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Objectives: A systematic review of the literature was undertaken to address four questions:
- How have "preventive care" and "economic incentive" been defined in the literature?
- Do incentives work?
- Is there evidence of a dose/response curve?
- What is the evidence for cost-effectiveness of economic incentive interventions?
Data Sources: MEDLINE®, the Cochrane Library, EconLit, Business Source Premier, and PsychINFO. Reference lists from previous studies and systematic reviews, including the Cochrane Library were also examined.
Review Methods: Articles for both provider and consumer incentives were subjected to the inclusion and exclusion criteria. Individual articles must be primary studies in which preventive care or health promotion was a primary outcome measure. Preventive care was defined as care prior to illness diagnosis, thus excluding adherence studies. Also excluded were studies which included multiple factors in addition to economic incentives within the intervention arm. We included only RCTs, time series, and prospective quasi-experimental designs for the structured literature reviews. Nineteen articles passed the
inclusion criteria for provider economic incentives, and 47 articles passed the criteria for the consumer economic incentives. The abstraction tool was created with the purpose of facilitating the ability to capture emergent themes from the heterogeneous literature. The form was reviewed and commented on by the TEP members, piloted, and subsequently revised. Abstraction of the articles was performed by two independent reviewers. Disagreements were resolved by consensus of the group.
Results: Formal meta-analysis of the incentive literature was not possible because there were not a large number of studies that examined the same incentive type, research outcome measures, and similar populations. General trends were summarized.
Conclusions: Definitions for neither "prevention" nor "economic incentive" are specifically addressed in the literature. There is little evidence to support the idea that provider financial incentives, particularly of the modest and artificial nature that were evaluated in the studies, are effective. Further, it appears bonuses do not work simply and easily. In the short run, consumer economic incentives are effective for simple preventive care and well-defined behavioral goals. There isn't sufficient evidence that economic incentives are effective for promoting long-term lifestyle changes. There is no evidence for a dose response for provider incentives, although one may assume that a sizable enough incentive should produce the desired behavior, if at a high cost. There is a possible dose response for consumer incentives. Even more interesting for consumer incentives is the effectiveness of relatively modest incentives.
Economic Incentives for Preventive Care
Evidence-based Practice Center: Minnesota
Topic Nominator: Agency for Healthcare Research and Quality (AHRQ)
Current as of August 2004