Harkness Project Title: Decision-Making Across Medical Specialties – Shedding Light On the Real Effects of Incentives At the Point-of-Care
Mentors: Lawrence D. Brown, Ph.D., Sherry Glied, Ph.D., and David Blumenthal, M.D.
Placement: Department of Health Policy and Management, Mailman School of Public Health, Columbia University
Biography at time of Harkness Fellowship: Katharina Janus, Ph.D., a 2006–07 Commonwealth Fund Harkness Fellow in Health Care Policy, is an assistant professor at Columbia University's Mailman School of Public Health. In addition, she is a research fellow and senior lecturer for health services research and management at Hannover Medical School (Department of Epidemiology, Social Medicine and Health System Research) since 2003 and a visiting scholar at the University of California at Berkeley (Center for Health Research) since 2005. From 2001–02 she worked as a research scientist for one of the largest multi-hospital systems in the U.S. The results of the large-scale market study on integrated delivery systems and managed care strategies she conducted in the San Francisco Bay Area set the basis for her Ph.D. in organizational theory and health care management. In her position at Hannover Medical School, she has worked on developing a proposal for legislation for the improvement of the delivery of palliative care in Lower-Saxony, on integrated care delivery structures and on incentive systems in health care delivery. Most recently, she was the principal investigator of an international comparative study of physician job satisfaction in cooperation with the Center for Health Research at UC Berkeley and the Department of Health Research & Policy at Stanford University. She is particularly interested in the effects of monetary and non-monetary incentives on quality of care, including the physician and the patient factor in the production process of health care delivery. Janus obtained a master's degree in business administration and economics from the Universities of Hamburg and Panthéon-Sorbonne Paris in 2000 and completed her Ph.D. at the Helmut-Schmidt-University in Hamburg in 2003.
Project: Janus’ project shed light on how monetary and non-monetary incentives are perceived by physicians and their actual impact on decision-making, including how this differs across specialties and whether the incentives are for routine or non-routine services. She interviewed more than 40 physicians from different specialties (surgery, general internal medicine, anesthesiology and psychiatry) on their decision-making process.
Career Activity Since Fellowship
(Updated July 2013)
Janus K. The effect of professional culture on intrinsic motivation among physicians in an academic medical center. J Healthc Manag. 2014 Jul-Aug;59(4):287-303; discussion 303-4.
Janus K, Brown LD. Physician integration revisited-An exploratory study of monetary and professional incentives in three countries. Health Policy. 2014 Aug 12. pii: S0168-8510(14)00202-4.
Rundall T, Oberlin S, Thygesen B, Janus K. “Success under duress: policies and practices managers view as keys to profitability in five California hospitals with challenging payer mix.” Journal of Healthcare Management. 2012 Mar-Apr;57(2):94-111.
Bevan, G., Janus, K. "Why hasn’t integrated care developed in the US and not at all in England?" Journal of Health Politics, Policy and Law 2010, 36(1): 141-164.Glied, S.A., Janus, K. (2009). Managed Care and Public Health, in: Health Systems Policy, Finance, and Organization. Carrin, G., Buse, K., Heggenhougen, H.K. and Quah, S.R. (ed), New York: Elsevier.
Janus, K., Amelung, V.E., Baker, L.C., Gaitanides, M., Rundall, T.G., Schwartz, F.W., “Warum sind amerikanische Ärzte zufriedener? –Ergebnisse einer internationalen Studie unter Klinikärzten [Why are US physicians more satisfied than German physicians – Results of an international study among hospital physicians], in press at Das Gesundheitswesen [The Health Care System],” Das Gesundheitswesen 2009; 71: 1-8.
Amelung, V.E., Janus, K. (2008). Health Care vor der Wahl [The US health care system before the election], GGW [Health Care and Society] 1(11): 22-28.
Amelung, V.E., Janus, K., “Gesundheit vor der Wahl” [The US health care system before the election], Niedersächsisches Ärzteblatt [Physician’s Journal of Lower Saxony] 2008: 60-62.
Janus, K., Amelung, V.E., Baker, L.C., Gaitanides, M., Schwartz, F.W., Rundall, T.G. (2008). “Job Satisfaction and Motivation Among Physicians in Academic Medical Centers: Insights from a Cross-National Study,” Journal of Health Politics, Policy and Law, 33(6): 1133-1167.
Janus, K., Amelung, V.E., Gaitanides, M., Schwartz, F.W., “German physicians ‘on strike’ – Shedding light on the roots of physician dissatisfaction,” Health Policy 2007, 82: 357-365.
Janus K, Brown LD. “Medicare as Incubator for Innovation in Payment Policy,” Journal of Health Politics Policy and Law 2007; 32(2): 293 - 306.
Böcken J, Janus K, Schenk U, Zweifel P. “Neue Versorgungsmodelle im Gesundheitswesen – Gestaltungsoptionen und Versichertenpräferenzen im internationalen Vergleich” [New models of health care delivery – possible structures and preferences of insureds], Gütersloh: Verlag Bertelsmann Stiftung, 2007.
Janus, K., Amelung, V.E., Voss, H., “Innovative Vergütungsmodelle in der integrierten Versorgung auf dem Prüfstand – Ansätze zur Erhöhung der Behandlungsqualität und der Kosteneffizienz” [Innovative concepts to integrated care delivery – Approaches to enhance quality and cost-efficiency], in: Wagner, K., Lenz, I. (eds.), Erfolgreiche Wege in die integrierte Versorgung – Eine betriebswirtschaftliche Analyse [Successful approaches to integrated care delivery – A management approach], 2007, Kohlhammer-Verlag: 78-99.