Authors' objectives:

A systematic review of the literature was undertaken to address four questions: - Key Question 1: How have preventive care and economic incentive been defined in the literature? - Key Question 2: Do incentives work? - Key Question 3: Is there evidence of a dose/response curve? - Key Question 4: What is the evidence for cost-effectiveness of economic incentive interventions?

Authors' recommendations: Definitions for neither 'prevention' nor 'economic incentive' are specifically addressed in the literature. Research on the effects of incentive interventions on preventive care and health promotion appears to be driven by policy considerations. Definitions for preventive care and economic incentives are not emphasized in the literature, not only in terms of locating the incentive intervention within larger environmental contexts, but also with regard to the function of the incentive. There is little evidence available to support the idea that explicit provider financial incentives, particularly of the modest and artificial nature that were evaluated in the studies, are effective. Further, it appears bonuses do not work simply and easily. In the short run, consumer economic incentives are effective for simple preventive care and distinct behavioral goals that are well defined. There isnt sufficient evidence at this time to say that economic incentives are effective for promoting the long-term lifestyle changes required for health promotion. The reviewed literature cannot answer whether there is a dose response for provider incentives, although one may assume that a sizable enough incentive should produce the desired behavior, if at a high cost. There is a possible dose response for consumer incentives. Even more interesting for consumer incentives is the effectiveness of relatively modest incentives. The threshold dose appears low. None of the provider studies and few of the consumer studies undertook to make this calculation, thus it is difficult for us to assess the net predicted benefit of a given financial incentive. Overall, the scientific quality of the current evidence is fair. While many studies were adequately designed to address the specific research question, the question itself was often uninformative.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/ecinctp.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)