October, 12 2012, 02:52pm EDT
For Immediate Release
Contact:
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
Dan Ariely, Ph.D.
Mark Almberg, communications director PNHP, (312) 782-6006, mark@pnhp.org
Financial Incentives May Sap Motivation, Undermine Quality: Health Affairs Article
Recent findings in behavioral economics may help explain how pay-for-performance schemes in health care can ‘crowd-out’ intrinsic motivation and worsen performance
WASHINGTON
A leading authority on behavioral economics has teamed up with two health policy experts in an article at the Health Affairs blog to argue that pay-for-performance (P4P) schemes in medicine may do more harm than good by "crowding out" altruism and other intrinsic motivations to do a good job.
Such P4P schemes, which are being quickly adopted by Medicare and many private insurers under the new federal health law, typically involve giving bonuses to doctors and hospitals for hitting specific, numerical targets in such matters as prescribing certain drugs or ordering screening tests.
However, despite the widespread rush to embrace P4P, a growing body of research has found no evidence that these schemes actually benefit patients, write professor Dan Ariely and physicians Dr. Steffie Woolhandler and Dr. David Himmelstein. Their article was posted to the blog late Thursday afternoon.
Moreover, it's likely the introduction of such schemes into the cognitively complex work of medicine will backfire, they say.
"Traditionally, economists have viewed extrinsic (i.e. monetary) reward as either the only motivator or as simply additive to intrinsic motivators such as purpose, altruism, mastery, or autonomy," the authors write.
"According to this view, higher pay induces better performance. But this simple model of reward-induced performance ignores the complexity of human drive, particularly the role of intrinsic motivation - the desire to perform an activity for its own inherent rewards.
"Offering your dinner-party host a $10 reward for cooking a wonderful meal isn't likely to motivate future invitations."
The authors cite multiple research studies - involving blood donors in the United States, volunteer workers in Switzerland, and Israelis with children in day care, to name just a few - that show how introducing financial incentives into the picture led to diminished motivation to do the right thing.
They also cite a meta-analysis summarizing 128 studies that show such findings are representative of a consistent body of research.
In addition, the authors warn that "crowd-out" of doctors' intrinsic motivation may be particularly severe when contracts are more detailed and controlling. P4P incentives may also lead providers to game the system by checking boxes or exaggerating diagnoses when they know that doing so will garner bonuses.
Pay-for-performance programs also increase administrative costs, they say, citing the extensive economics literature on the downsides of overly detailed contracts.
The authors are recognized experts in their respective fields. Dan Ariely is the James B. Duke Professor of Psychology and Behavioral Economics at Duke University. He is the author of numerous research studies and three bestselling books on behavioral economics, including "The (Honest) Truth about Dishonesty."
Dr. Steffie Woolhandler and Dr. David Himmelstein are physicians and professors at the City University of New York's School of Public Health at Hunter College and visiting professors of medicine at Harvard Medical School. They have published many articles in leading medical journals on health insurance and mortality, medical bankruptcy and administrative costs in health care, among other subjects. They are also co-founders of Physicians for a National Health Program, a single-payer advocacy group. PNHP provided no financial or other support for their research.
Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 21,000 members and chapters across the United States.
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United Nations experts on Friday used U.S. President Joe Biden's own language regarding Israel's offensive in Rafah, Gaza to demand that the president follow through with his statement that an Israeli invasion of the southern city would be a "red line" and would push him to halt military support for Israel.
"States with influence over Israel have described any incursion into Rafah as a 'red line,'" said experts including Francesca Albanese, special rapporteur on human rights in the Palestinian territories occupied since 1967, and Michael Fakhri, special rapporteur on the right to food. "They must immediately put those words into practice and stop this disastrous campaign by ending the flow of arms into Israel and withholding investment and political support."
The latest call for the U.S. to end its support for Israel comes as humanitarian workers in Rafah, where 1.4 million people have been living in improvised tent encampments for weeks following the forced displacement of 90% of Gaza residents, are grappling with rapidly dwindling aid supplies.
Israel seized control of the crucial Rafah crossing between Gaza and Egypt this week, shutting off all humanitarian aid—which was already a fraction of what's needed—as the enclave's entire population suffers from acute food insecurity.
Along with food, said the U.N. experts, Rafah now has no access to shipments of other survival supplies and fuel, which is needed to run Gaza's remaining hospitals and water desalination plants.
As a full-scale ground assault on Rafah is threatened, Sam Rose, director of planning for the U.N. Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), toldAl Jazeera, people in Rafah "are petrified" of a potential "scorched earth" war on Palestinian civilians.
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U.S. Sen. Bernie Sanders (I-Vt.), who has long demanded that Biden end unconditional military support for the Israel Defense Forces (IDF), warned that the U.S. can no longer be "complicit" in Israel's starving of Palestinians, dozens of whom have already died of malnutrition due to Israel's blockade on nearly all aid since October.
Biden stopped a shipment of bombs to Israel last week, but NBC Newsreported Friday that shipments of "both offensive and defensive weaponry" have been sent to the IDF in recent days despite Israel's incursion.
UNRWA said Friday that 110,000 people have fled Rafah this week, with Israel claiming the coastal town of Al-Mawasi, about six miles from the city, is a new "expanded humanitarian area" where Palestinians will be safe. Rafah is one of many places in Gaza that have been previously designated as safe zones but were then bombarded by the IDF.
The U.N. experts said Al-Mawasi, a narrow strip of land, "cannot cope with a population influx."
The town is "already without sufficient food, water, medicine, hygiene products, electricity, shelter, and access to education for children," they said.
"In light of the grievous humanitarian situation on the ground, no evacuation order issued by Israel can be considered compliant with international humanitarian law," said the rapporteurs. "Further displacement of Gaza's population through evacuation orders or military operations contravenes binding provisional measures imposed on Israel by the International Court of Justice."
On Friday, Israeli troops were advancing in eastern Rafah as cease-fire talks brokered by the U.S., Qatar, and Egypt appeared to stall. Hamas said the "ball is now completely" in the hands of Israel, which on Monday rejected a cease-fire deal that Hamas had accepted, just as the IDF launched strikes on Rafah.
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U.N. Secretary-General António Guterres called on the international community to "speak with one voice for an immediate humanitarian cease-fire in Gaza."
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Anti-Apartheid stalwart Ronnie Kasrils gives a passionate address at the Global Anti-Apartheid Conference On Palestine. #PalestineAfrica2024 pic.twitter.com/32i6KQfA85
— Salaamedia (@salaamedia) May 10, 2024
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Lamis Deek, a New York-based attorney specializing in international human rights, called for "liberation of all the land from institutions of Zionist violence and supremacy, return, reparations, justice and accountability for every Zionist crime, and restitution."
"The Palestinian resistance is on the frontline against global descent into darkness and barbarism" @Lamis_Deek speaks powerfully about what it we means when we speak about Palestinian liberation. At The Global Anti Apartheid Conference on Palestine#PalestineAfrica pic.twitter.com/2eKGrS2EZ6
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Argentina's primary trade union federation on Thursday held another nationwide general strike, the second called since President Javier Milei, a far-right economist, took office in December and began pursuing sweeping austerity and deregulation.
The South American nation's unions organized the strike "in defense of democracy, labor rights, and the living wage," according to a statement from the General Confederation of Labor (CGT), the Argentine Workers' Central Union (CTA), and the Autonomous CTA.
"It is a day of resistance and demand," the groups said, blasting the Milei government's "brutal" attacks on labor rights, social security, public health, education, science, and "our cultural identity." The policies of austerity, say opponents, have disproportionately impacted working people and retirees.
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CGT celebrated the 24-hour strike's success on Friday, declaring that "Argentina stopped," and sharing photos of sparsely populated roads, transit hubs, and other public spaces.
As the
Buenos Aires Timesreported:
In the nation's capital, streets were mostly empty, with very little public transport. Many schools and banks closed their doors while most shops were shuttered. Garbage was left uncollected.
Rail and port terminals were closed, while the industrial action forced the cancellation of hundreds of flights, leaving airports semi-deserted. Some buses—from firms that did not take part in the strike—were running in the morning, although with few passengers. Cars were circulating, but traffic levels were similar to that seen on weekends.
The port of Rosario, which exports 80% of the nation's agro-industrial production, was all but paralysed in the midst of its busiest season.
A spokesperson for Milei, Manuel Adorni, claimed the nationwide action was "an attack on the pocket and against the will of the people" by those "who have curtailed the progress of Argentines over the last 25 years," the newspaper noted.
Meanwhile, union leaders stressed that the strike was the result of "a government that only benefits the rich at the expense of the people, gives away natural resources, and seeks to eliminate workers' rights," as CTA secretary general Hugo Yasky put it.
As the action wound down Thursday, Yasky described it as a "display of dignity of the Argentine people" that sent "a strong message" to Milei's government as well as the International Monetary Fund "that intends to govern us" and the country's senators.
Argentina's Senate is now debating an "omnibus" bill that contains some of Milei's neoliberal economic policies—including making privatization easier—after the package was approved last week by the Chamber of Deputies, the lower congressional body.
Rubén Sobrero, general secretary of the Railway Union, signaled that more strikes could come if lawmakers continue to advance the president's policies, tellingThe Associated Press that "if there is no response within these 24 hours, we'll do another 36."
From Europe to North America, trade groups around the world expressed solidarity with Thursday's strike.
"Milei's policies have not tackled the decadence of the elites that he decries, instead he has delivered daily misery for millions of working people. Plummeting living standards, contracting production, and the collapse of purchasing power means some people cannot even afford to eat," said International Trade Union Confederation general secretary Luc Triangle in a statement.
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"In this context, the work of the trade unions in Argentina is extraordinary. They have emerged as the main opposition to the government's dystopian agenda, uniting resistance and building a coalition in defense of workers' rights and broader democratic principles," he added. "The demands of the trade unions in Argentina for social justice, democracy, and equality are the demands of working people across the world. Their fight is our fight and that is why the global trade union movement stands with them."
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