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Patient financial incentives for preventive care

Health Factors: Quality of Care
Decision Makers: State Government Healthcare Professionals & Advocates Nonprofit Leaders
Evidence Rating: Scientifically Supported
Population Reach: 10-19% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Financial incentives such as payments and vouchers are often used to encourage patients to undergo preventive care such as screenings, vaccinations, and other brief interventions. Incentives are often focused on women of low socio-economic status (Slater 2005, Jepson 2000, Giuffrida 1997), immigrants, and high risk individuals such as those who are homeless (Giuffrida 1997) or use drugs (Seal 2003, Malotte 2001, Perlman 2003).

Expected Beneficial Outcomes

Increased preventive care
Increased adherence to treatment
Improved prenatal care

Evidence of Effectiveness

There is strong evidence that financial incentives increase preventive care among low income and high-risk populations (Bradley 2017, Mehrotra 2014, Kane 2004, Stone 2002, Briss 2000, Jepson 2000, Giuffrida 1997, Seal 2003, Slater 2005). Patients are most likely to attend appointments or receive services such screenings or testing if incentives include reduced out-of-pocket costs, free services (Briss 2000, Stone 2002, Jepson 2000, Slater 2005), or a large reward (Bradley 2017, Haukoos 2005Kane 2004Giuffrida 1997).  

Financial incentives can improve patients’ use of primary care (Bradley 2017). Incentives can also increase participation in vaccination programs (Stone 2002, Briss 2000, Seal 2003, Giuffrida 1997), screening for colorectal cancer, cervical cancer (Stone 2002, Jepson 2000), and breast cancer (Stone 2002, Slater 2005), and testing for tuberculosis (Kane 2004, Giuffrida 1997, Perlman 2003). Financial incentives have also been shown to improve adherence to treatments for tuberculosis (Giuffrida 1997, Kominski 2007, Malotte 2001) and sexually transmitted infections (Kane 2004, Haukoos 2005, Carey 2005).

Financial incentives can increase the number of prenatal appointments pregnant teens attend (Giuffrida 1997, Kane 2004), and reduce smoking during pregnancy (Cochrane-Lumley 2004, Cochrane-Chamberlain 2017).

Experts suggest that by increasing the likelihood that low income adults visit primary care providers, incentive programs may improve health outcomes and lower overall costs of care (Bradley 2017). 

Implementation

United States

In 2011, the Affordable Care Act created the Medicaid Incentives for the Prevention of Chronic Disease grant program (MIPCD), which awarded five year grants to ten states to provide incentives to Medicaid beneficiaries who participated in prevention programs, adopted healthier behaviors, and improved their health. The ten states included California, Connecticut, Minnesota, Montana, Nevada, New Hampshire, New York, Texas, and Wisconsin; each state selected focus areas to help beneficiaries quit using tobacco, lose weight, lower cholesterol or blood pressure, or avoid or manage diabetes. Early evaluations of the individual programs became available in 2017 (CMS-MIPCD, RTI-Hoerger 2017).

Wisconsin

In 2011, Wisconsin received a five year grant from the Medicaid Incentives for the Prevention of Chronic Disease grant program (MIPCD), which linked BadgerCare recipients with tobacco cessation resources. Early evaluations of the program became available in December 2016 (CMS-MIPCD, WI DHS-MIPDC).

Implementation Resources

CMS-MIPCD - Centers for Medicare & Medicaid Services (CMS). Medicaid incentives program for the prevention chronic diseases model. Accessed on February 5, 2018
RTI-Hoerger 2017 - Hoerger T, Boland E, Acquah JK, et al. Medicaid incentives for prevention of chronic diseases: Final evaluation report. Research Triangle Park, NC: RTI International for the Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services (CMS); 2017. Accessed on February 6, 2018

Citations - Description

Giuffrida 1997* - Giuffrida A, Torgerson DJ. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997;315(7110):703-707. Accessed on February 6, 2018
Jepson 2000* - Jepson R, Clegg A, Forbes C, et al. The determinants of screening uptake and interventions for increasing uptake: A systematic review. Health Technology Assessment. 2000;4(14). Accessed on February 6, 2018
Malotte 2001* - Malotte CK, Hollingshead JR, Larro M. Incentives vs outreach workers for latent tuberculosis treatment in drug users. American Journal of Preventive Medicine. 2001;20(2):103-107. Accessed on February 6, 2018
Perlman 2003 - Perlman DC, Friedmann P, Horn L, et al. Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange- based tuberculin skin testing. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2003;80(3):428-437. Accessed on February 6, 2018
Seal 2003* - Seal KH, Kral AH, Lorvick J, et al. A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug and Alcohol Dependence. 2003;71(2):127-131. Accessed on February 6, 2018
Slater 2005* - Slater JS, Henly GA, Ha CN, et al. Effect of direct mail as a population-based strategy to increase mammography use among low-income underinsured women ages 40 to 64 years. Cancer Epidemiology, Biomarkers & Prevention. 2005;14(10):2346-2352. Accessed on February 6, 2018

Citations - Evidence

Bradley 2017 - Bradley CJ, Neumark D. Small cash incentives can encourage primary care visits by low-income people with new health care coverage. Health Affairs. 2017;36(8):1376-1384. Accessed on February 6, 2018
Briss 2000* - Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. American Journal of Preventive Medicine. 2000;18(1 Suppl 1):97-140. Accessed on February 6, 2018
Carey 2005 - Carey MP, Vanable PA, Senn TE, Coury-Doniger P, Urban MA. Recruiting patients from a sexually transmitted disease clinic to sexual risk reduction workshops: Are monetary incentives necessary? Journal of Public Health Management and Practice. 2005;11(6):516-521. Accessed on February 6, 2018
Cochrane-Chamberlain 2017* - Chamberlain C, O’Mara-Eves A, Porter J, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews. 2017;(2):CD001055. Accessed on February 6, 2018
Cochrane-Lumley 2004* - Lumley J, Oliver S, Chamberlain C, Oakley L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews. 2004;(4):CD001055. Accessed on February 6, 2018
Giuffrida 1997* - Giuffrida A, Torgerson DJ. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997;315(7110):703-707. Accessed on February 6, 2018
Haukoos 2005* - Haukoos JS, Witt MD, Coil CJ, Lewis RJ. The effect of financial incentives on adherence with outpatient human immunodeficiency virus testing referrals from the emergency department. Academic Emergency Medicine. 2005;12(7):617-621. Accessed on February 6, 2018
Jepson 2000* - Jepson R, Clegg A, Forbes C, et al. The determinants of screening uptake and interventions for increasing uptake: A systematic review. Health Technology Assessment. 2000;4(14). Accessed on February 6, 2018
Kane 2004* - Kane RL, Johnson PE, Town RJ, Butler M. A structured review of the effect of economic incentives on consumers’ preventive behavior. American Journal of Preventive Medicine. 2004;27(4):327-352. Accessed on February 6, 2018
Kominski 2007* - Kominski GF, Varon SF, Morisky DE, et al. Costs and cost-effectiveness of adolescent compliance with treatment for latent tuberculosis infection: Results from a randomized trial. Journal of Adolescent Health. 2007;40(1):61-68. Accessed on February 7, 2018
Malotte 2001* - Malotte CK, Hollingshead JR, Larro M. Incentives vs outreach workers for latent tuberculosis treatment in drug users. American Journal of Preventive Medicine. 2001;20(2):103-107. Accessed on February 6, 2018
Mehrotra 2014 - Mehrota A, Brannen T, Sinaiko AD. Use patterns of a state health care price transparency web site: What do patients shop for? The Journal of Health Care Organization, Provision, and Financing. 2014:1-3. Accessed on November 17, 2015
Perlman 2003 - Perlman DC, Friedmann P, Horn L, et al. Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange- based tuberculin skin testing. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2003;80(3):428-437. Accessed on February 6, 2018
Seal 2003* - Seal KH, Kral AH, Lorvick J, et al. A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug and Alcohol Dependence. 2003;71(2):127-131. Accessed on February 6, 2018
Slater 2005* - Slater JS, Henly GA, Ha CN, et al. Effect of direct mail as a population-based strategy to increase mammography use among low-income underinsured women ages 40 to 64 years. Cancer Epidemiology, Biomarkers & Prevention. 2005;14(10):2346-2352. Accessed on February 6, 2018
Stone 2002* - Stone EG, Morton SC, Hulscher ME, et al. Interventions that increase use of adult immunization and cancer screening services: A meta-analysis. Annals of Internal Medicine. 2002;136(9):641. Accessed on February 6, 2018

Citations - Implementation

CMS-MIPCD - Centers for Medicare & Medicaid Services (CMS). Medicaid incentives program for the prevention chronic diseases model. Accessed on February 5, 2018
RTI-Hoerger 2017 - Hoerger T, Boland E, Acquah JK, et al. Medicaid incentives for prevention of chronic diseases: Final evaluation report. Research Triangle Park, NC: RTI International for the Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services (CMS); 2017. Accessed on February 6, 2018
WI DHS-MIPDC - Wisconsin Department of Health Services (WI DHS). Medicaid Incentives for the Prevention of Chronic Disease (MIPDC): Wisconsin Striving to Quit, implementation report. University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) and Wisconsin Women’s Health Foundation; 2016. Accessed on February 6, 2018

Page Last Updated

February 7, 2018

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