Paying the patient: Does it work?

A review of patient-targeted incentives

October 2008

Kim Sutherland
Sheila Leatherman
Jon Christianson

Key points

  • Most of the evidence on the contribution of patient incentives to quality improvement is focused on two areas of behaviour change:
    • improving public health
    • increasing patient compliance with recommended care.
  • Patient incentives can be effective in helping to secure simple, well-defined episodes of behaviour change (for example, vaccinations and cancer screening). Relatively modest rewards can encourage one-off changes in patient behaviour.
  • For complex and sustained behaviour change, such as smoking cessation, there is insufficient evidence to declare that patient incentives are effective as quality enhancing interventions. However, offsetting direct costs (eg transportation costs, cost of nicotine replacement therapy) can contribute to behaviour change in motivated patients.
  • The bulk of the evidence concerning discrete or simple behaviour change is drawn from disadvantaged groups
  • Interventions focused on more complex behaviour change tend to be focused on middle-class populations.
  • There is very little evidence available that explicitly evaluates the role of non-financial patient incentives.

This report focuses on patient-targeted incentives and summarises available evidence on the effectiveness of patient incentives in improving quality of healthcare.

It is a narrative account of available evidence in a number of healthcare areas, underpinned by systematic searches of the literature.

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