS using percent-within-limits (PWL).

The methodology offers an innovative approach for developing an initial set of pay factors when lifecycle cost data are lacking and the PRS are new or modified. An important finding is that, with a double-bounded PRS, it is not possible to represent pay factors using the simplified table PWL currently employed in practice because each PWL value occupies two separate positions in the payment structure – one above the design target and one below it. Therefore, a more detailed set of pay factors must be employed which explicitly specify the mean sample value and the design target. The approach is demonstrated in practice for the Agency of Transportation in state of Vermont.

The authors demonstrate a novel approach for developing a double-bounded PRS and introduce a payment incentive/disincentive policy with the goal of improving total product quality. The new pay factor policy includes both a payment penalty below the contracted price for failing to meet a specified performance criterion as well as a payment premium above the contracted price that increases as the sample product specification approaches an “ideal” design value. The PRS includes both an upper and lower acceptance boundary for the finished product as opposed to only a lower tail acceptance boundary, which is the traditional approach.

The authors illustrate a research collaboration between academia and a state agency that highlights the role academic research can play in advancing quality management practices. The study involves the use of actual product performance data and is operational as opposed to conceptual in nature. Finally, the authors offer important practical insights and guidance by demonstrating how a new PRS and pay factor policy can be developed without the use of site-specific historical lifecycle cost (LCC) data that include detailed manufacturing, producing and placement cost data, as data related to product performance over time. This is an important contribution, as the development and implementation of pay factor policies typically involve the use of historical LCC data. However, in many cases, these data are not available or may be incomplete.

With the new PRS and pay factor schedule, the Agency expects shrinkage and cracking on bridge decks to decrease along with overall maintenance and rehabilitation costs. A major focus the new PRS is to actively involve industry partners in quality improvement efforts.

The authors focus on a major modification to an existing QA/QC process that involves the development of a new PRS and an associated pay factor policy undertaken by the Vermont Agency of Transportation. The authors use empirical data to develop a novel double bounded PRS and payment schedule for concrete and offer unique operational/practical insight and guidance by demonstrating how a new PRS and pay factor policy can be developed without the use of site-specific historical LCC. Typically, PRS for in-place concrete have only a lower tail acceptance boundary.

Bundled payments for care are an efficient mechanism to align payer, provider, and patient incentives in the provision of health care services for an episode of care. In this chapter, we use agency theory to examine the evolution of bundled payment programs in private and public payer arrangements, and postulate future directions for bundled payment development as a key component in the provision and payment of health care services.

The purpose of this paper is to explore key challenges of adopting, designing and managing performance-based contracts (PBC) for advanced logistics services, as seen by providers. The shift toward performance-based solutions has proved challenging since providers often struggle to link performance to their payment. Despite such managerial challenges, empirical research in this area has been limited.

A multi-case design was adopted. Three cases of logistics service providers were selected based on purposive sampling. Data were collected through 38 semi-structured interviews and review of 43 documents such as contracts and customer target letters.

Key PBC adoption challenges include customer and provider intention to align their goals and incentives as well as their views on risk and reward sharing. Contract design challenges center around performance metric definition and weighting, designing performance monitoring systems that consider service co-production effects and help improve customer relationship and designing incentives with appropriate intensity levels. Contract management challenges include fostering provider pro-activity, provider changes in terms of processes and resource investments, perceived fairness of designed incentives and contract re-design to allow for win-win relationship outcomes.

The study empirically contributes to extant logistics service provider literature by identifying specific challenges that extend also beyond PBC adoption and design and cover contract management (and potential contract re-design). It also unpacks the notion of performance attributability by analyzing its role also in terms of contract and performance management as well as its potential effects on customer relationship management.

The study presents implications for logistics provider managers regarding how the observed PBC challenges can be overcome.

The study unearths several challenges of PBC for advanced logistics services, particularly in connection to contract management and re-design.

The study aims to address a critical gap in existing healthcare payment schemes and care service pricing by recognizing the influential role of patients' decisions on self-management efforts. These decisions not only impact health outcomes but also shape the demand for care, subsequently influencing care costs. Despite the significance of this interplay, current payment schemes often overlook these dynamics. The research focuses on investigating the implications of a novel behavior-based payment scheme, designed to align incentives and establish a direct connection between patients' decisions and care costs. The primary objective is to comprehensively understand whether and how this innovative payment scheme structure influences key stakeholders, including patients, care providers, insurers and overall social welfare.

In this paper, we propose a game-theoretical model to incorporate the performance of self-management with the demand for healthcare service, compare the patient's effort decision for self-management and provider's price decision for healthcare service under a behavior-based scheme with that under two implemented widely payment schemes, that is, co-payment scheme and co-insurance scheme.

Our findings confirm that the behavior-based scheme incentives patient self-management more than current schemes while reducing their possibility of seeking healthcare service, which indirectly induces the provider to lower the price of the service. The stakeholders' utility under various payment schemes is sensitive to the cost of treatment and the perceived health utility of patients. Especially, patient health awareness is not always benefited provider profit, as it motivates patient self-management while diminishing the demand for care.

We provide a novel framework for characterizing behavior-based payment schemes. Our results confirm the need for modification of the current payment scheme to incentivize patient self-management.

The purpose of this paper is to present a case study on the use of performance-based contracting in the outsourcing of a reliability-centered maintenance program of a Gulf oil refinery.

A case study method is used whereby data are collected through semi-structured interviews, informal discussions with executives from the participant companies, in addition to official documents and secondary materials.

The case analysis reveals the use of a risk–reward payment scheme and key performance indicators (KPIs) deployed to support the management of the outsourced maintenance function. The financial incentive scheme was clearly designed to motivate the outsourcing contractor to achieve more financial benefits when meeting a defined set of KPIs while also delivering operating cost savings and other qualitative benefits to the outsourcing company. Managing the outsourced function also involved the use of routine budgetary control systems, in addition to other informal control mechanisms such as trust, knowledge sharing, mutual understanding and co-operation between the two collaborative partners.

The evidence presented in the case description and analysis may assist in increasing the understanding of how outsourcing relationships in maintenance business are managed and evaluated. The case findings may also provide the opportunity for further research investigating the use of performance measurement systems and incentive-based schemes in a variety of maintenance contracts.

The case study presents new empirical evidence on the use of performance risk–reward payment schemes in the management of an outsourcing relationship. Findings reported in the study will add to the existing literature on maintenance performance measurement and management practices in outsourcing relationships.

The performance of service supply chains in terms of service levels and cost efficiency depends not only on the effort of service providers but also on the inputs of sub-contractors and the customer. In this sense, performance-based contracting (PBC) entails increased financial risk for providers. Allocating and managing risk through contractual relationships along the service supply chain is a critical issue, and yet there is scant empirical evidence regarding what factors influence, and how, provider willingness to bear PBC-induced risk. This paper aims to address this gap.

The paper draws on agency theory and two cases of logistics service supply chains, in the food retail and automotive industries respectively, to identify key influencing factors. Data were collected through semi-structured interviews with 30 managers of providers and sub-contractors and review of 35 documents, notably contracts and target letters.

Four influencing factors were found: performance attributability within the service supply chain; relational governance in service supply chain relationships; provider risk and reward balancing; and provider ability to transfer risk to sub-contractors. The propositions developed address how these factors influence provider willingness to bear PBC-induced risk.

The factors identified are external to the provider mindset and refer to the management of contractual relationships and service delivery interactions along the service supply chain. The paper contributes to agency theory by stressing the risk allocation implications of bi-directional principal-agent relations in service supply chains.

The study suggests ways in which providers can increase their capacity to bear and manage financial risk related to PBC design.

The paper identifies factors that influence provider willingness to bear financial risk induced by PBC in service supply chains.