Objectives: Titmuss hypothesized that paying blood donors would reduce the quality of the blood donated and would be economically inefficient. We report here the first systematic review to test these hypotheses, reporting on both financial and nonfinancial incentives. Method: Studies deemed eligible for inclusion were peer-reviewed, experimental studies that presented data on the quantity (as a proxy for efficiency) and quality of blood donated in at least two groups: those donating blood when offered an incentive, and those donating blood with no offer of an incentive. The following were searched: MEDLINE, EMBASE and PsycINFO using OVID SP, CINAHL via EBSCO and CENTRAL, the Cochrane Library, Econlit via EBSCO, JSTOR Health and General Science Collection, and Google. Results: The initial search yielded 1100 abstracts, which resulted in 89 full papers being assessed for eligibility, of which seven studies, reported in six papers, met the inclusion criteria. The included studies involved 93,328 participants. Incentives had no impact on the likelihood of donation (OR = 1.22 CI 95% 0.91–1.63; p = .19). There was no difference between financial and nonfinancial incentives in the quantity of blood donated. Of the two studies that assessed quality of blood, one found no effect and the other found an adverse effect from the offer of a free cholesterol test (β = 0.011 p < .05). Conclusion: The limited evidence suggests that Titmuss’ hypothesis of the economic inefficiency of incentives is correct. There is insufficient evidence to assess their likely impact on the quality of the blood provided.

In this cluster randomised trial (N=1060), we tested the impact of financial incentives (£5 voucher vs. £200 lottery) framed as a gain or loss to promote Chlamydia screening in students aged 18-24 years, mimicking the standard outreach approach to student in halls of residence. Compared to the control group (1.5%), the lottery increased screening to 2.8% and the voucher increased screening to 22.8%. Incentives framed as gains were marginally more effective (10.5%) that loss-framed incentives (7.1%). This work fundamentally contributes to the literature by testing the predictive validity of Prospect Theory to change health behaviour in the field.

Pension reforms in many countries have resulted in more choice and risk to individuals, decreasing the dependability on State public pensions. However, it is not clear how research has addressed this issue and how much is know about retirement saving decisions. With this paper, we provided two major contributions to the literature on retirement saving. As a starting point, we developed a general chart of retirement saving choices, extending the work of Hurd and Panis (2006). These authors focused exclusively on choices at job change or retirement age and we extended their diagram to all main decisions at each stage of retirement saving, providing a more comprehensive framework. We then used this diagram as the yardstick to perform the systematic review and evaluate the breadth of research in the last 20 years. We found 130 papers and identified the most studied retirement choices and the under-researched areas. Most papers focused on asset allocation, decision to save and contribution rate. Less attention was given to decisions at retirement age and voluntary savings. Furthermore, very few papers studied the psychological and social influences in retirement saving decisions. Policy implications and future research are discussed.

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