I’ve enjoyably wasted a good chunk of my morning reading about a tipless restaurant (thanks Aimai)
When in time we started contemplating the elimination of tips from the Linkery, Ilooked for actual research on the subject, and found Michael Lynn’s then-recently-published“Tip Levels and Service”. This paper shows that in spite of what people think motivates theirtipping calculations, the quality of service has only a tiny effect on how much a restaurant customer actually leaves as a tip. In fact, the percent tip left by a guest is as much influenced by whether the server (if female) draws a smiley face on the check, or predicts good weather, as by the guests’ happiness with the quality of service…if you’re a server who wants to maximize your income, service quality should not be your focus….
The Incidental Economist links to an interesting study on pay for performance evaluation:
The strength of their intervention is that they made it incredibly simple for adoctor to get a payout: 1) Measure blood pressure, 2) Treat accordingly. But that strengthmorphs into a weakness when it comes to what we’re supposed to do with this study. As the authors note, it didn’t require complex diagnosis—really any diagnosis, for that matter, since blood pressure is measured at every physician visit. And it didn’t require treating the blood pressure successfully; everyone who tried got an A for effort. So in this particular condition(hypertension), with this particular incentive structure, pay for performance worksbeautifully. The RCT was a success.
These two things are related.
Simple monetary incentives are pretty good at motivating people to do check box activities. And these incentives have their place in medicine. For instance, it is a good thing that everyone who can safely take a flu shot gets a flu shot, or every child in their 4 year old well visit gets a hearing and vision screening or the body part that is to be operated on is marked with an “X” with a Sharpie pen before surgery. These things are simple, direct and rely on a vast literature which supports doing these actions 10,000 times will produce significantly better results than not doing these actions 10,000 times.
The entire set of activities that actually promote good health are not check box activities.
They are complex, multi-variate problems with massive interdependencies. What if the blood pressure problem is due to a complex underlying root cause that the basic treatment that was rewarded masks for a few years? How does the incentive structure prevent proper care?
Most pay for performance systems are multi-tiered. The first tier are direct payments for following guidelines and best practice recommendations (flu shots, aspirin for people complaining of chest pains/tightness, handwashing protocals etc). These are the low hanging fruit which should produce strong signals of quality and reward. However, the second level is the more complex and higher pay-off levels. How do we promote health of a population instead of encouraging providers to only “treat” health patients and pocket the health incentives?
This is a complex problem with plenty of opportunities to royally jack things up (that is the highly technical insurance jargon). The solution has to been to create metrics that attempt to measure health care quality given a population’s initial starting condition. A population that is older and has more problems will be normalized in a different manner than a population that consists of 23 year old tri-atheletes. And even then, there will be odd results and perverse incentives that will need to get ironed out in multiple iterations.
(BTW — this is similar to the complex problem of actually measuring teacher value add — it is a highly complex problem where the simple solution of just taking test scores and looking at the yearly delta is amazingly wrong but appealing)
mathguy
Richard-thanks for all of the informative posts. The information has been incredibly useful and timely.
aimai
I found that entire series about Tipping really eye opening, although I knew quite a bit about the literature which the restaurateur needed to discover or intuit for himself. And I sent my children to a school more or less based on the principles encoded in “Punished By Rewards.” Also, from a childrearing perspective “Raising Lifelong Learners.”
The thing is that what you value in an interaction or a process–like waiting tables, serving customers, or learning in school–is not really brought about by a system of incentives such as tipping or grading. Evaluation, recognition, praise and communal systems of support are very valuable but as the tipping essays show a direct consumer to waiter system of praise or punishment can be very harmful. People do respond well to praise and incentives but they don’t necessarily respond well to disincentives.
Money is a special category, as well, transforming an interaction that could be based on love and respect into one that is based on gain. In his book “The Gift” Henry Hyde (I think, though its a long time since I’ve read it) explores what is known about what happens to blood supply and organ donation when you go from a donor/unpaid model to a paid model. Its not pretty. Rather than increasing the supply you decrease it.
cvstoner
How about we promote the concept of the “family doctor” who actually spends time getting to know his or her patients so that they can be helped in determining health options that work for them, as opposed to cookie-cutter options that only seek to improve efficiency?
aimai
Also: Richard, can I ask you to correct the broken link to my blog post about Punishers, Tippers, Republicans and Federal Workers? The correct link is Here.
amk
So, what is the insider info on ACA registration levels in the past week?
Mary G
My rheumatologist was complaining about this the other day – she said good medicine is just not measured by how many minutes it takes her to get a good patient visit accomplished, because a patient who is really sick is often confused and hard to get good info from and she has to ask the same question five different ways before she gets a clear picture. Whereas I have been going to her for years and our visits are usually only a couple of minutes because I know all the lingo.
catclub
@aimai: I remember the story (probably made up, but so what)
about the old man who pays kids to do the things that annoyed him. He stopped paying and They stopped doing those things. Before payment they had enjoyed doing it just to annoy him.
Comrade Mary
I don’t care what anyone says: I tip 25% in restaurants and I am now in a cab headed LATE to my CORRECT meeting location, so this driver will be getting ALL my cash.
edub
btw, the Linkery (the restaurant mentioned above that eliminated tips for its employees) is now closed.
Bummed because, in my many visits to SD, I never got the chance to eat there!
amk
@Comrade Mary: I am with you. 10 to 15% on food bill. Nothing on booze biil since they are padded already.
Richard Mayhew
Can’t say, I like my job :)
Violet
IT DOES.
Sorry for yelling, but I lived this. My cholesterol was high at my annual physical several years ago. Nurse calls me and tells me the doctor wants me to go on a cholesterol lowering medication. I asked if I could try diet and exercise first–they said okay (still can’t believe they didn’t suggest it first, but whatever). I got my cholesterol down to acceptable levels, but it was always on the high end.
Fast forward a few years–I go for my annual Ob/Gyn checkup–she says my thyroid is slightly enlarged, but my TSH, the thyroid hormone they measure, is “normal.” (It wasn’t, but that’s another issue–problem with doctors not being up on current research).
At my following annual exam I am tired and not feeling well and I ask my doctor to test my thyroid. It took a lot of arguing with him for me to get him to agree to test it, and then only after I told him my Ob/Gyn told me my thyroid was enlarged. When the results came back, my TSH was way out of range. I now take thyroid medication.
Guess what–thyroid problems can cause high cholesterol. That’s what was going on the first time my cholesterol was high. The underlying problem was my thyroid, not my cholesterol. No incentive to treat that, though. So it was just throw medication at the cholesterol. Thankfully I was informed enough to refuse. How many people are?
Now my challenge is figuring out why my thyroid is out of line. There’s a reason. I just haven’t found it yet.
Edited for clarity.
negative 1
I used to work for the devil — that is to say I was in compensation planning for a top 20 bank. We used to do statistical experiments by raising the compensation for tellers and comparing their performance with that of their coworkers. It didn’t make a difference at all. It didn’t attract “a better hiring base”, none of it.
Corner Stone
@negative 1:
I’m certain there’s more to the story there.
NonyNony
@negative 1:
Out of curiosity, how do you measure the performance of a teller anyway?
FlyingToaster
@cvstoner: The only problem with a “family” doctor is that they tend not to be good for every member of the family.
We (HerrDoktor and I) go to an adult practice; we have different primary care physicians, but any member of the practice (5 GPs, 1 prescribing nurse, 1 locum, and each day a different specialist, e.g. a podiatrist) can see you as needed. My daughter goes to what we think is a large pediatric practice (4 Pediatricians, 1 prescribing nurse), and has her specific PCP. Both of these practices are affiliated with teaching hospitals, and often we have medical students taking histories or observing examinations.
It’s not always about “knowing the patient”; it’s also about knowing the medicine and the advances in same. And a medical office that is good about record-keeping means that you can talk to whoever’s on duty and they can accurately assess what’s going on, advise you, and pass on what they’ve done to your PCP. We’ve been through that with my husband (fell ill on Father’s Day 2012; called and got my PCP who was on duty; she accessed his charts and told him to go ahead and drive himself to the emergency room; they’d be waiting for him. Monday morning his PCP called as a follow up to make sue the stopgap treatment was working, and to schedule a drop in that week and a visit to a specialist the following week).
An old-fashioned family-practice is not a panacea.
Corner Stone
In the series Jay Porter did re: The Linkery, I was interested to see his take on how the social dynamic of tipping in restaurants was akin to a strip club.
FlyingToaster
@Violet: If you’re female and over 40, this is a common deterioration. I was told that it was near 50% of women lose some thyroid function by menopause.
I’ve been on the same maintenance dose for 7 years; my (younger) sister-in-law has been doubling her dose every three years.
Richard Mayhew
@aimai: fixed
Roger Moore
@Violet:
Unfortunately, there’s a strong tendency to treat cholesterol even in the absence of direct incentives from the doctor’s employer. A lot of cholesterol medications are very profitable because they’re still under patent protection, so there’s an army of
pusherssales reps out there telling doctors all about them, giving out sales literature and free samples, inviting doctors to seminars about lowering cholesterol (some of which count as CME credit), etc. Thyroid medicine, not so much. So doctors may wind up looking at cholesterol rather than thyroid just because they’ve been primed to look at cholesterol. The big pharma marketing machine is an overall negative both for costs and public health.Eric U.
my doctor has a sign by the scale that says something to the effect that they have to weigh you or the insurance company will not pay. Last time I was there, it was for a rash, but they had to weigh me. I was also looking into blood pressure, since apparently I have a bad case of white coat syndrome, and riding my bike to the doctor’s office doesn’t really help the measurement accuracy anyway. From what I can tell, the risk represented by mildly high blood pressure is vastly overblown. And they need to put in a bike rack.
I tip more if the wait person is bad. I figure they need the money.
aimai
@negative 1: My father went into business from academia late in life. One of the things that cracked him up were all the ways it was explained to him how to get around actually paying people for the work they do via salary. Instead the venture capitalists and other people involved in setting up the business focused on creating different status degrees–such as whether you got arms on your desk chair or not–that would enable the employees to feel like they were on a reward structure that could take the place of actual salary or valuable perks.
Violet
@Roger Moore: Yep. The pay structure for doctors is ridiculous. Our health system doesn’t promote health. I do a lot of my own research and do my best to find doctors who will work in partnership with me. It’s a lot harder than it should be.
@FlyingToaster: That’s crazy when you take a step back and look at it. Why does it happen? What environmental or other issues are leading that many women to lose thyroid function?
Roger Moore
@Eric U.:
Weighing people is probably a good idea. It’s a simple thing related to health that it’s easy and fast to check, and it’s also helpful for making dosing decisions.
beltane
@Violet:
I think it’s akin to enlarged prostates in men. A couple of hundred years ago. 40 was considered old age. Nature selects for the ability to reproduce successfully, not for the ability to enjoy a healthy, post-menopausal old age.
Sister Rail Gun of Warm Humanitarianism
@edub: The owner has moved to Oakland and is in the process of opening another restaurant there. No word yet on whether it will also be a no-tipping place.
Cacti
I hate everything about how tipping is practiced in the U.S. food service industry. It gives employers an excuse to pay starvation wages to their staff, it adds cost without adding value, and it is based on arbitrary measures that having nothing to do with the quality of table service.
MomSense
@Violet:
Ok, I am just now dealing with the high cholesterol issue and I do exercise regularly so I decided to become a vegetarian because I don’t want to do the medication route.
My TSH has never tested abnormally but I will ask about it.
Thank you.
Corner Stone
@Cacti: The people with money want to eliminate the min wage for the same reason you see described in the tipping series by Porter.
It takes the “burden” of paying workers a living wage and gives the power to those demanding the service.
Roger Moore
@beltane:
I think you can overstate this. Evolutionarily successful reproduction requires more than a safe childbirth; it requires ensuring that children survive to reproductive age themselves. There should be strong evolutionary pressure for women to remain healthy for long enough after menopause to rear their last child, and at least some pressure for them to stay healthy enough to help with their grandchildren.
Corner Stone
It’s the same kind of thing I’ve noticed in local Subway sandwich shops here in TX. A couple years ago you would never see a tip jar on the counter. Now, it’s quite common.
IMO, the decreasing buying power of the low wages have put the people working there in an awkward and damaging situation.
Corner Stone
@Roger Moore:
I don’t see how any of this follows.
Roger Moore
@Cacti:
I fairness, some states have the same minimum wage for tipped and non-tipped employees. I haven’t noticed it having a drastic effect on restaurant prices- local rents are almost certainly more important- and it lets waiters earn a good enough living to treat waiting as an actual career. I would strongly support elimination of the separate tipped wage everywhere, especially as part of a general move to raise the minimum wage to something closer to a living wage.
Lurking Canadian
@Cacti: I tip. But I’ve always thought that the notion of tipping based on a fraction of the cost of the meal is just plain stupid. The waitron at the diner who brings your $2.99 bacon and eggs is doing the same job as the waitron who brings your $50 steak at Ruth Chris, but we’re expected to pay the latter more than ten times as much? For what?
the Conster
There is a lot of data from long term tests that show cholesterol isn’t a problem, especially for women – it’s inflammation that causes heart disease and most other systemic problems. Statin drugs are a scam, and a lot of doctors are lazy by prescribing them. A change in diet should be able to fix most dietary related things, which is most of what health consists of.
Uncle Ebeneezer
Finally read the whole post Amai, excellent. Really interesting stuff. One thing that has never made much sense to me in the whole tip-as-incentive idea is that it seems to neglect our amazing ability as humans to avoid blaming ourselves. I only briefly worked in service fields (bussing tables and working a deli counter.) In both cases tips were only a small part of my incentive, but there nonetheless. And in cases with disappointed customers and low or no tip it was obviously a case of them being ridiculously picky, impatient, having unrealistic expectations, being cheap bastards or just assholes. I’m guessing this sort of mentality to find other culprits for a poor experience for the customer (and like mixups with the line-cooks, inventory etc., there often ARE other places in the chain of staff/actions where the blame can be placed) is not uncommon among wait-staffers. And thus the whole idea that a bad customer experience and low tip will somehow teach the waiter a lesson is knee-capped by the fact that it’s much easier to chalk it up to the customer being a jerk.
cvstoner
@FlyingToaster:
That may be true, but the point I was trying to make is that we may be sacrificing the most important parts of health care just to improve efficiency of delivery; namely, a trained health care professional with more motivation than the number of patients he or she can efficiently push through in a daily basis. Having a doctor who knows you and is truly concerned for your health can mean a lot :-)
Roger Moore
@Corner Stone:
It’s basically a question of K-type (fewer offspring with more parental involvement) vs. R-type (more offspring with less parental involvement) reproductive strategies. Menopause makes evolutionary sense if you see it as a trigger for women to invest their energy in raising their existing children rather than having more children, i.e. to force them into a K-type rather than an R-type strategy. But that only makes sense if they’re alive to devote the energy into child rearing. If they die shortly after menopause, they won’t be around to raise their final few children, and those children will be much more likely to die before growing up to have children of their own. Since children who don’t provide grandchildren are an evolutionary dead-end, women who die shortly after menopause would be less successful than ones who live long enough to see their last children grow up.
Richard Mayhew
Here is an interesting chapter on K-type child rearing in foraging societies (http://www.fas.harvard.edu/~hbe-lab/acrobatfiles/who%20tends%20hadza%20children.pdf)
Grandmothers are net calorie contributors as well as nurturers to kids for a very long time.
Amber
@amk: Are you serious!?! Not only are you cheap, but the alcohol bill is not “padded” for your server or bartender. You think your server magically adds on a dollar to your drink price and s/he gets that money? Wow.
I’m assuming you have never been a regular at an actual sit down restaurant outside of maybe Denny’s where those unfortunate servers are used to bad tips (unless that is when you give 15%, which will get you consistent good service). You definitely must not be a regular at a bar since after the first few times of no tipping, I’m sure you are ignored. Back in my bar/serving days, we would occasionally get a person like you and after the first 2 times, we would all be ‘fighting’ to not take their drink order and ignore as long as possible. After a little bit that person would stop coming in to all of our relief. Hint: when the bar is busy and your rushing around you are not going to waste time on someone like you.
FlyingToaster
@Violet:
It’s probably genetic/evolutionary rather than envrionmental. My grandmother and mom and one sister (so far) are all hypothyroidic. My mom severely (she had hyperthyroidism at age 19; steadily decreasing function from her early 40s)); me and my sis mildly. There are a number of age-related disorders (prostate function in men; type 2 diabetes and hypertension for everyone) that we are just learning how best to deal with, by having a large and variant enough population to figure out best practices with.
@beltane: This.
There is no evidence that living longer ensures that your grandchildren reach reproductive age; given some of the selfish old asshats (and I’m looking at all of the GOP congressMEN in this), it seems more likely that they’ll have fewer viable offspring.
Sister Rail Gun of Warm Humanitarianism
@MomSense: Ask for the full panel. My TSH was borderline high, but my T3 and T4 were all out of whack.
And yes, my cholesterol dropped dramatically as my thyroid levels approached normal.
Mnemosyne
@negative 1:
You mean that simply raising wages didn’t improve the crappy workplace conditions that made people not want to work there? Get outta town!
The Giant Evil Corporation I work for is notorious for paying a bit under the going rate as far as salaries, but I know that if there’s a tool I need to do my job, all I have to do is ask for it and I’ll get it. Frankly, that’s worth more than an extra dollar or two an hour at a place that seems to put obstacles in the way of me doing my job.
Eolirin
@Roger Moore: That makes an assumption that menopause is evolutionarily adaptive, rather than just something that wasn’t selected against because until recently (in evolutionary terms) the percentage of people who lived long enough to experience it was near zero. I’m not sure that claim can be made conclusively
JenJen
@Lurking Canadian: Servers at fine dining restaurants provide service that is more attentive and requires more steps than diner or casual service. Servers in a steakhouse must be very knowledgeable about wine, for example, and are trained to answer every possible question about how entrees are prepared. There are more courses in fine dining as well; wine presentation or delivery of alcoholic beverages, appetizers, entrees, coffee service, dessert. There’s a lot of plate and silverware clearing, and if a busser or server assistant is doing that job, they receive a percentage of the tip you leave your server.
Servers in fine dining get fewer tables than in casual dining, so that they have time to provide attentive service, whereas casual dining servers make their money on volume, aka “burn and turn”. The average diner in a casual restaurant is in and out in under an hour; fine dining experiences can last three times as long. Finally, servers pay taxes based on their sales, not their actual tips. As a general rule, servers declare at least 8% of their sales whether they received those tips or not, and in fine dining, servers have to tip out other employees (SA’s, bussers, bartenders) and therefore don’t get to keep all of that tip a guest left.
It’s just not the same job as a server at a coffee shop.
Scotius
The thing that really got me was that restaurant reviewer who mentioned a wait person by name in a negative review and justified it by saying that was the only way she could punish him since she couldn’t give a reduced tip. If I were that waiter, I would make it my mission to out her real identity since she had so little respect for his privacy to begin with.
negative 1
@NonyNony: Metric of the moment. Either accuracy, transactions/minute or “customer feedback” (which means surveys).
@aimai: Honestly upper level management used to call up and complain when someone next to them was using the wrong title. Like “Mike’s calling himself a Regional Supervisor but he’s only a District Personnel Manager!” Really. They’d tattle.
@Mnemosyne: It may be a little different depending on the field, but there the general attitude was anything that wasn’t a sales person was a cost, and costs should be cut. I realize that opinion leads to some real stupid decisions, but there it is. Plus people horde office supplies like cans in a bomb shelter.
Corner Stone
@Roger Moore: I understand the benefits of the nurturing model you describe, I’m just not sure where the evolutionary pressure would come from to do something about it.
Maybe I’m not reading it very clearly.
Villago Delenda Est
There are a lot of people out there who cannot handle these sort of complex issues. They’re just too difficult for their minds to grasp, so the look for easy metrics to simplify things for them.
We call these people “MBAs”.
Villago Delenda Est
@Uncle Ebeneezer:
Bingo.
JenJen
@Scotius: As the GM of a restaurant, that part of the series infuriated me! I certainly would’ve called the reviewer, as the owner did. That exchange really illustrated the point of the series too.
It was a great read; I have hoped for decades that we could pay wait staff a living wage and eliminate the tipping custom, but I just don’t see diners in the near future accepting the higher cost that built-in service fees would require. I am curious as to why the restaurant ultimately failed, though. It’s likely not because the owners simply wanted to move on to another project.
Mnemosyne
@negative 1:
I’m in entertainment, so there is at least a little bit of recognition that the people who are creating the product to be sold (and, fortunately, the people supporting them) need tools to do that job. It hasn’t always been like that, but it’s greatly improved under a relatively new regime whose motto is, “Quality is the best business plan.” But, yeah, the previous regime made some really stupid decisions, like thinking IT guys could do the job of computer animators. Not the same skill set, to say the least.
Look, pal, I’m the only thing standing between you and a massive Post-It shortage, okay?! What will you do if you need Post-Its during the zombie apocalypse?
Corner Stone
@Scotius: That part incensed me as well. Complete douchecanoe move on the reviewers part.
A dozen different and better ways she could have made her displeasure apparent – and useful.
aimai
@Eolirin: I thought that the claim had been made that having grandparents was evolutionarily adaptive. And though I hate evopsych style arguments it makes sense–at least as far as women are concerned–because having a noncompeting female who can help with childrearing (as opposed to a co-wife who is competing with you and still producing children herself) would be a definite benefit.
aimai
@Uncle Ebeneezer: Thank you for reading it, Uncle Ebeneezer. I agree with you completely about the indeterminacy of the meaning of the “tip/no tip” situation. In fact I was reading a fascinating book recently called “Mistakes Were Made, But Not By Me” which explores the ways in which people fail to grasp the connections between information and action, or between punishments/responses and actions they themselves have taken. People just don’t have perfect information, whether about their own motives, their own actions, or the way those motives and actions are perceived by others. In fact its a great thing to read in considering the different ways the Republicans and the Democrats view the standoff/shutdown. The two sides don’t start from the same point historically, politically, or morally and intellectually in considering who is doing what to whom. That is why we see the Republicans claiming, with a straight face, that President Obama is forcing the government to shut down while Democrats see it exactly from the opposite perspective.
catclub
@Amber: “unless that is when you give 15%, which will get you consistent good service”
The whole point of the articles discussed in this post is that this is not true.
JenJen
@catclub: Amber was referring to “regulars”, which is a segment of diners not addressed in the tipping series. I can assure you that I, my servers, and my bartenders know the regulars who tip and the ones who don’t, and they do adjust at least the speed of their service accordingly.
StringOnAStick
@Sister Rail Gun of Warm Humanitarianism: Let me also be supportive of getting ALL the thyroid tests, T3, T4, and TSH; too often docs just do the last 2 and consider it a simple math problem to derive T3, but that is incorrect. My TSH and T4 look OK-ish, but the T3 measurement told the tale.
T4 is essentially the storage form of thyroid hormone, and T3 is the active form. TSH is a measure of how much you thyroid gland is being stimulated to produce each of these, but it doesn’t differentiate. The most commonly prescribed med is Synthroid, which is basically T4, but if your body is having trouble converting T4 to T3, this med isn’t the best choice, the old-fashioned Armour is (it’s cheap, it’s made of bovine thyroid, and it contains T3). It takes a fairly up-on-the-research doc to overcome the drug rep push to prescribe Synthroid. 90 days of Armour costs me less than $15, and it gave me my life back. My gynecologist just did the TSH and T4 test which failed to find the problem; the clinic that did my knee therapy also does hormone evaluations, and they were totally up on this.
Bottom line: insist on them measuring T3 too, even if your insurance won’t pay for it. It was a life saver for me and I can’t be the only one.
Roger Moore
@Corner Stone:
Or that I’m not stating it very clearly. My theory is that children whose mothers die when the child is young have a greatly reduced chance of surviving to adulthood. That means that women who survive for long enough after menopause to raise their last children will have more children survive to adulthood than women who die shortly after menopause. Since evolutionary success depends on the number of nth generation descendants, not just the number of children, that gives women who live after menopause an evolutionary advantage. Basically, you get more grandkids if you stick around to raise your children to adulthood than if you die shortly after the last one is born.
@Eolirin:
I think the research on pre-agricultural life expectancy is lacking. There’s also the problem of pre-modern life expectancy estimates being skewed by high infant and childhood mortality. People who made it to adulthood had a decent chance of living to old age. Women were obviously a lot more likely to die in childbirth than they are today, but IMO that can be used to argue for menopause as an adaptation rather than a side effect of aging. If you assume that women had an increased chance of dying in childbirth as they got older, you’d eventually reach a point where the risk of complications from pregnancy outweigh the advantages of having one more child. At that point, it’s evolutionarily advantageous for women to stop being able to have more children.
RobNYNY1957
@Amber: Yeah, at the local bar where I go once a week, the bartenders don’t get paid. That is, the deductions are always the same as the earnings. They have a lot of non-tip time (they work without barbacks, so they have to fetch ice, slice fruit, clean). A glass of happy hour wine is $4. I cringe when I see someone tip $1 on a blender drink.
jl
As for individual financial incentives for improving medical practice, sometimes they work and sometimes they don’t. Don’t have time to find the articles, but for interventions that require consistent attention over long time horizons, individual financial incentives don’t work very well, or at all. Smoking cessation, alcohol abuse, addictive behaviors are examples. May take twenty or more contacts with consistent protocol to get behavioral change. What works there is reducing the costs of multiple providers implementing an effective protocol. Stuff like inserting automatic reminders of most appropriate next step in care, or reminder to assess status in check list of things to do at the appointment.
As an example, inserting reminder to ask the right question on current smoking status, and appropriate question for willingness to reduce or quit. Organizations specializing in addiction medicine offer software packages and kits and instructions on where to place stickers and reminders in the medical record, that can be integrated into normal practice. These work far better than incentives.
i can see how financial incentives would work with blood pressure, since a relatively few measurements can establish a baseline, and the measured blood pressure problem can be handled with a simple drug prescription. Whether the financial incentive distorts the incentives involved in looking further in unusual cases for a unexpected underlying cause (like thyroid problem mentioned above), is another matter.
SectionH
@edub: The Linkery was OK, but not that special aside from its no tipping policy. To its credit, it was one of the early locavore restaurants here.
JenJen
@RobNYNY1957: Do those bartenders know it’s a violation of both state and federal law to not pay tipped employees a tip-credit minimum wage? Yikes. They can’t file taxes, and since none of their earnings are being reported, they’re not paying into Social Security, and they’re ineligible for unemployment or workers compensation in the event of a store closure or job-related injury. That’s awful (but, in my business, sadly not uncommon).
$1 tips on blended drinks make me cringe too. In fact, blended drinks alone make me cringe. :-)
Uncle Ebeneezer
@aimai: That looks like an interesting book. In addition to the things you mentioned (imperfect info) there’s also our common bias towards our self interest. They probably get into it in that book, but I’ve also read stuff in Behavioral Economics (Dan Ariely) and other areas that shows that it’s fairly common for people to judge positive outcomes as being due to our own awesomeness and bad outcomes to someone else. And reverse for other people (if they suffer it’s their fault, if they prosper they were just lucky.)