Financial Incentives in Medicine: Good Idea or Icky?

Money is a great way to incentivize people –but should it be used in medicine to achieve better outcomes with patients? Is this a smart idea that has been successfully used in other areas of the traditional business world and should it be translated to the medical world? Or, is there something slightly off-putting about trying to get health care workers to achieve better outcomes by motivating them with money?

Philosophically, shouldn’t health care providers always try to achieve the best outcomes for their patients no matter what? Does trying to incentivize providers with money degrade their mission? Or, does it question the fact that they are always trying to achieve the best outcomes possible? What if patients knew about such incentives? Does it matter?

Or, am I thinking about this too much? Should good providers simply be rewarded for good care? After all, it is human nature to want to be rewarded for a job well-done… And, whether you support this idea or not, it is being implemented more and more and is often tied to health-care reform.

A new JAMA study on this topic looked at doctor bonuses and was recently discussed in the Houston Chronicle. The study, done at the Baylor College of Medicine, found that providing financial bonuses to physicians improved patient outcomes, and when the incentive was later removed, care regressed.

The study examined the use of financial incentives with four groups:
1) one group where only the physician received an incentive;
2) one group where the incentive was split equally among the entire health care team;
3) one group where all members of the team received an incentive but the doctor’s was larger; and
4) a control group in which there was no incentive.

Interestingly, the group that scored the best was the one where only the physician received the incentive. A management expert commenting on the study tried to explain the results and suggested 1) that the incentive gets “diluted” when it is extended to a group and 2) that the dynamics of a group can make it tough to motivate everyone involved and that individuals sometimes try to freeload on the work of others in a group situation.

What do you think about financial incentives? Let us know!