Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?

In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries. First, a schematic view of the main cost-containment methods and the variables in the health system they intend to influence is presented. Two types of instruments to control the level and growth of public health expenditure are considered: (i) provider payment methods that influence the price and quantity of health care, and (ii) cost-containment measures that influence the behaviour of patients. Belonging to the first type of instruments, we have: fee-for-service, per diem payment, case payment, capitation, salaries and budgets. The second type of instruments consists of patient charges and reference price systems for pharmaceuticals. Secondly, we provide an overview of experience in high-income countries that use or have used these particular instruments. Finally, the paper assesses the overall potential of these instruments in cost-containment policies

Identifying nurses' rewards: a qualitative categorization study in Belgium

BACKGROUND: Rewards are important in attracting, motivating and retaining the most qualified employees, and nurses are no exception to this rule. This makes the establishment of an efficient reward system for nurses a true challenge for every hospital manager. A reward does not necessarily have a financial connotation: non-financial rewards may matter too, or may even be more important. Therefore, the present study examines nurses' reward perceptions, in order to identify potential reward options. METHODS: To answer the research question "What do nurses consider a reward and how can these rewards be categorized?", 20 in-depth semi-structured interviews with nurses were conducted and analysed using discourse and content analyses. In addition, the respondents received a list of 34 rewards (derived from the literature) and were asked to indicate the extent to which they perceived each of them to be rewarding. RESULTS: Discourse analysis revealed three major reward categories: financial, non-financial and psychological, each containing different subcategories. In general, nurses more often mentioned financial rewards spontaneously in the interview, compared to non-financial and psychological rewards. The questionnaire results did not, however, indicate a significant difference in the rewarding potential of these three categories. Both the qualitative and quantitative data revealed that a number of psychological and non-financial rewards were important for nurses in addition to their monthly pay and other remunerations. In particular, appreciation for their work by others, compliments from others, presents from others and contact with patients were highly valued. Moreover, some demographical variables influenced the reward perceptions. Younger and less experienced nurses considered promotion possibilities as more rewarding than the older and more senior ones. The latter valued job security and working for a hospital with a good reputation higher than their younger and more junior colleagues. CONCLUSION: When trying to establish an efficient reward system for nurses, hospital managers should not concentrate on the financial reward possibilities alone. They also ought to consider non-financial and psychological rewards (in combination with financial rewards), since nurses value these as well and they may lead to a more personalized reward system

Optical simulations for design, alignment, and performance prediction of silicon pore optics for the ATHENA x-ray telescope

The ATHENA X-ray observatory is a large-class ESA approved mission, with launch scheduled in 2028. The technology of silicon pore optics (SPO) was selected as baseline to assemble ATHENA's optic with hundreds of mirror modules, obtained by stacking wedged and ribbed silicon wafer plates onto silicon mandrels to form the Wolter-I configuration. In the current configuration, the optical assembly has a 3 m diameter and a 2 m2 effective area at 1 keV, with a required angular resolution of 5 arcsec. The angular resolution that can be achieved is chiefly the combination of 1) the focal spot size determined by the pore diffraction, 2) the focus degradation caused by surface and profile errors, 3) the aberrations introduced by the misalignments between primary and secondary segments, 4) imperfections in the co-focality of the mirror modules in the optical assembly. A detailed simulation of these aspects is required in order to assess the fabrication and alignment tolerances; moreover, the achievable effective area and angular resolution depend on the mirror module design. Therefore, guaranteeing these optical performances requires: a fast design tool to find the most performing solution in terms of mirror module geometry and population, and an accurate point spread function simulation from local metrology and positioning information. In this paper, we present the results of simulations in the framework of ESA-financed projects (SIMPOSiuM, ASPHEA, SPIRIT), in preparation of the ATHENA X-ray telescope, analyzing the mentioned points: 1) we deal with a detailed description of diffractive effects in an SPO mirror module, 2) we show ray-tracing results including surface and profile defects of the reflective surfaces, 3) we assess the effective area and angular resolution degradation caused by alignment errors between SPO mirror module's segments, and 4) we simulate the effects of co-focality errors in X-rays and in the UV optical bench used to study the mirror module alignment and integration

Strategic Framing in Contracts

We provide a hidden-action principal-agent model where the agent has referencedependent preferences. The loss-averse agent considers the base wage as reference point, and bonuses and/or penalties as gains and losses, respectively. When choosing optimal payments, the principal strategically sets the base wage, knowing that this determines the agent's reference point. We consider two variants of the model. In a first variant, the agent's reservation utility is not reference-dependent. We show that it is always optimal in this case for the principal to employ bonuses. In a second variant, the reservation utility is reference-dependent and the principal may use penalties

Reference Points, Performance and Ability: A Real Effort Experiment on Framed Incentive Schemes

The paper investigates the effect of four differently framed payment contracts on the agent's effort provision and performance in a real effort experiment. The four incentive payments are framed as a base wage and bonuses (one immediately pays bonuses, the other only after an initial performance-independent part), penalties or a combination of bonuses and penalties. The base wage that is offered, induces the reference point. The participants provide real effort and are paid for finding pairs in a customized Memory game. The bonus-only frame elicits the highest effort, whereas frames with penalties lag behind. Ability positively complements the effect of effort on performance. The combination of penalties and bonuses minimises the costs of the principal only for low levels of performance employing heterogeneous agents. For higher performance levels, framing a base wage with bonuses is cost-effective