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Lottery-Based versus Fixed Incentives to Increase Clinicians' Response to Surveys

Authors

  • Scott D. Halpern,

    1. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 723 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021
    2. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
    3. Center for Health Incentives/Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, PA
    4. Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, PA
    5. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
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    • Address correspondence to Scott D. Halpern, M.D., Ph.D., M.BE., Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 723 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021; e-mail: shalpern@exchange.upenn.edu. Scott D. Halpern, M.D., Ph.D., M.BE., David A. Asch, M.D., M.B.A., and Kevin G. Volpp, M.D., Ph.D., are with the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott D. Halpern, M.D., Ph.D., M.BE., Aaron Dornbrand-Lo, B.A., David A. Asch, M.D., M.B.A., and Kevin G. Volpp, M.D., Ph.D., are with the Center for Health Incentives/Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott D. Halpern, M.D., Ph.D., M.BE., Rachel Kohn, B.A., and David A. Asch, M.D., M.B.A., are with the Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott D. Halpern, M.D., Ph.D., M.BE., is with the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; Thomas Metkus, M.D., is with the Department of Medicine, Brigham and Women's Hospital, Boston, MA; Kevin G. Volpp, M.D., Ph.D., and David A. Asch, M.D., M.B.A., are with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA.

  • Rachel Kohn,

    1. Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Aaron Dornbrand-Lo,

    1. Center for Health Incentives/Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Thomas Metkus,

    1. Department of Medicine, Brigham and Women's Hospital, Boston, MA
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  • David A. Asch,

    1. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
    2. Center for Health Incentives/Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, PA
    3. Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, PA
    4. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
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  • Kevin G. Volpp

    1. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
    2. Center for Health Incentives/Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, PA
    3. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
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Abstract

Objective. To compare the effects of lottery-based and fixed incentives on clinicians' response to surveys.

Data Sources. Three randomized trials with fixed payments and actuarially equivalent lotteries.

Study Design. Trial 1 compared a low-probability/high-payout lottery, a high-probability/low-payout lottery, and no incentive. Trial 2 compared a moderate-probability/moderate-payout lottery with an unconditional fixed payment (payment sent with questionnaire). Trial 3 compared a moderate-probability/moderate-payout lottery with a conditional fixed payment (payment promised following response).

Principal Findings. Neither the low-probability nor high-probability lotteries improved response compared with no incentive. Unconditional fixed payments produced significantly greater response than actuarially equivalent lotteries, but conditional fixed payments did not.

Conclusions. Lottery-based incentives do not improve clinicians' response rates compared with no incentives, and they are inferior to unconditional fixed payments.

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