Patients as Mercenaries?: The Ethics of Using Financial Incentives in the War on Unhealthy Behaviors A systematic review of the use of financial incentives and penalties to encourage uptake of healthy behaviors: protocol The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland: a natural experiment An Empirical Evaluation of the Effectiveness of Tangible Incentives in Increasing Participation and Behavior Change in a Worksite Health Promotion Program Coupling Financial Incentives With Direct Mail in Population-Based Practice Incentives increased return rates but did not influence partial nonresponse or treatment outcome in a randomized trial. The effect of physician disclosure of financial incentives on trust. The effect of a monetary incentive on return of a postal health and development questionnaire: a randomised trial [ISRCTN53994660] Effects of Different Monetary Incentives on the Return Rate of a National Mail Survey of Physicians Response rates and representativeness: a lottery incentive improves physician survey return rates. The use of monetary incentives in a community survey: impact on response rates, data quality, and cost. Can Financial Incentives Help People Trying to Establish New Habits? Experimental Evidence with New Gym Members Impact of a patient incentive program on receipt of preventive care. Effectiveness of Financial Incentives in a Worksite Diabetes Prevention Program Does It Pay to Pay?: A Randomized Trial of Prepaid Financial Incentives and Lottery Incentives in Surveys of Nonphysician Healthcare Professionals Healthcare providers’ views on the acceptability of financial incentives for breastfeeding: a qualitative study
Consider the following paradox : few people would balk if research ers offered smokers $ 1,000 to participate in a year-long r and omized trial of a smoking cessation intervention , yet many would find it distasteful for a large employer to pay its smoking employees an extra $ 1,000 if they remained smoke-free for one year . Such discrepant judgments are underst and able from the perspective of classical economics . Research participants merit compensation for the risks and opportunity costs they endure in the service of public health , whereas individuals should need no reward for promoting their own well being . However , contrary to traditional theories of rationality , people frequently fail to make health-promoting choices , particularly when such choices require short-term sacrifices to foster long-term goals .1,2 Thus , corporate and government health plan leaders are increasingly applying extrinsic motivations such as financial incentives and other programs to augment health – particularly cardiovascular health – while hopefully increasing productivity and restraining costs.3 , 4 Early evidence suggests that financial incentives can effectively promote the cardioprotective behaviors of smoking cessation,5 , 6 weight loss,7 , 8 and cholesterol reduction.9  Incentives are also currently being studied as a means of promoting warfarin adherence.10 Although the results of these early studies are promising , further research is needed to determine which incentive structures and amounts are optimal , assess the ability of incentives to produce sustained behavior changes , and evaluate the cost-effectiveness of implementing incentive programs  . Ethical dimensions of the incentives themselves are also in need of further analysis . For example , some have charged that financial incentive programs are coercive , inequitable , and inconsistent with shared social values.11 Others have even suggested that implementing incentive programs serves to punish patients for their illnesses.12 In this essay , we outline the rationale for incentive programs to promote cardiovascular health , identify the ethical arguments that have been used to challenge such programs , and assess the merits of these arguments Background The use of financial incentives and penalties to encourage uptake of healthy behaviors is increasingly seen as a viable intervention in developed countries . Previous review s of the effectiveness of financial incentives and penalties for encouraging the uptake of healthy behaviors have focused on individual behaviors making it difficult to draw overall conclusions about the effectiveness of such interventions . This systematic review will explore the effectiveness of financial incentives and penalties for encouraging a wide range of behaviors , including : smoking cessation , increased physical activity , healthier dietary intake , sensible patterns of alcohol consumption , safe sun , safe sex , and primary preventive clinical behaviors . Methods Systematic methods will be used to search existing literature and screen studies for inclusion . All studies that meet the following inclusion criteria will be included in the review : participants were 18 years old or older and living in high-income countries ; interventions included cash or cash-like incentives to promote the uptake of healthy behaviors , or cash or cash-like penalties to discourage unhealthy behaviors ; the comparator was usual care or no intervention ; study design was r and omized controlled trial , cluster r and omized controlled trial , controlled before and after study , or interrupted time series analysis . Two review ers will independently screen the publications to ensure they meet the inclusion criteria . Quality will be assessed by two research ers , working independently , using the Cochrane risk of bias tool . Meta- analysis will be conducted , if appropriate . Any studies identified as at ‘ high risk of bias ’ will be excluded from meta- analysis . Discussion This systematic review will provide policy-relevant recommendations for the use of financial incentives and penalties as a method of encouraging uptake of healthy behaviors BACKGROUND This study tested the effects of two organizational support processes , the provision of financial incentives for superior clinical performance and the availability of a  patient ( smoker ) registry and proactive telephone support system for smoking cessation , on provider adherence to accepted practice guidelines and associated patient outcomes . METHODS Forty clinics of a large multispecialty medical group practice providing primary care services were r and omly allocated to study conditions . Fifteen clinics each were assigned to the experimental conditions " control " ( distribution of printed versions of smoking cessation guidelines ) and " incentive " ( financial incentive pay-out for reaching preset clinical performance targets ) .  Ten clinics were r and omized to receive financial incentives combined with access to a central ized patient registry and intervention system ( " registry " ) . Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients ' smoking cessation behaviors . RESULTS  Patients ' tobacco use status  was statistically significant ( P < 0.01 ) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition . Patients visiting registry clinics accessed counseling programs statistically significantly more often ( P < 0.001 ) than patients receiving care in the control condition . Other endpoints did not statistically significantly differ between the experimental conditions . CONCLUSIONS The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practice s and patient behaviors was mixed . Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment 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 ( Scotl and ’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 st and ard 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 , prospect i ve , population -wide study , a financial incentive moderately increased FVA in dental practice . Novel longitudinal use of a vali date d theoretical framework to underst and 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 The first is that they have value in enhancing the program ’s salience . For participants they serve as a reminder of their commitment and goals . For non participants they may function as a means of making them more aware of the program and thus enhancing the likelihood that they will participate in future program offerings . A second reason for using tangible incentives is for their direct motivational value . To the extent that they are delivered contingent on level of participation or accomplishment , employees may participate at a higher level and change their behavior more in order to earn these rewards . A number of worksite health promotion programs have employed tangible incentives . 4 - 1 ° In the well-known Live for Life program developed by Johnson and Johnson , for example , employees are offered annual risk factor screening as well as a variety of educational classes on diet , exercise , smoking cessation , and stress management . Participants in these classes receive a variety of tangible items , including T-shirts , pens , and caps . This program is reported to have had positive effects on smoking , l~ exercise ] 2 and absenteeism ? " Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy . However , little is known about how to translate incentive-based strategies to public health practice geared toward improving population -level health , and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail . This study reports results of a population -based r and omized controlled trial testing a direct mail , incentive-based intervention for promoting mammography uptake . The study population was composed of a r and om sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening . Participants ( N = 18,939 ) were r and omized into three groups : ( 1 ) Direct Mail only , ( 2 ) Direct Mail plus Incentive , and ( 3 ) Control . Both direct mail groups received two mailers with a message about the importance of mammography ; however , Mail plus Incentive mailers also offered a $ 25 incentive for getting a mammogram . Logistic regression analyses measured intervention effects . Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups . The use of incentives also proved to be cost-effective . Additionally , the Direct Mail only group was more likely to receive mammography than the Control group . Findings offer experimental evidence on how the population -based strategy of direct mail coupled with a financial incentive can encourage healthy behavior , as well as how incentive-based programs can be translated into health promotion practice aim ed at achieving population -level impact OBJECTIVE Our aim was to analyze monetary incentives and shortening the question naire as means of increasing response rates in a mailed follow-up survey 1 year after inpatient psychotherapeutic treatment . Additionally , effects on partial nonresponse and the assessment of treatment outcome were examined . STUDY DESIGN AND SETTING In a 2x2 factorial design , a sample of 3,825 patients was r and omized to the two following interventions : ( 1 ) receiving a prepaid monetary incentive or none ; and ( 2 ) getting a short or a long question naire . Treatment outcome was measured prospect ively by a self- assessment instrument for psychopathology . RESULTS When using incentives , the response rate significantly increased by 7.3 % ( 95 % confidence interval [ CI ] 2.6 - 11.9 % ) . Receiving a short question naire led to an augmentation of the response rate of 3.7 % ( 95 % CI 0.9 - 8.3 % ) , which was not significant . The corresponding odds ratios were significantly increased for monetary incentives ( 1.36 ; 95 % CI 1.30 - 1.88 ) , and when abridging the question naire ( 1.15 ; 95 % CI 1.01 - 1.31 ) . However , partial nonresponse and treatment outcome were independent of the two factors . CONCLUSION Incentives and a shorter question naire led to higher return rates but did not affect partial nonresponse and self-report of treatment outcome in a r and omized postal survey BACKGROUND Many physicians receive financial incentives to limit their ordering of expensive tests and procedures . While Medicare m and ates disclosure of incentives , it is not clear how to inform patients without undermining trust . METHODS Our objective was to determine public opinion about physician  disclosure of financial incentives and how this might be best communicated to patients . The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households . The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image . Respondents heard 1 of 6 r and omly selected disclosure strategies . The measurements included ratings of trust , satisfaction , agreement with the physician 's decision , and likelihood of remaining with the physician/health plan or seeking a second opinion . RESULTS Nearly half ( 48.8 % ) of respondents had previously heard of financial incentives to limit test ordering . Of the respondents , 94.8 % wanted to be told about incentives , at the time of enrollment in a health plan ( 80.5 % ) , by a health plan representative ( 44.8 % ) , their physician ( 17.1 % ) , or both ( 38.1 % ) . Of the 6 different disclosure strategies , " addressing emotions " and " negotiation " were associated with the best outcomes , while " common enemy " and " denying influences " were most negatively perceived . Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion . CONCLUSIONS The public wants information about physician financial incentives . Specific communication styles enhance how this information is conveyed to patients , increasing trust and supporting the physician-patient relationship Background Postal question naires are widely used to collect data in healthcare research but a poor response rate may reduce the validity and reliability of results . There was a lack of evidence available relating to use of a monetary incentive to improve the response rate in the healthcare setting . Methods The MRC ORACLE Children Study is assessing the health and development of nearly 9000 seven year old children whose mothers ' joined the MRC ORACLE Trial . We carried out a r and omised controlled trial of inclusion of monetary incentive ( five pound voucher redeemable at many high street stores ) with the reminder question naire to parents . This trial took place between April 2002 and November 2003 . When the parents were sent the reminder question naire about their child 's health and development they were r and omly assigned by concealed computer-generated allocation stratified by week of birthday to receive a five pound voucher or no incentive . The population were 722 non-responders to the initial mailing of a 12-page question naire . Main outcome measures : Difference in response rate between the two groups . Results Inclusion of the voucher with the reminder question naire result ed in a 11.7%(95 % CI 4.7 % to 18.6 % ) improvement in the response rate between the two groups . Conclusion This improvement in response rate and hence the validity and reliability of results obtained appears to be justified ethically and financially Background .Mail surveys of physicians have been characterized by lower response rates than general population surveys , raising concerns about nonresponse bias . Although monetary incentives have routinely been used to improve survey response among physicians , questions remain regarding how much of an incentive is most cost-effective . The present study seeks to further examine the effects of incentive size on response rates to a national mail survey of physicians . Methods .This study used a r and om sample of 873 physicians practicing in the United States ; the response rate was 65 % ( n = 563 ) . Respondents were r and omly assigned to receive a $ 5 , $ 10 , or $ 20 cash incentive in the initial mailing . Except for the magnitude of the incentive , the procedures for each condition were identical , with each respondent receiving up to 3 follow-up mailings and 2 telephone calls . Results .Overall response rates ranged from 60.3 % for the $ 5 incentive category to 68.0 % for the $ 10 incentive category . Differences in overall response rates across the incentive categories , however , were not significant . Higher levels of incentives also did not significantly reduce the number of mail and /or telephone interventions required to reach the target response rate of 60.0 % . As expected , aggregate costs ( excluding labor ) were lowest for the $ 5 incentive group . Conclusions .Our findings suggest that changes in the magnitude of incentive do not automatically result in increases in survey response among physicians . Possible reasons for this lack of effect as well as alternatives to monetary incentives are addressed PURPOSE To test the effect of a AU dollars 2 scratch lottery ticket on response rates to a national mailed question naire of Australian general practitioners ( GPs ) and medical specialists . METHODS A r and omized controlled trial was conducted and the incentive sent to half of the participants with the first mailing . A single follow-up mailing without incentive was sent to all non-respondents . Survey respondents were then informed of the research question regarding incentives and allowed to withdraw their study data . Differences in response rates between doctors receiving and not receiving the incentive , and between respondents and non-respondents , were examined . RESULTS The overall response rate was 47 % ( 443 respondents ) . Twenty-two respondents ( 5 % ) withdrew their data after being informed of the research question . Of the remaining 421 respondents , 233 had received the incentive ( response rate 49.7 % ) and 188 had not ( 40.1 % , p=0.0032 ) . The absolute increase in response rate with the incentive ( 9.6 % , 95%CI 3.2 , 15.9 ) was quantitatively similar in effect to the reminder mailing ( 11.8 % ) . The incentive had a larger effect among the GP sample compared with specialists ( 13.4 vs. 5.9 % ) , although the difference was not statistically significant ( p=0.20 ) . There were no systematic differences in demographic characteristics between respondents and non-respondents . CONCLUSIONS Increased response rates associated with a small incentive may reduce the need for a second mailed reminder , but strong views about the use of incentives may negatively influence the participation of some practitioners . While the overall response rate was low , there was no evidence of bias in our sample OBJECTIVES To assess the effect of incentive size on response rates , data quality , and cost in a digestive health status mail survey of a community sample of health plan enrollees . DATA SOURCES / SETTING The study population was selected from a data base of enrollees in various health plans obligated to receive care at Park Nicollet Clinic-HealthSystem Minnesota , a large , multispecialty group in Minneapolis , Minnesota , and the nearby suburbs . STUDY DESIGN A total of 1,800 HealthSystem Minnesota enrollees were r and omly assigned to receive a survey with an incentive of $ 5 or $ 2 . The response rates for each incentive level were determined . Data quality , as indicated by item nonresponse and scale scores , was measured . Total cost and cost per completed survey were calculated . PRINCIPAL FINDINGS The response rate among enrollees receiving $ 5 ( 74.3 percent ) was significantly higher than among those receiving $ 2 ( 67.4 percent ) ; differences were more pronounced in the first wave of data collection . Data quality did not differ between the two incentive groups . The total cost per completed survey was higher in the $ 5 condition than in the $ 2 condition . CONCLUSIONS A $ 5 incentive result ed in a higher response rate among a community patient sample with one mailing than did a $ 2 incentive . However , the response rates in the $ 2 condition approached the level of the $ 5 incentive , and costs were significantly lower when the full follow-up protocol was completed . Response rates were marginally increased by follow-up phone calls . The incentive level did not influence data quality . The results suggest if a survey budget is limited and a timeline is not critical , a $ 2 incentive provides an affordable means of increasing participation We conducted a r and omized controlled trial testing the effect of modest incentives to attend the gym among new members of a fitness facility , a population that is already engaged in trying to change a health behavior . Our experiment r and omized 836 new members of a private gym into a control group , receiving a $ 30 payment unconditionally , or one of 3 incentive groups , receiving a payment if they attended the gym at least 9 times over their first 6 weeks as members . The incentives were a $ 30 payment , a $ 60 payment , and an item costing $ 30 that leveraged the endowment effect . These incentives had only moderate impacts on attendance during members ’ first 6 weeks and no effect on their subsequent visit trajectories . We document substantial overconfidence among new members about their likely visit rates and discuss how overconfidence may undermine the effectiveness of a modest incentive program OBJECTIVES Patient financial incentives are being promoted as a mechanism to increase receipt of preventive care , encourage healthy behavior , and improve chronic disease management . However , few empirical evaluations have assessed such incentive programs . STUDY DESIGN In South Africa , a private health plan has introduced a voluntary incentive program which costs enrollees approximately $ 20 per month . In the program , enrollees earn points when they receive preventive care . These points translate into discounts on retail goods such as airline tickets , movie tickets , or cell phones . METHODS We chose 8 preventive care services over the years 2005 to 2011 and compared the change between those who entered the incentive program and those that did not . We used multivariate regression models with individual r and om effects to try to address selection bias . RESULTS Of the 4,186,047 unique individuals enrolled in the health plan , 65.5 % ( 2,742,268 ) voluntarily enrolled in the incentive program .  Joining the incentive program was associated with statistically higher odds of receiving all 8 preventive care services . The odds ratio ( and estimated percentage point increase ) for receipt of cholesterol testing was 2.70 ( 8.9 % ) ; glucose testing 1.51 ( 4.7 % ) ; glaucoma screening 1.34 ( 3.9 % ) ; dental exam 1.64 ( 6.3 % ) ; HIV test 3.47 ( 2.6 % ) ; prostate specific antigen testing 1.39 ( 5.6 % ) ; Papanicolaou screening 2.17 ( 7.0 % ) ; and mammogram 1.90 ( 3.1 % ) ( P < .001 for all 8 services ) . However , preventive care rates among those in the incentive program was still low . CONCLUSIONS Voluntary participation in a patient incentive program was associated with a significantly higher likelihood of receiving preventive care , though receipt of preventive care among those in the program was still lower than ideal Purpose To evaluate the effect of financial incentive in a diabetes prevention weight loss program at worksites . Design Group-level r and omized intervention study . Setting Four long-term care facilities , r and omly assigned to “ incentive-IG ” or “ non incentive-NIG ” groups . Participants Ninety-nine employees , all overweight or obese ( BMI = mean 34.8±7.4 kg/m2 ) and at risk for type 2 diabetes . Intervention A 16 week weight loss program ( diabetes prevention program ) with a 3 month follow up . IG could either choose a " st and ard incentive " to receive cash award when achieving the projected weight loss or to participate in a " st and ard plus deposit incentive " to get additional money matched with their deposit for projected weight loss . All of the participants received a one-hour consultation for a healthy weight loss at the beginning . Measures Weight-loss , diabetes risk score ( DRS ) , and cardiovascular risk outcomes . Analyses Linear and logistic regressions for completed cases with adjustments for clustering effect at group level . Results IG lost on average more pounds ( p=0.027 ) , reduced BMI ( p=0.04 ) , and reduced in DRS ( p=0.011 ) compared to NIG at week 16 . At the 12-week follow-up period , those in IG plus deposit subgroup had twice the odds ( OR=2.2 , p=0.042 ) and those in the st and ard IG had three times the odds of achieving weight loss goals than NIG ; those in the IG plus deposit group reduced DRS by 0.4 ( p=0.045 ) . Conclusion Monetary incentives appear to be effective in reducing weight and diabetes risk Background Monetary incentives in survey research may provide important gains from a method ological perspective in the control and reduction of survey error associated with potential nonresponse of participants . However , few studies have systematic ally investigated the use of monetary incentives or other methods to improve the response rates in the nonphysician clinician population . Objective To investigate differences in response rates to a mailed self-administered survey of nonphysician clinicians who were r and omized to receive a prepaid monetary incentive , a postsurvey prize drawing , or no incentive . Methods A r and omized controlled trial of financial incentives was conducted from November 2002 to February 2003 . Nonphysician clinicians ( nurse practitioners [ NPs ] and physician assistants [ PAs ] ; N = 3,900 ) r and omly selected to participate in a national ethics-related study were assigned r and omly in equal allocations ( n = 1,300 [ 650 NPs , 650 PAs ] ) to three incentive groups : ( a ) no incentive ; ( b ) a $ 5 prepaid token incentive in the initial mailing ; or ( c ) a chance to win one of ten $ 100 prize drawings upon completion and return of a self-administered survey . Results A $ 5 cash incentive increased survey response rates to an adjusted 64.2 % : a 19.5 percentage point increase over the lottery group ( 44.7 % response rate ) , and a 22 percentage point increase over the control group ( 42.2 % response rate ) . Discussion A nominal cash incentive of $ 5 yields a significantly higher response rate from nonphysician providers than receiving either a lottery option or no incentive Background Despite a gradual increase in breastfeeding rates , overall in the UK there are wide variations , with a trend towards breastfeeding rates at 6–8 weeks remaining below 40 % in less affluent areas . While financial incentives have been used with varying success to encourage positive health related behaviour change , there is little research on their use in encouraging breastfeeding . In this paper , we report on healthcare providers ’ views around whether using financial incentives in areas with low breastfeeding rates would be acceptable in principle . This research was part of a larger project looking at the development and feasibility testing of a financial incentive scheme for breastfeeding in preparation for a cluster r and omised controlled trial . Methods Fifty – three healthcare providers were interviewed about their views on financial incentives for breastfeeding . Participants were purposively sample d to include a wide range of experience and roles associated with supporting mothers with infant feeding . Semi-structured individual and group interviews were conducted . Data were analysed thematically drawing on the principles of Framework Analysis . Results The key theme emerging from healthcare providers ’ views on the acceptability of financial incentives for breastfeeding  was their possible impact on ‘ facilitating or impeding relationships ’ . Within this theme several additional aspects were discussed : the mother ’s relationship with her healthcare provider and services , with her baby and her family , and with the wider community . In addition , a key priority for healthcare providers was that an incentive scheme should not impact negatively on their professional integrity and responsibility towards women . Conclusion Healthcare providers believe that financial incentives could have both positive and negative impacts on a  mother ’s relationship with her family , baby and healthcare provider . When design ing a financial incentive scheme we must take care to minimise the potential negative impacts that have been highlighted , while at the same time recognising the potential positive impacts for women in areas where breastfeeding rates are low
Financial incentives may be effective in changing healthcare professional practice .
We found no evidence from review s that examined the effect of financial incentives on patient outcomes
BACKGROUND There is considerable interest in the effectiveness of financial incentives in the delivery of health care .
Incentives may be used in an attempt to increase the use of evidence -based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive , diagnostic and treatment decisions , or both .
Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way .
Since there are numerous review s performed within the healthcare area describing the effects of various types of financial incentives , it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals ' behaviour and patient outcomes .
OBJECTIVES To conduct an overview of systematic review s that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes .