Impact of cash incentives for low-income individuals to seek a primary care visit on mental health outcomes: Evidence from a randomized controlled trial.

Abstract

We explore whether a cash incentive to see a primary care provider (PCP) improves self-reported depression, anxiety, and pain among low-income patients in a randomized trial. Secondary outcomes of a randomized controlled trial, enrolling low-income uninsured adults to receive cash incentives ($0, $25, $50) to see a PCP. Interview data was collected at enrollment and 12 months later. Health outcomes were measured with the PROMIS depression, anxiety, and pain interference scales. We estimated adjusted logistic regressions to determine whether self-reported improvements occurred in depression, anxiety, or pain. 981 subjects completed surveys 12 months following study enrollment (80% retention). Subjects who were incentivized were 5.7 percentage points more likely to see a PCP in the initial six months (p<0.05). Incentivized subjects were 6 percentage points more likely to experience an improvement in depression and pain at 12 months. Among those who reported high levels of depression and pain at baseline, they were 10.6 and 8 percentage points, respectively, to experience an improvement relative to those who were not incentivized. Meaningful improvements were observed for depression and pain PROMIS domains for subjects randomized to the incentive groups, presumably through their interaction with a PCP and the health care system. This finding was robust for the full sample and a group that reported more severe symptoms at baseline.