On several occasions during this GH trip, the notion of incentivizing medical care was discussed, most notably in terms of providing pregnant women with money if they followed through with prenatal care, ante-natal visits, and hospital delivery of their child (a government attempt to improve maternal and fetal health). This notion was also raised during the GHD case discussion when pondering ways in which to ensure a greater percentage of people were vaccinated and the possibility that people may be more apt to be vaccinated if there were some financial incentive. I’ve weighed the pros/cons of implementing an incentivization program in the U.S for certain medical conditions and in my opinion, this would land somewhere in the gray zone, being not fully detrimental or beneficial.
The potential benefits of incentivizing any type of medical care (vaccinations, weight loss, hitting target A1c levels, etc.) are large from a health perspective. If this method were able to increase the number of childhood vaccinations, decrease the obesity epidemic, and decrease complications of uncontrolled DM, all by simply providing a monetary amount when reaching these end points and providing needed medications/clinic appointments, it would greatly improve the overall health of American citizens afflicted by DM, obesity and poor access to care. Additionally, if this program were only offered to those who were beneath the federal poverty line, this initiative would prevent individuals from needing to choose between allocating their money for medications/health care or providing for their families. Lastly, not only would the participating individuals reap the benefits, but all U.S. citizens would likely benefit from this approach due to a decrease in the amount of federal dollars poured into the medical system to treat complications of chronic diseases.
In terms of the negative aspects of such a program, there are several that could have long lasting effects on the U.S. health care system. If I use the example above, the goal is to increase the number of vaccinated children, decrease obesity epidemic and aim for A1c values <7, but is unclear at which point financial incentives have gone too far and we are paying patients for each well controlled blood pressure value, POC glucose or LDL. Missing from this scheme is a component of personal accountability and desire to pursue health for its own sake. From my own continuity clinic experience, it is great to watch patients get excited about taking control of their health and trying to reach certain goals, and there is no doubt that adding a financial component may cheapen the experience.
In sum, while incentivizing health care is an intriguing concept and is at play in many countries, it is unclear if it would have a more harmful or beneficial effect if implemented in the U.S..