As we reported last month, up to half of all patients fail to take their medications faithfully as prescribed, compromising their health and costing the healthcare system $100 billion in preventable hospital stays per year. But a handful of recent experiments indicate that providing patients with small financial incentives to follow their regimes can result in dramatic turnarounds.
The pros: The incentives, which for some reason work better when they "are just large enough to be significant," seem to cost less than the consequences of poor adherence.
"It's better to spend money on medication adherence for patients, rather than having them boomerang in and out of the hospital," Valerie Fleishman, executive director of the New England Healthcare Institute, told the New York Times, adding that about one-tenth of hospital admissions and one-quarter of nursing home admissions result from incorrect adherence to medication. "Financial incentives are a critical piece of the solution."
The articles points to a Philadelphia program, paid for in part by Aetna, in which people prescribed warfarin can win $10 or $100 each day they take the drug. During six months of participating in the lottery program, Chiquita Parker, a 25-year-old single mother with lupus, pocketed a total of $300 and took her medications correctly for the first time.
The cons: After the program ended, Parker confessed that she "really went backward," telling the newspaper, "I'm just forgetting all over again."
In addition to the temporary benefit of the incentive, some critics worry that patients may claim they'll have trouble remembering to take their medications to be eligible for incentives. Some skeptics even question whether payments can be coercive or harm doctor-patient relationships. "Why should people who don't want to take medication be paid, when prudent people who take medication are not?" said Dr. George Szmukler, a psychiatry professor at King's College London.
Nonetheless, longer-running lotteries may still be worthwhile, given the potential for long-term savings, says project co-leader Dr. Kevin G. Volpp, noting that many patients did continue to take their medications after the program ended out of desire to take credit for having changed their ways on their own.
To learn more:
- read this article in the New York Times