TABLE B-1 Articles Identified as Assessing Explicit Financial Incentives and Health Care Quality from a Systematic Review of the Literature After Applying Study Inclusion and Exclusion Criteriaa


Study Design


Norton, 1992

RCT (2 arms); November 1980 to April 1983; 36 SNFs (18 study facilities; 18 control facilities)

Level: payment system

Type: bonus

Duration: admission incentive up to 4 y; outcome and discharge incentives 1 to 2 y

Admission incentive: per diem bonus for type D ($5) and E ($3 to $28) patients (vs. $36 reimbursement)

Outcome incentive: improved health status within 90 d (measured by ADL classification); $126 to $370 per case (range of bonus)

Discharge incentive: timely discharge and resident did not return within 90 d; $60 to $230 (range of bonus); type A patients not eligible

Payment frequency: NS

Shen, 2003

CBA; FY 1991 to 1995; 5552 clients (2367 OSA clients; 3185 Medicaid clients)

Level: payment system

Type: PBC

Duration: FY 1993 to 1995

Description: additional funds based on efficiency, effectiveness, and service to special populations

Efficiency: minimum service delivery (% of contracted amount); minimum service to primary clients (% of units delivered)

Effectiveness: abstinence/drug-free 30 d before termination; reduction of use of primary substance abuse problem; maintaining employment; employability; employment improvement; reduction in number of problems with employer; reduction in absenteeism; not arrested; participation in self-help during treatment; reduction of problems with spouse/family members

Special populations: female; age 0 to 19 y; age ≥50 y; corrections; homeless; concurrent psychological problems; history of IV drug use; polydrug use

Payment frequency: yearly

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