Incentives for Primary Care Use in a Safety Net Setting
Condition: Health Care Utilization; Primary Care Physician; Uninsured
Study type: Interventional

Summary: 
      A randomized controlled trial (RCT) of incentives for an initial primary care visit within 6
      months of enrollment in a health care coverage program. Study subjects are drawn from a
      low-income adult population that gains coverage and access to community-based primary care
      services under a program administered by an academic safety-net hospital. The investigators
      will offer financial incentives to encourage an initial primary care visit within 6 months of
      enrollment and evaluate whether the primary care visit altered subsequent health seeking
      behavior and influenced patient satisfaction and other outcomes such as self-reported health
      status.
    

Detailed description: 
      A randomized controlled trial (RCT) of incentives for an initial primary care visit within 6
      months of enrollment in a health care coverage program. Study subjects are drawn from a
      low-income adult population that gains coverage and access to community-based primary care
      services under a program administered by an academic safety-net hospital. The investigators
      will offer financial incentives to encourage an initial primary care visit within 6 months of
      enrollment and evaluate whether the primary care visit altered subsequent health seeking
      behavior and influenced patient satisfaction and other outcomes such as self-reported health
      status.

      Incentives should steer patients in their decision to seek primary care, reduce barriers to
      care, and ultimately improve patient health and reduce utilization and costs through their
      relationship with a PCP. This study is the first of its kind to incentivize low-income
      patients. This population has the greatest need for health care and exerts the greatest
      pressure on the United States' safety net system. Furthermore, the safety net population is
      the target of policies such as Medicaid eligibility expansions, yet urban safety net patients
      are largely understudied. These patients are rarely given the opportunity to participate in
      research, and when they are the subjects of measures to reduce health care utilization, they
      are the subject of policies using negative incentives such as those that introduce cost
      sharing for using ED services.1 Alternatively, safety net providers invest in case management
      systems to reduce utilization. The proposed study is a departure from prior measures to
      reduce utilization among low-income patients by focusing on patients and using positive
      incentives. The study borrows from the principles of behavioral economics to motivate
      patients towards primary care utilization. Once in the primary care system, The investigators
      will test whether primary care contact reduces more expensive forms (e.g., inpatient, ED) of
      health care.

      The investigators will compare outcomes of patients assigned in the highest incentive group
      ($50) to patients assigned to the modest incentive group ($25) and to patients assigned to
      usual care (no incentive, but assignment to a PCP). The investigators will also compare
      incentive patients ($50, $25) to a contemporaneous group of patients that enroll in the
      safety net clinic at the same time.
    

Intervention name(s): 0 dollars group; 50 dollars group; 25 dollars group
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Those assigned to the $0 group will not receive an incentive for visiting their PCP.; Those assigned to the $50 group will receive $50 if they visit their PCP within 6 months of study enrollment.; Those assigned to the $25 group will receive $25 if they visit their PCP within 6 months of study enrollment.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research