“All the Money in the World …” Patient Perspectives Regarding the Influence of Financial Incentives

Authors

  • Heather Schacht Reisinger,

    1. University of Iowa, Iowa City, IA
    Search for more papers by this author
    • Address correspondence to Heather Schacht Reisinger, Ph.D., The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), the Iowa City VA Medical Center, Iowa City, IA; e-mail: heather.reisinger@va.gov. Rachel Horner Brackett, M.A., M.P.H., Colin D. Buzza, M.Sc., Monica B. Willims Páez, B.A., Ryan Gourley, B.S., Mark W. Vander Weg, Ph.D., Alan J. Christensen, Ph.D., and Peter J. Kaboli, M.D., M.S., are with the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, IA. Mark W. Vander Weg, Ph.D., Alan J. Christensen, Ph.D., Heather Schacht Reisinger, Ph.D., and Peter J. Kaboli, M.D., M.S., are also with the Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. Alan J. Christensen, Ph.D., is also with the Department of Psychology, University of Iowa, Iowa City, IA.

  • Rachel Horner Brackett,

    1. University of Iowa, Iowa City, IA
    Search for more papers by this author
  • Colin D. Buzza,

    1. University of Iowa, Iowa City, IA
    Search for more papers by this author
  • Monica B. Williams Páez,

    1. University of Iowa, Iowa City, IA
    Search for more papers by this author
  • Ryan Gourley,

    1. University of Iowa, Iowa City, IA
    Search for more papers by this author
  • Mark W. Vander Weg,

    1. University of Iowa, Iowa City, IA
    Search for more papers by this author
  • Alan J. Christensen,

    1. University of Iowa, Iowa City, IA
    Search for more papers by this author
  • Peter J. Kaboli

    1. University of Iowa, Iowa City, IA
    Search for more papers by this author

Abstract

Objective. To analyze patient perspectives of the use of financial incentives in a hypertension intervention.

Study Setting. Twelve Veterans Affairs primary care clinics over a 9-month period.

Study Design. Qualitative semistructured interviews conducted with 54 hypertensive veterans participating in an intervention to promote guideline-consistent therapy. Intervention components included an intervention letter requesting patients talk with their providers, an offer of U.S.$20 to bring in the letter to their provider, and a health educator phone call.

Data Collection Methods. Semistructured interviews were conducted. Transcripts were coded for thematic content. The financial incentive theme was then subcoded for more detailed analysis.

Principle Findings. Most participants (n=48; 88.9 percent) stated the incentive had (or would have) no effect on their decision to initiate a discussion with their provider. Some participants articulated reservations about the effectiveness and/or appropriateness of financial incentives in health care decisions; however, a few expressed the opinion that there may be some potential benefits to the use of financial incentives if they encourage patients to be active in their health care.

Conclusion. The findings of this study raise questions about the appropriateness and unintended consequences of employing patient-directed financial incentives in health care settings.

Ancillary