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Moderating Effects of Patient Characteristics on the Impact of Financial Incentives
Meredith B Rosenthal1, Andrea B Troxel2, Kevin G Volpp3,4
11 Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Insights
Financial incentives for healthcare quality improvement show varied effects. Some patient subgroups, like the uninsured, responded less to shared incentives, indicating potential disparities in treatment adjustments.
Area of Science:
- Health Services Research
- Health Economics
- Clinical Quality Improvement
Background:
- Financial incentives are common quality improvement strategies.
- Their impact on patient subgroups and health disparities remains unclear.
- Understanding these effects is crucial for equitable healthcare delivery.
Purpose of the Study:
- To analyze the impact of financial incentives on patient subgroups.
- To examine potential health care disparities related to incentive programs.
- To assess differential responses to financial incentives in cardiovascular disease risk management.
Main Methods:
- Analysis of data from a randomized clinical trial.
- Study focused on financial incentives aimed at lowering low-density lipoprotein (LDL) cholesterol.
- Inclusion of patients at risk for cardiovascular disease.
Main Results:
- Patients with higher baseline LDL showed greater cholesterol reduction with shared incentives.
- Physician incentives were associated with fewer medication potency increases in some groups.
- Uninsured patients and non-Black/White racial groups were less likely to receive medication potency increases under shared incentives.
Conclusions:
- Financial incentives can lead to differential responses among patient subgroups.
- Potential for exacerbating health care disparities exists.
- Targeted medication changes may be unevenly influenced by incentive structures.
Abstract:
While financial incentives to providers or patients are increasingly common as a quality improvement strategy, their impact on patient subgroups and health care disparities is unclear. To examine these patterns, we analyzed data from a randomized clinical trial of financial incentives to lower low-density lipoprotein (LDL) cholesterol levels in patients at risk for cardiovascular disease. Patients with higher baseline LDL experienced greater cholesterol reductions in the shared incentive arm (0.23 mg/dL per unit change in baseline LDL, 95% CI [-0.46, -0.00]) but were also less likely to have medication potency increases in the physician incentive arm ( OR = 0.98, 95% CI [0.97, 0.996]). Uninsured patients and those of race other than Black or White were less likely to have potency increases in the shared incentive arm ( OR = 0.15, 95% CI [0.03, 0.70] and OR = 0.09, 95% CI [0.01, 0.93], respectively). These findings suggest some differential response to incentives, particularly in the form of targeted medication changes.
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