- Patients become more likely to access treatment when there is money to be gained, according to research published in the Journal of the American Medical Association. These recent findings add to the growing literature indicating that financial incentives can help drive patient behavior change.
In a randomized control trial, the research team looked at how financial incentives can drive patients who are HIV positive to access different parts of the healthcare system, including viral suppression medications and linkage to care.
Linkage to care is a program used across the nation to help connect patients with more specialized HIV support services. This program is both free and confidential.
The team tested patients who visited both HIV test and treatment sites in the Bronx, New York, and Washington DC. Test and treatment sites were each randomly selected to offer patients financial incentives to reach certain care benchmarks.
In HIV test sites offering financial incentives, patients were offered $125 gift cards if they accessed linkage to care. In intervention treatment sites, patients could earn $70 gift cards quarterly if they accessed antiretroviral treatments and remained virally suppressed.
The researchers found that financial incentives did not increase the number of patients accessing linkage to care. At the study’s baseline, many patients were already accessing the linkage to care program, leaving little room for improvement, even given financial incentives.
However, the financial incentives did drive the number of patients accessing viral suppression treatment. By study’s end, the proportion of patients accessing the treatment increased by 3.8 percent.
Financial incentives had an even larger effect on patients who previously were not accessing viral suppression treatment. The proportion of new treatment patients increased by 4.9 percent by the end of the study.
Financial incentives were also effective in driving regular clinic attendance, as opposed to intermittent attendance, the researchers found.
“Regular clinical and laboratory monitoring is important to enable provision of adherence support, prevention counseling, or screening for other health conditions,” the team explained. “However, care should be taken to safeguard against overutilization of clinic services motivated by FI.”
The investigators found greater improvements in antiretroviral access in Washington DC than in the Bronx.
New York has had a long-standing and strong system for connecting HIV positive patients to treatment and encouraging that treatment. Thus, the baseline level of patients accessing viral suppression or those who were already virally suppressed was higher in New York, leaving less room for improvement.
The researchers did acknowledge some of the ethical issues that arise when offering financial incentives to drive patient behavior.
The team consulted with industry experts to determine the appropriate value for financial incentives for example, and randomized incentives by care site rather than individual patient to drive equity in rewards. The team also required patients to continue at a care or test site for at least three months to discourage patients from transitioning care to an incentive site.
While numerous studies have suggested the efficacy of financial incentives on changing patient behavior, the industry has yet to reach a conclusive opinion on the strategy.
A separate 2016 study has suggested that financial incentives cannot drive patient behavior change, specifically with regard to HIV viral suppression. This is because other social barriers get in the way of patient wellness, such as socioeconomic status, researchers have said.
“Most participants were low-income persons of color who may experience negative sociocultural factors such as poverty, racism, unstable housing, HIV-related stigma, and high rates of incarceration,” researchers wrote in a 2016 article in the Journal of the American Medical Association. “Systemic and structural barriers to care may be difficult to overcome with an individual-level behavioral intervention, even an intensive one.”
However, other models such as wellness programs and smoking cessation programs have shown that financial incentives can be useful.
Going forward, more research may be necessary to uncover which types of patient behavior change lends itself better to financial incentives. Additionally, researchers should look into the financial viability of these programs and whether they truly produce a positive return on investment for healthcare organizations.