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An Automated T-maze Based Apparatus and Protocol for Analyzing Delay- and Effort-based Decision Making in Free Moving Rodents

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Uncertainty about the effort-performance relationship in threshold-based payment schemes.

Anne Sophie Oxholm¹, Søren Rud Kristensen², Matt Sutton³

¹Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000 Odense C, Denmark.

Journal of Health Economics

|October 21, 2018

Summary

Healthcare providers may exert unrewarded effort in incentive schemes when uncertain about performance metrics. This uncertainty, linked to experience and control, can lead to payers extracting unpaid work.

Keywords:

Pay for performance Provider behaviour Threshold Uncertainty

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Area of Science:

Health economics
Healthcare management
Behavioral economics

Background:

Performance-based incentive schemes are common in healthcare.
These schemes often include payment thresholds, limiting rewards for exceeding targets.
Uncertainty regarding effort-performance links is a potential issue.

Purpose of the Study:

To investigate if provider uncertainty about effort-performance relationships causes unrewarded performance in incentive schemes.
To identify factors contributing to this uncertainty.

Main Methods:

Utilized data from the British Quality and Outcomes Framework (QOF).
Proxied general practitioners' (GPs) uncertainty using scheme experience and span of control.
Employed econometric analysis to assess the relationship between uncertainty and performance.

Main Results:

Found evidence that providers engage in financially unrewarded performance when facing uncertainty.
GP experience with the scheme and span of control were significant proxies for uncertainty.
Suggests that uncertainty can be a mechanism for payers to obtain uncompensated performance.

Conclusions:

Provider uncertainty about the effort-performance link in incentive schemes can lead to unrewarded effort.
This phenomenon may allow healthcare payers to acquire performance without additional financial compensation.
Understanding and mitigating this uncertainty is crucial for equitable incentive design.