Small Financial Incentives Promote Primary Care Visits Among Low-Income Adults

Incentives for newly covered low-income patients may also reduce long-term costs.

New findings suggest that small cash incentives may encourage primary care visits for low-income individuals with new health care coverage, and ultimately, reduce overall costs.

In a study published in Health Affairs, investigators sought to determine whether a cash incentive could encourage low-income adults newly covered by a primary care program to make an initial visit to a primary care provider.

Included in the randomized, controlled trial were individuals residing in Virginia who lived 100% below the federal poverty line.

The participants were randomized among 4 groups. Members in 3 of the groups received $10 to complete a baseline survey during an interview and then either $50, $25, or $0 to visit their provider within 6 months. The nonincentivized control group received no contact from the investigators.

A total of 1228 participants were included in the 3 incentive groups, and 414 participants in the control group.

The results of the study showed participants in the $50 and $25 incentive groups were more likely to see a primary care provider compared with the $0 group—–77%, 74%, and 68%, respectively. Sixty-one percent of participants in the control group received care.

“This shows a potential for cost savings for a very small amount of money,” said author Cathy Bradley. “Access to primary care does not necessarily mean a visit will occur. Establishing a primary care relationship with an initial visit helps prevent chronic conditions, avoids hospitalizations, and use of emergency departments and provides better care to the patient.”

Cash incentives are used by some employers to encourage healthy behaviors among workers. Furthermore, the use of these incentives was expanded to public insurance programs under the Affordable Care Act.

The investigators hoped to inform policymakers considering Medicaid expansion.

“At the time this experiment began, Medicaid expansions were happening across the US,” Bradley noted.

Prior studies have suggested low-income patients may be especially responsive to financial incentives, such as cost-sharing for emergency departments.

“An emergency room visit would treat the patient’s immediate acute need and discharge them,” Bradley said. “A primary care doctor will do all the things that improve their wellbeing and prevent a medical crisis.”

The biggest limitation to the study was recruitment, because a large proportion of potential subjects did not have stable phone connectivity, were homeless, or were incarcerated.

Overall, the authors concluded, “Cash incentive programs may steer newly covered low-income patients toward primary care, which could result in improved health outcomes and lower costs.”