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Carrot or Stick? Neither, Says Study

MANAGED CARE October 2013. © MediMedia USA
News & Commentary

Carrot or Stick? Neither, Says Study

Of course, the crucial question in wellness is “What really motivates people?” The carrot? The stick? Neither, says a study by François de Brantes, the executive director of the Health Care Incentives Improvement Institute.

In fact, argues “Improving Incentives to Free Motivation,” the health system’s entire approach to incentives is wrong. The study primarily looks at provider motivation, but also discusses what motivates patients. Get the study at http://tinyurl.com/De-Brantes-Study.

“Many financial incentives are designed to change simple behaviors, like improving productivity in rote tasks, but do not work for more complex behaviors,” says the executive summary. “The research which this report draws on shows that they actually undermine assets like creativity and drive, which are essential to the success of health professionals.”

Health care must rely on something other than a carrot-or-stick approach. Michael W. Painter, JD, MD, says in the prologue that “the more complex the task, the less effective financial incentives directed at it are. In fact, they may even degrade desirable behavior. Financial incentives seem to dull creativity and inhibit motivation…. If your problem … requires even rudimentary cognitive skills, then rewards do not work. Plus, here’s the kicker: Larger rewards lead to worse performance.”

What really motivates people are:

  • Autonomy: the ability to direct our own lives
  • Mastery: the desire to get better at something that matters
  • Purpose: the opportunity to do what we do in service of something larger than ourselves

Too often, the incentives for patients and providers are at odds. “For example, a provider might receive a very high marginal benefit from ordering a diagnostic imaging test, while the benefit to the patient might be negative, such as a high copayment or unnecessary exposure to radiation. Conversely, a diagnostic test that is important for the patient might have very little marginal benefit for the provider. Either way, in general, the relative health benefit of services is not taken into account in most payment models or benefit designs.”

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