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In response to rising costs and growing concerns about safety, quality, equity and affordability of health care, many countries have now developed and deployed performance-based incentives, targeted at facilities as well as individuals. Evidence of the effect of these efforts has been mixed; it remains unclear how effective strategies of varying design and magnitude (relative to provider salary) are at incentivizing individual-level performance. This study reviews the current evidence on effectiveness of individual-level performance-based incentives for health care in Organisation for Economic Co-operation and Development countries, which are relatively well situated to implement, monitor and evaluate performance-based incentives programs. We delineate the conditions under which sanctions or rewards - in the context of gain-seeking, loss aversion, and increased social pressure to modify behaviors - may be more effective. We find that programs that utilized positive reinforcement methods are most commonly observed - with slightly more overall bonus incentives than payment per output or outcome achieved incentives. When comparing the outcomes from negative reinforcement methods with positive reinforcement methods, we found more evidence that positive reinforcement methods are effective at improving health care worker performance. Overall, just over half of the studies reported positive impacts, indicating the need for care in designing and adopting performance-based incentives programs.

To understand how the COVID-19 pandemic affected women of reproductive age, specifically their economic conditions, desire for pregnancy, and access to contraceptive services during the pandemic.A total of 554 women respondents age 18 to 49 and reside in the United States were recruited using social media between May 16, 2020 and June 16, 2020. Logistic regression models assessed predictors of reporting pandemic-related changes in economic conditions, desire for pregnancy, and contraceptive access.Compared to White/Caucasian respondents, Hispanics/Latinx and Black/African Americans have 4 times the odds of experiencing inability to afford food, transportation, and/or housing (p0.01) during the pandemic; Hispanics/Latinx have twice the odds of experiencing food insecurity (p0.05). Inability to afford food, transportation, and/or housing was associated with drop in desire to be pregnant (p0.01). Despite the 25% of participants who reported a drop in desire for pregnancy, 1 in 6 reported difficulty accessing contraceptives, particularly those who experienced reduced income (p0.01).In our sample, the pandemic unevenly affected people from different socioeconomic groups. Many simultaneously experienced reduced income, difficulties in accessing contraception, and a greater desire to avoid a pregnancy. This combination of factors increases the chance that people will experience unintended pregnancies.The pandemic caused economic hardship and an increased desire to postpone or prevent pregnancy at the same time that it created new barriers to contraceptive services. This pattern may lead to a potential net effect of an increase in unintended pregnancy, particularly among people who had difficulty affording food, transportation, and/or housing during the pandemic.