Altruistic decisions are influenced by the allocation of monetary incentives in a pain-sharing game

Why people hesitate to help: Neural correlates of the counter-dynamics of altruistic helping and individual differences in daily helping tendencies

Recent psychological and neuroimaging studies on altruism–egoism dilemmas have promoted our understanding of the processes underlying altruistic motivation; however, little attention has been paid to the egoistic counter-dynamics that prompt hesitancy to help. These counter-dynamics may involve the construction of reasons not to help based on contextual elaboration and explain individual differences in the tendency to help others in daily life. In this functional magnetic resonance imaging (fMRI) study, we explored the neural correlates of altruism–egoism dilemmas during empathy-driven helping decisions, with particular attention to the counter-dynamics related to individual helping tendency traits. We used two context-rich helping decision scenarios. In the empathy dilemma (Emp) scenario, empathy-driven motivation to help a poor person was associated with a cost, whereas in the economic-dilemma (Eco) scenario, self-beneficial motivation to help a non-poor person was associated with a cost. Our results showed activation of the right anterior prefrontal cortices, supramarginal gyrus, and posterior cingulate cortex (PCC) for the altruism–egoism dilemma (i.e., Emp > Eco). A significant negative effect of the helping tendency trait score was observed on PCC activation; interestingly, this effect was observed for both Emp and Eco dilemmas. The identified neural correlates of altruism–egoism dilemmas appear to be related to the construction of decision reasons based on contextual elaboration in naturalistic situations. In contrast to the classical view, our results suggest a two-stage model that includes an altruistic helping decision followed by counter-dynamics to determine the individual helping tendency.

Distribution of monetary incentives in health insurance scheme influences acupuncture treatment choices: An experimental study

BACKGROUND

Understanding how doctors respond to occupational and monetary incentives in health care payment systems is important for determining the effectiveness of such systems. This study examined changes in doctors' behaviors in response to monetary incentives within health care payment systems in a ceteris paribus setting.

METHODS

An online experiment was developed to analyze the effect of monetary incentives similar to fee-for-service (FFS) and capitation (CAP) on doctors' prescription patterns. In the first session, no monetary values were presented. In the second session conducted 1 week later, doctors were randomly assigned to one of two monetary incentive groups (FFS group: n = 25, CAP group: n = 25). In all sessions, doctors were presented with 10 cases and asked to determine the type and number of treatments.

RESULTS

In the first session with no monetary incentives, there was no significant difference between the FFS and CAP groups in the number of treatments. When monetary incentives were provided, doctors in the CAP group prescribed fewer treatments than the FFS group. The perceived severity of the cases did not change significantly between sessions and between groups. linear mixed-effects regression model indicated the treatment choices were influenced by monetary incentives, but not by the perceived severity of the patient's symptoms.

CONCLUSION

The monetary values incentivized the doctors' treatment choices, but not their professional evaluation of patients. Monetary values designed within health care systems influence the doctor's decisions in the form of external rewards, in addition to occupational values, and can thus be adjusted by more effective incentives.