Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA.
Prev Med. 2012 Nov;55 Suppl:S118-23. doi: 10.1016/j.ypmed.2012.03.005. Epub 2012 Mar 16.
To determine whether the commonly drawn distinction between the fairness of incentives targeting behavioral processes (or effort) and those targeting outcomes (or achievement) provide suitable grounds for favoring either approach in healthcare research, policy and practice.
Conceptual analysis, literature review.
A categorical distinction between process- and outcome-based incentives is less crisp than it seems. Both processes and outcomes involve targets, and both are subject to differences - across and within socio-economic groups - in circumstance and perspective. Thus, a spectrum view is more appropriate, in which the fairness of incentive programs increases with the extent of control that people have. The effectiveness of incentives is a further relevant consideration, and some available evidence suggests that incentives closer to the outcome-end of the spectrum can be more effective.
Simple distinctions between processes and outcomes by themselves provide little assurance that programs are effective or fair. Effectiveness can and should be assessed empirically. Assessments of fairness should focus on the extent to which an activity or outcome might be feasible and under an individual's control, not on whether it targets a process or outcome. Rigid uniform targets for all are generally less desirable than those that reward person-specific improvement.
确定针对行为过程（或努力）和针对结果（或成就）的激励措施之间的常见区别是否为在医疗保健研究、政策和实践中偏向任何一种方法提供了合适的依据。
概念分析，文献回顾。
基于过程和基于结果的激励之间的分类区别并不像看起来那么明显。过程和结果都涉及目标，并且都受到环境和观点在社会经济群体之间和内部的差异的影响。因此，更合适的是一种连续谱观点，其中激励计划的公平性随着人们所拥有的控制程度的增加而增加。激励的有效性是另一个相关的考虑因素，一些现有证据表明，处于连续谱结果端的激励措施可能更有效。
仅凭过程和结果之间的简单区别并不能保证计划的有效性或公平性。有效性可以而且应该通过经验进行评估。对公平性的评估应侧重于某项活动或结果是否可行以及在个人的控制之下，而不是它是否针对过程或结果。针对所有人的僵化统一目标通常不如针对个人具体改进的目标更可取。
