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Nitrogen runoffs induced by agricultural fertilisation cause serious environmental damage to surface waters. Environmental and consumer protectionists demand government intervention to mitigate these externalities. With this in mind, the present study examines the effects of nudge-based regulatory strategies. We use an incentivised single-player multi-period business management game as an experimental device to study how nudges affect compliance with the minimum-distance-to-water rule in a sample of German farmers. We investigate two different nudge treatments: a nudge with information and pictures showing environmental and health damages that are presumably caused by breaching the minimum-distance-towater rule, and a nudge with an additional social comparison suggesting that the majority of farmers in the same region comply with the rule. We observe three core experimental outcomes: first, nudging has a preventive effect and reduces the share of non-compliant participants. Second, against all expectations, the preventive effect of the nudge with an additional social comparison is weaker than that of the nudge with information and pictures alone. Third, despite the overall positive effects of nudging, the nudge with social comparison even increased the severity of non-complying behaviour in the deviant subpopulation. Abstract 4Nitrogen runoffs induced by agricultural fertilisation cause serious environmental damage to surface 5 waters. Environmental and consumer protectionists demand government intervention to mitigate these 6 externalities. With this in mind, the present study examines the effects of nudge-based regulatory 7 strategies. We use an incentivised single-player multi-period business management game as an 8 experimental device to study how nudges affect compliance with the minimum-distance-to-water rule 9 in a sample of German farmers. We investigate two different nudge treatments: a nudge with 10 information and pictures showing environmental and health damages that are presumably caused by 11 breaching the minimum-distance-to-water rule, and a nudge with an additional social comparison 12 suggesting that the majority of farmers in the same region comply with the rule. We observe three core 13 experimental outcomes: first, nudging has a preventive effect and reduces the share of non-compliant 14 participants. Second, against all expectations, the preventive effect of the nudge with an additional 15 social comparison is weaker than that of the nudge with information and pictures alone. Third, despite 16 the overall positive effects of nudging, the nudge with social comparison even increased the severity 17 of non-complying behaviour in the deviant subpopulation. 18 Key Words 19Green nudge, behavioural economics, business management games, ex-ante policy impact analysis 20 JEL Classifications 21 Q18, Q28, Q53, Q58, D91 22

This paper is the culmination of a three-year project in the Caribbean region to support countries in better managing the fiscal impact of public-private partnerships. It draws on findings from three workshops organized in the region during 2014 to 2017, which brought together representatives from 14 countries and staff from the International Monetary Fund (IMF), the IMF's Caribbean Regional Technical Assistance Center (CARTAC), the Caribbean Development Bank (CDB), the World Bank, and the Public-Private Infrastructure Advisory Facility. This departmental paper was prepared by a team of the IMF's Fiscal Affairs Department (FAD), comprising Maximilien Queyranne (lead), Wendell Daal, and Katja Funke. Contributors also include S. Brian Samuel (CDB), Celeste Kubasta, and Bruce Stacey (both resident advisors in the CARTAC). Devin D'Angelo provided excellent research support. Geneviève Verdier and Rui Monteiro reviewed this paper. The authors are grateful to Gerd Schwartz, deputy director of the Fiscal Affairs Department, for his valuable comments and support. The authors' views as expressed in this paper do not necessarily reflect the views of the IMF, its Executive Board, or IMF management. Errors and omissions are the authors' sole responsibility. The work leading to this paper benefitted from financial support from the government of Canada, as well as financing provided to CARTAC from its 22 regional member countries and development partners (that is, Canada, the United Kingdom, the European Union, the Netherlands, Mexico, and the CDB).

Background and objective: Disease management programs (DMP) e.g. for diabetes mellitus, should be the clinical and economic basis for a structured treatment. This article shows results of specialized outpatient treatment using a risk factor depending patient classification. Patients and methods: Diabetes associated co-morbidities, micro-and macrovascular complications, the results and findings of blood pressure and metabolism of glucose and lipids, as well as all treatment-associated costs of 5245 type 2 diabetics were collected for a period of 12 months, accompanied by different measures of quality control. For documentation in the centres, all available original data were used as local data sources. Results: The patient classification system, on which diabetic risk profiles are based, covered 74.3% of all type 2 diabetic patients. Daily direct costs for all treatment measures ranged between EUR 4.79 (primary prevention) and EUR 8.96 for patients suffering from advanced diabetic foot syndrome. Most of the treatment costs arose from prescriptions of pharmaceuticals, other remidies and aids. Specific strategies of therapy were both related to the severity of co-morbidities and the time since manifestation of diabetes (r = 0.486; p<0.01, two-sided). The share of patients receiving diet and exercise only decreased from 22.8% (primary prevention) to below 10% of patients suffering from microvascular complications. Simultaneously, the share of patients receiving insulin increased up to 81.8% of patients suffering from advanced diabetic retinopathy. Conclusion: The risk profile specific variation in the results clearly shows the need of a risk factor depending classification system for type 2 diabetes, which could be useful to reform and focus the system of compensating payments between health insurances more and more on morbidity, or on risk profiles. Patientenklassifikation und Risikoprofilanalysen beiTyp-2-Diabetikern in der Schwerpunktpraxis