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December 1, 2015

Harnessing the Right Combination of Extrinsic and Intrinsic Motivation to Change Physician Behavior

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
  • 3Center for Health Equity and Promotion, Cresencz VA Medical Center, Philadelphia, Pennsylvania
  • 4Institute of Health Policy Management and Evaluation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 5Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
JAMA. 2015;314(21):2233-2234. doi:10.1001/jama.2015.15015

During the last 50 years, technological progress in health care has been achieved primarily through spectacular discoveries in medications and imaging. More recently, policy makers have focused on changing the behavior of physicians as a way to improve efficiency in the production of health. One approach has been to shift incentives from the quantity of services to a mixture of quantity and quality, known as “value based reimbursement.” The Department of Health and Human Services aims to have 50% of all Medicare payments tied to quality or value by the end of 2018.1 As health care financing evolves toward reimbursement schemes in which physicians assume risk, there are important questions to consider regarding the balance of extrinsic motivators (eg, financial reimbursement or other forms of recognition such as awards) and intrinsic motivators (eg, personal satisfaction derived from doing good work, or internal desire to achieve a particular objective). This Viewpoint discusses the complexities involved in determining the right mix of physician motivators to achieve the “value goal” in health care.

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