Health Care and Incentives
Round Table Discussion
Pay and Non-Pay Incentives, Performance and Motivation
Prepared for WHO’s December 2000 Global Health Workforce Strategy Group,
Geneva
Orvill Adams, BA (Hons), MA (Economics), MA (International Affairs); V Hicks
Department of Organization of Health Services Delivery,
World Health Organization, Geneva
Abstract
This paper provides an overview of evidence of the effects of incentives on the performance and motivation of independent health professionals and health workers. Incentives are viewed in the context of objectives held by paying agencies or employers. The review defines the nature of economic incentives and of non-financial incentives. Particular attention is paid to the need for developing countries to understand the impacts of health reform measures on incentives. A review of current literature found that the response of physicians to economic incentives inherent in payment mechanisms appears to follow directions expected in theory. Incentive structures are becoming more complex, however, as a result of managed care and blended payment mechanisms. There is insufficient evidence of the effects of incentives on motivation and performance of other health workers, due perhaps to a preoccupation of researchers with economic responses. Incentives must be viewed in a broad context in order to understand constraints and success factors that affect their prospects of success. Health human resources should be seen as a complex and interrelated system where incentives aimed at one group of professionals will impact on the entire system.
Introduction
The World Health Report 2000, Health Systems: Improving Performance defines incentives as “all the rewards and punishments that providers face as a consequence of the organizations in which they work, the institutions under which they operate and the specific interventions they provide” ([i]). This definition suggests that the organization, the work that
Pay and Non-Pay Incentives, Performance and Motivation
Prepared for WHO’s December 2000 Global Health Workforce Strategy Group,
Geneva
Orvill Adams, BA (Hons), MA (Economics), MA (International Affairs); V Hicks
Department of Organization of Health Services Delivery,
World Health Organization, Geneva
Abstract
This paper provides an overview of evidence of the effects of incentives on the performance and motivation of independent health professionals and health workers. Incentives are viewed in the context of objectives held by paying agencies or employers. The review defines the nature of economic incentives and of non-financial incentives. Particular attention is paid to the need for developing countries to understand the impacts of health reform measures on incentives. A review of current literature found that the response of physicians to economic incentives inherent in payment mechanisms appears to follow directions expected in theory. Incentive structures are becoming more complex, however, as a result of managed care and blended payment mechanisms. There is insufficient evidence of the effects of incentives on motivation and performance of other health workers, due perhaps to a preoccupation of researchers with economic responses. Incentives must be viewed in a broad context in order to understand constraints and success factors that affect their prospects of success. Health human resources should be seen as a complex and interrelated system where incentives aimed at one group of professionals will impact on the entire system.
Introduction
The World Health Report 2000, Health Systems: Improving Performance defines incentives as “all the rewards and punishments that providers face as a consequence of the organizations in which they work, the institutions under which they operate and the specific interventions they provide” ([i]). This definition suggests that the organization, the work that
References: 5. Chaisiri K. Human resource development through continuous improvement: a case study of Yasothon hospital, Thailand (1994-1997). HRDJ 1998;2:142-151.