PNS88 IMPACT OF PATIENT-TARGETED FINANCIAL INCENTIVES ON HEALTHCARE COSTS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Abstract

Patient-targeted financial incentives have the potential to be used as policy instruments to improve health and healthcare use efficiency. Prominent examples of health policy trials are the RAND and Oregon Health Insurance Experiments. The objective of this study was to provide a comprehensive assessment of the impact of financial incentives on healthcare costs through a systematic review of published health policy trials. We searched electronic databases (Medline, Embase, Econlit, and The Cochrane Library), clinical trial registries, and websites of health economic organisations to identify randomized controlled trials (RCTs) in which the intervention was a patient-targeted financial incentive and healthcare costs were included as an outcome. Two reviewers independently reviewed titles, abstracts and full texts to assess study eligibility using a piloted form. Due to heterogeneity between studies, results were synthesized qualitatively. A total of 15,845 records were retrieved through the literature searches, of which 25 articles fulfilled the inclusion criteria, describing 15 RCTs. Ten RCTs were conducted in the United States and one each in Ghana, Nicaragua, India, Burkina Faso, and Mexico. The interventions included increased health insurance coverage (n=13, 86.7%) and voucher or cash-back programs (n=2, 13.3%). Of the 17 articles that measured costs from the perspective of healthcare payers, 10 (58.8%) found no difference and 4 (23.5%) a significant increase in total healthcare costs. When evaluating specific cost components (e.g. ambulatory or preventative care), 9 articles (52.9%) found an increase in healthcare costs associated with the intervention. Of the 10 articles that measured the costs to patients, 6 (60.0%) found a significant decrease and 4 (40.0%) no difference in out-of-pocket costs (note: two articles included both perspectives). Patient-targeted financial incentives decreased or had no impact on the cost to patients. This type of policy intervention might increase specific resource use but not the total costs to healthcare payers.