Open Access
Motivational capital and incentives in health care organizations
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
This paper explores optimal incentive schemes in public health institutions when agents (doctors) are intrinsically motivated. We develop a principal-agent dynamic model with moral hazard in which agents’ intrinsic motivation could be promoted (crowding-in) by combining monetary and non-monetary rewards, but could also be discouraged (crowding-out) when the health manager uses only monetary incentives. We discuss the conditions under which investing in doctors’ motivational capital by the use of well designed nonmonetary rewards is optimal for the health organizations manager. Our results show that such investments will be more efficient than pure monetary incentives in the long run. We will also prove that when doctors are riskaverse, it is profitable for the health manager to invest in motivational capital.
Open Access
Incentives beyond the money: identity and motivational capital in public organizations
(2012) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
This paper explores optimality of contracts and incentives when the principal (public organisation) can undertake investments to change agents’ (public workers) identity. In the model, workers within the organisation can have different identities. We develop a principal-agent dynamical model with moral hazard, which captures the possibility of affecting this workers’ identity through contracts offered by the firm. In the model, identity is a motivation source which reduces agents’ disutility from effort. We use the term identity to refer to a situation in which the worker shares the organisational objectives and views herself as a part of the organisation. Contrary, we use the term conflict to refer to a situation in which workers behave self-interested and frequently in the opposite way of the organisation. We assume that identity can be achieved when principal include mission-sense developing investments in contracts. By mission we mean a single culture that is shared by all the members of an organization. We discuss the conditions under which spending resources in changing workers’ identity and invest in this kind of motivational capital is optimal for organisations. Our results may help to inform public firms’ managers about the optimal design of incentive schemes and policies. For instance, we conclude that investing in motivational capital is the best option in the long run whereas pure monetary incentives works better in the short run.
Open Access
Comparing the psychometric properties of the EQ-5D-5L between mental and somatic chronic patients populations
(2013) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Hernández Arenaz, Íñigo; Economía; Ekonomia
The validity and reliability of the EQ-5D-5L in comparison with the standard 3L has been tested through the analysis of psychometric properties making use of different samples of patients. However, it is likely that the condition of the illness may affect the power of the 5L version with respect to the 3L one. Here we report on parallel testing of EQ-5D-5L and 3L administered to a sample of chronic patients of both somatic and mental illness. The aim of this study is to check some psychometric properties in both subsamples. Methods: We check for the usual psychometric properties: feasibility, (in)consistency, ordinality (and transitivity), informativity, face validity and convergent validity. Also, we perform new analysis for checking transitivity and the Cronbach-? for convergent validity. Finally, we proposed a complementary way for looking at the property of informativity through three different indexes (effective, absolute and overall) based on the statistical discriminatory power. Data: We have a total of 1002 questionnaires finally collected. 444 (46.25%) chronic mental patients, 516 (53.75%) have somatic chronic illnesses; 42 observations of unknown origin of the illness have been dropped to perform this analysis. Results: The mean value reported in the VAS for the full sample is 60.93. Somatic patients report a mean of 64.42 points in this scale and mental patients report 56.83 points in the VAS. Analyzing the distribution of the responses to problems on each dimension we found, for all cases, a highly skewed distribution. Moreover, the distribution of responses changes significantly between subsamples, as expected. In all dimensions, it seems that somatic patients take more advantage of the extra levels introduced by the EQ-5D-5L. This group reduces to a greater extent the missing response rate, commit less (and of lower importance) inconsistencies, get a higher correlation of the 5L scale and the VAS within the 3L levels, complements better the dimensions to get an overall score (measured through the Cronbach’s alpha), reduces in a more significant way the “no problem” response and the Informativity gain is also superior (for both the Shannon Evenness Index and our Absolute Index). This higher performance of the EQ-5D-5L on somatic patients is endorsed by a higher preference of somatic patients toward the 5L version of the questionnaire than to the 3L one. Conclusion: Results show the suitability of the 5L version in both subsamples, but it is much more effective for somatic patients. These subsamples’ differences may be of concern when aggregating and comparing different data.
Open Access
Identity, incentives and motivational capital in public organizations
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
This paper explores optimality of contracts and incentives when the principal (public organization) can undertake investments to change agents’ (public workers) identity. In the model, workers within the organization can have different identities. We develop a principal-agent dynamical model with moral hazard, which captures the possibility of affecting this workers’ identity through contracts offered by the firm. In the model, identity is a motivation source which reduces agents’ disutility from effort. We use the term identity to refer to a situation in which the worker shares the organizational objectives and views herself as a part of the organization. Contrary, we use the term conflict to refer to a situation in which workers behave self-interested and frequently in the opposite way of the organisation. We assume that the principal can include investments to foster identity in contracts. Think for instance in developing a single culture that is shared by all the members of an organization. We discuss the conditions under which spending resources in changing workers’ identity and invest in this kind of motivational capital is optimal for organizations. Our results may help to inform public firms’ managers about the optimal design of incentive schemes and policies. For instance, we conclude that investing in motivational capital is the best option in the long run whereas pure monetary incentives works better in the short run.
Open Access
A pilot inquiry on incentives and intrinsic motivation in health care: the motivational capital explained by doctors
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
Where the contracts are incomplete, the resulting co-ordination problems may be attenuated if workers are intrinsically motivated to do the work. It is established by theoretical and empirical literature that workers within public organizations are intrinsically motivated to exert effort doing the job and have a strong sense of social agents with the mission of providing collective goods to citizens and tax payers. This paper is an empirical pilot study in the health care sector using methods of Qualitative Analysis research. We run semistructured interviews á-la-Bewley to sixteen physicians of Navarre’s health Care Servicio Navarro de Salud-Osasunbidea (SNS-O). The objective of the work is twofold: first, to find empirical evidence about doctors’ non-monetary motives and second, to find evidence about how these non-monetary motives shape doctors’ behavior. We formulate several testable hypotheses: (1) Doctors are intrinsically motivated agents, (2) Economic incentives and control policies may crowd-out intrinsic motivation and (3) Well designed incentives may crowd-in agents intrinsic motivation. Results confirm the hypotheses formulated above and coming from our theoretical findings [11], [12]. Finally, we also found empirical evidence of conflict between political advisors or health managers (principals) and physicians (agents). Results are a step forward in the optimal design of incentive schemes and policies which crowd in doctors’ intrinsic motivation.
Open Access
El EQ-5D como medida de resultados en salud
(Elsevier España, S.L.U., 2015) Cabasés Hita, Juan Manuel; Economía; Ekonomia
El EQ-5D ha mostrado su validez y fiabilidad como medida de salud, pero su versión original presentaba algunas limitaciones, como efecto techo y escaso poder discriminatorio, especialmente en los cambios pequeños en los estados de salud más leves. Con objeto de superar estos problemas, el Grupo EuroQol lanzó la versión EQ-5D-5L en 2009, con la adición de dos niveles en cada una de las dimensiones (sin problemas, problemas leves, problemas moderados, problemas graves y problemas extremos/imposibilidad), lo que define un total de 3125 (5) estados de salud. El EQ-5D-5L ha mostrado ser una extensión válida del EQ-5D-3L que mejora las propiedades de medición, y ya se encuentra disponible en más de 120 idiomas. Existe también una versión juvenil, el EQ-5D-Y.
Open Access
Reflexiones sobre la sanidad pública en España en el horizonte de 2020
(2013) Cabasés Hita, Juan Manuel; Economía; Ekonomia; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa: OTRI 2012005009
Este trabajo pretende desarrollar una visión para el Sistema Nacional de Salud (SNS) en la perspectiva del año 2020. Partiendo de una evaluación de la situación actual del sistema sanitario y a la luz de los principios que definen un buen sistema sanitario, describe un escenario factible para la sanidad en España basado en cambios estructurales que afectan a la financiación, la equidad en el acceso a la asistencia sanitaria, la coordinación sanitaria, la colaboración público-privada, la detección y corrección de holguras de ineficiencia en la oferta y la demanda sanitarias, el cambio en el modelo de cuidados orientado a la cronicidad, el nuevo papel de la Atención Primaria y de la Especializada, la motivación e incentivos de los profesionales sanitarios, el papel creciente de los ciudadanos, destinatarios de la asistencia sanitaria y responsables de su salud, y la determinación de prioridades mediante la evaluación económica sistemática de las decisiones en materia sanitaria
Open Access
Attitudes towards blood and living organ donations
(2010) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
We model the decision of whether or not to become a blood/living organ donor. The expected utility for becoming a donor is a function of the degree of altruism, the consumption of goods, the costs of donation, the very pleasure of giving, and the recipient’s utility associated to donation. Empirically, we observe differences in the expected costs and benefits from donation between blood and non-blood donors, and between individuals with different willingness to donate living organs. Looking at benefits/costs of donation through reasons for donating/not donating, we conclude policies to encourage donation should focus on raising awareness and provide information.
Open Access
Evaluación económica del impacto de la prohibición de plomo en las gasolinas en el cociente intelectual de los niños de 7 y 8 años de la Comunidad de Madrid
(Ministerio de Sanidad y Consumo, 2015) Ordóñez Iriarte, José María; Guillén Pérez, José Jesús; Bodas Pinedo, Andrés; Aparicio Madre, Manuel Ignacio; Martínez García, María José; González Estecha, Montserrat; Cabasés Hita, Juan Manuel; Economía; Ekonomia
Fundamentos: la evaluación económica de las repercusiones sanitarias de las políticas públicas es difícil y escasa. El objetivo del presente estudio fue cuantificar monetariamente los beneficios de la reducción del plomo en la sangre de los niños de 7-8 años en la Comunidad de Madrid (España), derivada de la prohibición del plomo en las gasolinas. Métodos: se calculó la disminución de puntos de cociente intelectual (CI), utilizando dos estudios realizados en niños de 7 a 8 años según los valores de plomo en sangre que presentaban: media geométrica de 3,8 μg/dL en 1995 y 0,9 μg/dL en 2010. La mejoría neta de CI se midió en términos de capacidad de producción ganada a lo largo de la vida laboral, siguiendo los métodos de Schwartz y Salkiver. Resultados: la reducción de los niveles de plomo en sangre de estos niños evitó perder entre 135.391 y 144.153 puntos de CI. La valoración económica actual de estos puntos en términos de capacidad de producción ganada a lo largo de la vida laboral de estos sujetos se estimó en un rango entre 626,4 y 865,4 millones de euros (valor 2009). Conclusiones: las cifras de beneficios económicos encontradas derivadas de la medida de prohibición de uso de plomo en las gasolinas son importantes en términos sociales.
Open Access
Incentives beyond the money and motivational capital in health care organizations
(2012) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Economía; Ekonomia
This paper explores the conditions that characterize the optimality for a principal (health manager) to undertake investments to motivate agents (doctors). In the model, doctors are intrinsically motivated and can have different identities. We develop a principal agent dynamical model with moral hazard, which captures the possibility of affecting doctors’ intrinsic motivation and identity through contracts offered by the health manager. Identity and intrinsic motivation of the doctor can be undermined (crowding-out) or enhanced (crowding-in) by incentive policies and monetary rewards. When motivations beyond the money play a role in the agents behaviour, the optimality of the equilibrium outcomes may be altered. Intrinsic motivation is defined as doctor’s experienced enjoyment from doing her work and commit toward a mission. By “full” identity we mean a situation in which the doctor shares the organizational objectives and views herself as a part of the organization. We assume that “full” identity can be achieved when health managers include mission supportive investments in contracts. This also crowds in intrinsic motivation. However, crowding out occurs when the health manager uses only pure monetary rewards to incentivize doctors with the goal of drive their actions in his own interest. Solving the model, we are allowed to make comparative statics and discuss the conditions under which spending resources to invest in motivational capital, is optimal for the health organization’s manager. Our results may help to inform policy-makers about optimal policy design and optimal management of health organizations. For instance, we conclude that investing in motivational capital is more likely to be profitable in the long run whereas mere monetary incentives are more likely to be optimal in the short run.