The Efficacy of Using Financial Incentives to Change Unhealthy Behaviors Among a Rural Chronically Ill and Uninsured Population

Abstract

Purpose: To measure the effects of weight loss, medication compliance, and physical activity financial incentives delivered by health providers to uninsured patients. Design: Full factorial (orthogonal) randomized design. Setting: Primary care clinic in rural Mississippi. Participants: A total of 544 uninsured adult patients with diabetes or hypertension. All patients were enrolled in the clinic’s care management program. Intervention: Patients randomly received 0, 1, 2, or 3 financial incentives. Incentives for weight loss, medication compliance, and physical activity were awarded quarterly over 1 year. Measures: Weight loss, medication compliance, physical activity, and 6 clinical measures related to diabetes and hypertension. Analysis: Cross-section and panel data regression models were used to compare outcomes for those who received incentives to those who did not receive incentives and to measure interaction effects. Results: Effects of the weight loss incentive were positive but statistically insignificant (−3.7 lb; P = .106), while medication compliance was high in both the treatment and control groups (+2.37 percentage points; P = .411), and physical activity take-up was very limited. Effects on clinical outcomes, as well as interaction effects between incentives, were mixed and generally statistically insignificant. Conclusion: This study found little to no evidence that these financial incentives had beneficial effects on the incentivized behaviors in this setting. Likewise, the study found no effects on clinical outcomes nor any systematic evidence of interaction effects between 2 and 3 incentives.