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"All the Money in the World..."Patient Perspectives Regarding the Influence of Financial Incentives

Keywords: Hypertension; veterans; financial incentives; qualitative

Objective: To analyze patient perspectives of the use of financial incentives in a hypertension intervention.

Study Setting: Twelve Veterans Affairs primary care clinics over a 9-month period.

Study Design: Qualitative semistructured interviews conducted with 54 hypertensive veterans participating in an intervention to promote guideline-consistent therapy. Intervention components included an intervention letter requesting patients talk with their providers, an offer of U.S.$20 to bring in the letter to their provider, and a health educator phone call.

Data Collection Methods: Semistructured interviews were conducted. Transcripts were coded for thematic content. The financial incentive theme was then subcoded for more detailed analysis.

Principle Findings: Most participants (n=48; 88.9 percent) stated the incentive had (or would have) no effect on their decision to initiate a discussion with their provider. Some participants articulated reservations about the effectiveness and/or appropriateness of financial incentives in health care decisions; however, a few expressed the opinion that there may be some potential benefits to the use of financial incentives if they encourage patients to be active in their health care.

Conclusion: The findings of this study raise questions about the appropriateness and unintended consequences of employing patient-directed financial incentives in health care settings.

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