Small financial incentives might make a big difference in encouraging newly insured low-income patients who do not have a regular source of care to visit a primary care physician.
That's what researchers found when they offered as much as $50 to participants in a study that tracked how likely they were to make an initial primary care visit. The likelihood that individuals would make such a visit within six months of enrollment rose in relation to the amount of the incentive. The study, "Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage,"(content.healthaffairs.org) by Cathy Bradley, Ph.D., and David Neumark, Ph.D., was published in the August issue of Health Affairs.
Low-income individuals without consistent insurance coverage are often reluctant to visit a primary care physician for multiple reasons, the authors wrote, even though such a visit can help new patients address long-ignored or emerging health care needs.
"Patients may view such a visit as unnecessary or daunting, particularly if they are unfamiliar with making appointments and communicating with physicians," the authors wrote.
Study participants, who were newly enrolled in the Virginia Coordinated Care (VCC) program, were randomized to one of four groups: a $0 incentivized, a $25 incentivized, a $50 incentivized or a nonincentivized group. Those in the three incentivized groups initially received $10 to complete a telephone survey to gather information about their health status. After completing the survey, individuals were then told to which of the three incentivized groups -- each made up of about 400 individuals -- they had been assigned.
The incentivized participants were told they had six months to schedule an appointment but received no reminders to do so. Control group participants were not contacted by researchers.
Seventy-seven percent of individuals who received $50 completed a primary care appointment within six months. The rate dropped to 74 percent for those who received $25 and to 68 percent for those who received $0. Sixty-one percent of those in the control group made a primary care visit within six months.
Participants who were older and female were more likely to make the visit. Individuals who said they receive most of their care in the ER were less likely to see a primary care physician.
The average age of study participants was 46, and approximately two-thirds of the members of each incentive group were African-American. Demographics of each incentive group were equal in terms of income, employment, smoking, drug or alcohol use and mental health.
To be eligible for VCC, patients must have a household income no greater than the federal poverty level, they must have no other source of health care coverage, and they must live within 30 miles of the Virginia Commonwealth University Medical Center in Richmond, a safety-net facility with an urban and primarily African-American patient population.
The authors wrote that their findings probably apply generally to urban safety-net settings but may have limited application in other settings.
The Patient Protection and Affordable Care Act expanded the ability of public insurance programs to offer financial incentives as a way to encourage patients to maintain healthier habits. One 10-state Medicaid pilot program that paid participants to lose weight, stop smoking and schedule wellness visits reported mixed results(content.healthaffairs.org). Other studies indicated that when patients assume some shared cost for ER visits, they will reduce their nonurgent ER visits(www.nejm.org).
The new research indicated that small cash incentives can be a contributing factor in encouraging development of a regular source of primary care and driving down overall health costs.
"If the use of primary care is shown to reduce overall health care use and improve health in this high-cost population, cash incentives may be a cost-effective way to steer low-income patients away from more expensive services and help them establish a relationship with a primary care provider," the authors wrote.
Related AAFP News Coverage
Graham Center Forum
Panelists Highlight Unique Value of Primary Care Research