Paying the patient: does it work?

This report summarises available evidence on the effectiveness of patient incentives in improving quality of healthcare.

Background

Most of the evidence is focused on securing change in patient-related behaviours with two main aims. These are to increase how often patients adhere to recommended care and to improve public health through changing lifestyle behaviours.

Paying the patient: does it work? focuses on patient-targeted incentives and complements a report by the same authors. [1] It is a narrative account of available evidence in a number of healthcare areas, underpinned by systematic searches of the literature.

Patients not adhering to care is a major problem across healthcare systems. Common examples are patients not using medication as prescribed, not complying with recommended self-care and not following through with appointments. Incentives are one of a range of interventions that have been used to increase this adherence.

Upstream and downstream interventions

Public health interventions often seek to secure complex behaviour change by individuals. Interventions can be either ‘upstream’ or ‘downstream’. Downstream interventions seek to alter adverse health behaviours (such as smoking). Upstream interventions focus on the wider circumstances that produce those behaviours (social conditions, employment and so on). Most of the available evidence focuses on downstream interventions, of which incentives are one example.

Incentives and disincentives are powerful instruments that, set at the right level, can secure significant behaviour change on the part of individuals and organisations. Healthcare incentives can be targeted at professionals, organisations and patients.

Financial and non-financial incentives

Patient incentives can be financial (that is, behaviour change results in a prize, payment, voucher or the chance of winning such monetary rewards) or non-financial (that is, behaviour change results in improved quality of life, enhanced self-esteem or other non-monetary benefits). The literature on patient incentives is dominated by financial incentives.

The attraction of non-financial incentives – not least the potential for longer life and higher quality of life – is undoubtedly significant. Finding ways to incentivise change via non-financial rewards is central to health promotion approaches. Yet the impact of non-financial incentives is not differentiated in the literature. We found few studies that examined the mechanisms through which non-financial incentives motivate enduring behavioural change.

Who should read this report?

This report is intended for healthcare decision makers, including policy makers, managers, clinical leaders, researchers and patient groups. They should use this independent source of data to inform decisions and take actions that will lead to better quality of patient care.