Cost-benefit analysis of six alternative payment incentives for child therapists.

Abstract

The outcomes and costs of 6 different methods of motivating therapists to meet service delivery goals at a community mental health center for children and adolescents were evaluated over a 5-year period. The costs and cost-savings benefits of each motivational method were compared with each other and with two baselines. Four incentive interventions generated more cost savings than they required in monetary outlays. Most cost-beneficial were bonuses paid to therapists for each hour of service they delivered over their monthly goals and bonus plans that rewarded therapists for exceeding their goals while also rewarding staff if total department goals were exceeded. The most cost-beneficial system saved $25,542 over 6 months that would have been paid to compensate for therapy hours not delivered, for an incentive investment of $9,726 over the 6 months. This yielded a net benefit of $15,816, or $31,632 annually.

Annotation: Economic evaluations of child and adolescent mental health interventions: a systematic review

“…Interventions geared towards a combination of mental health problems among youth, including children at risk of self‐harm, have used mainly cost‐offset methods. Costs incurred have been compared to savings from reductions in the utilisation of mental health services (Foster & Bickman, 2000), reductions in direct service hours delivered (Yates, Yokley, & Thomas, 1994), averted hospitalisation costs (Margolis & Petti, 1994; Gustafsson & Svendin, 1988; Blumberg, 2002) and reduction in direct service hours delivered (Yates et al, 1994). One study conducted by Schoenwald and colleagues (1996) sought to extend the success of multisystemic treatment (MST) to children with severe psychiatric problems.…”

Changing Conceptions of Employee Compensation

“…For example, the effects of contingent reinforcement have been reported to improve employee quality control (Adam, 1974;Adam & Scott, 1971), increase job attendance (Orpen, 1978), improve waitpersons' sales per table (George & Hopkins, 1989), increase salespersons' selling performance in a department store (Luthans, Paul, & Baker, 1981), and increase client contact hours of clinical therapists (Yates, Yokley, & Thomas, 1994). A recent comprehensive review of the individual-based monetary incentive literature concluded that when reinforcement in the form of pay is contingent upon actual work behaviors, those behaviors do in fact appear to increase, and that the specifics of the contingency arrangement are not as important as the existence of the contingency itself (Bucklin & Dickinson, 2001).…”

Economic Evaluations and Interventions for Children and Adolescents with Mental Health Problems

“…If families are directly bearing some of the treatment cost, through co-payments in insurance-based systems or user charges in public health systems, what they pay could certainly infiuence what they decide to use (Birch, 1986;Brand, Smith & Brand, 1977). For example, the raising of copayments and the reduction of coverage between 1978 and 1983 for U.S. federal employees and their dependents insured by Blue Cross and Blue Shield lowered both outpatient and inpatient mental health service use by children and adolescents , Families will be concerned that their treatments are worth what they pay for them (McGuire, 1989;Yates, 1994), They may not express this latter concern in terms of cost-effectiveness, nor will they seek out the latest published evaluative evidence on alternative treatments, but service providers and governments surely have an obligation to ensure that such information is available to advise those who can advise famihes.…”

“…Economy is the criterion addressed in the simplest of cost evaluations (cost-offset and cost-minimization analyses). Saving money need not mean a reduction in the health status achievements of treatment interventions; sometimes the more expensive option is the less effective (Siegert & Yates, 1980;Yates, 1994), Effectiveness is conventionally defined in terms of improvements to patient (and family) health and quality of hfe. It pays no regard to costs.…”

“…The three most useful modes of economic evaluation are cost-effectiveness analysis, cost-benefit analysis and cost-utility analysis, (See reviews in Drummond, Stoddart & Torrance, 1987;Kavanagh & Stewart, 1995;Yates, 1994,) They have some common elements, but differ in two main characteristics: they measure outcomes differently, and consequently they address sHghtly different policy or practice questions, (Other modes of evaluation are cost-offset and cost-minimization analyses, but these do not measure outcomes in terms of the health and quality of life impacts on children or families, Cost-ofillness or burden-of-illness studies are not economic evaluations as such, but they are popular and increasingly common preludes to cost-effectiveness or other analyses. They are still rare for child psychiatric disorders.…”