Impact of a patient incentive program on receipt of preventive care.

OBJECTIVES: Patient financial incentives are being promoted as a mechanism to increase receipt of preventive care, encourage healthy behavior, and improve chronic disease management. However, few empirical evaluations have assessed such incentive programs. STUDY DESIGN: In South Africa, a private health plan has introduced a voluntary incentive program which costs enrollees approximately $20 per month. In the program, enrollees earn points when they receive preventive care. These points translate into discounts on retail goods such as airline tickets, movie tickets, or cell phones. METHODS: We chose 8 preventive care services over the years 2005 to 2011 and compared the change between those who entered the incentive program and those that did not. We used multivariate regression models with individual random effects to try to address selection bias. RESULTS: Of the 4,186,047 unique individuals enrolled in the health plan, 65.5% (2,742,268) voluntarily enrolled in the incentive program. Joining the incentive program was associated with statistically higher odds of receiving all 8 preventive care services. The odds ratio (and estimated percentage point increase) for receipt of cholesterol testing was 2.70 (8.9%); glucose testing 1.51 (4.7%); glaucoma screening 1.34 (3.9%); dental exam 1.64 (6.3%); HIV test 3.47 (2.6%); prostate specific antigen testing 1.39 (5.6%); Papanicolaou screening 2.17 (7.0%); and mammogram 1.90 (3.1%) (P < .001 for all 8 services). However, preventive care rates among those in the incentive program was still low. CONCLUSIONS: Voluntary participation in a patient incentive program was associated with a significantly higher likelihood of receiving preventive care, though receipt of preventive care among those in the program was still lower than ideal.

Innovative business approaches for incenting health promotion in sub-Saharan Africa: progress and persisting challenges.

Non-communicable chronic diseases related to behaviors such as tobacco use, overeating, excess alcohol intake and physical inactivity account for increasing morbidity and mortality in South Africa. Over the last 15 years, Discovery Health, the largest private health plan in South Africa, has developed a voluntary health promotion program called Vitality with over 1.5 million members. Vitality was designed with many applications drawn from the growing field of behavioral economics, including the use of incentives and rewards. Incentives offered on the program are aimed at lowering the financial barriers to activities such as visiting the gym, buying healthy food or receiving preventive screening. Members accrue points for engagement which translate into discounts on a range of goods and services. Although the full impact of the program cannot yet be quantified, engagement with the program is continually increasing and there is compelling evidence that this translates into better health and cost outcomes.

The association between medical costs and participation in the vitality health promotion program among 948,974 members of a South African health insurance company.

PURPOSE: Examine the association between the levels of participation in an incentive-based health promotion program (Vitality) and inpatient medical claims among members of a major health insurer. DESIGN: A 1-year, cross-sectional, correlational analyses of engagement with a health promotion program and hospital claims experience (admissions costs, days in hospital, and admission rate) of members of a national private health insurer. SETTING: Adult members of South Africa's largest national private health insurer, Discovery Health. Insured members were also eligible for voluntary membership in an insurance-linked incentivized health promotion program, Vitality. SUBJECTS: The study sample included 948,974 adult members of the Discovery Health plan for the year 2006. Of these, 591,134 (62.3%) were also members of the Vitality health promotion program. MEASURES: The study sample was grouped based on registration and the level of engagement with the Vitality health promotion program into the following: not registered (37.5%), registered but not engaged with any health promotion activity (21.9%), low engagement (30.9%), and high engagement (9.5%). High engagement was defined a priori by the accumulation of an arbitrary number of points on the Vitality program, allocated against specific activities (knowledge, fitness-related activities, assessment and screening, and healthy choices). Hospital admission costs, the number of days in hospital, and hospital admission rates were compared among highly engaged members and those members who were not enrolled in the program, nonengaged, and lowly engaged. Data were normalized for age, gender, plan type, and chronic disease status. RESULTS: Highly engaged members had lower costs per patient, shorter stays in hospital, and fewer admissions compared with other groups (p < .001). Low or no engagement was not associated with lower hospital costs. Admission rates were also 7.4% lower for cardiovascular disease, 13.2% lower for cancers, and 20.7% lower for endocrine and metabolic diseases in the highly engaged group compared with any of the other groups (p < .01). CONCLUSIONS: Engagement in an incentive-based wellness program, offered by a health insurer, was associated with lower health care costs.