Reminders, Cost Sharing, and Healthcare Use

Study Overview
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Brief Summary
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The investigators conduct a large-scale randomized controlled trial in Finland by sending three types of information letters to households to examine whether the reminder letters affect healthcare use. All letters remind of the importance of seeking care to treat potential health problems. This study has two primary objectives are: to evaluate the effects of an information nudge reminding on the importance of diagnosing and treating health problems and to evaluate the effects of additionally providing information on the fact that primary care nurse visits have become exempt from copayments. Main outcomes include the number of primary care nurse visits and general practitioner (GP) visits in a six-month follow-up.

Detailed Description
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This study has two main objectives: (i) to evaluate the effect of an information nudge reminding on the importance of diagnosing and treating health problems and (ii) to evaluate the effect of providing information on the fact that primary care nurse visits have become exempt from co-payments.

Official Title
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Reminders, Cost Sharing, and Healthcare Use

Conditions
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Health Care Utilization, Health Care Seeking Behavior, Health Behavior

Intervention / Treatment
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* Other: Reminder (information letter)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Residency in one of the 25 target municipalities as of September 15, 2021. Born in 1966 or earlier (aged 55 or more at the end of 2021). Living in a household with a maximum of three individuals aged 55 or above. Exclusion Criteria: Individuals living in households (postal address) with more than three individuals aged 55 and above.

Ages Eligible for Study
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Minimum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This is a randomized controlled trial with three active treatment arms and a control group (not assigned to any treatment, information and services as usual).
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Basic letter<br>This reminder states that if healthcare is not consumed at the right time, health may deteriorate and diagnoses and treatment may be delayed. | Other: Reminder (information letter)<br>* Reminders<br>|
| Active Comparator: Co-pay<br>This reminder states that if healthcare is not consumed at the right time, health may deteriorate and diagnoses and treatment may be delayed AND informs recipients about a new law that abolished all co-payments for all primary care nurse visits in Finland. | Other: Reminder (information letter)<br>* Reminders<br>|
| Active Comparator: GP-Co-pay<br>This reminder states that if healthcare is not consumed at the right time, health may deteriorate and diagnoses and treatment may be delayed AND informs recipients about a new law that abolished all co-payments for all primary care nurse visits in Finland, AND informs recipients that the new law did not abolish co-payments related to general practitioner visits. | Other: Reminder (information letter)<br>* Reminders<br>|
| No Intervention: Control treatment<br>There is no intervention in the control treatment. The entire population aged 55 and above in the treatment regions will serve as a control group. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of nurse visits (as recorded in the Finnish National Register of Primary Health Care Visits) |  | Six months starting from the date the letters are sent | 
| Number of doctor visits (as recorded in the Finnish National Register of Primary Health Care Visits) |  | Six months starting from the date the letters are sent | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of referrals to specialized care (as recorded in the Finnish National Register of Primary Health Care Visits) |  | Six months starting from the date the letters are sent | 
| Number of drug prescriptions for newly initiated therapies (as recorded in the Finnish national register for prescribed medicines) |  | Six months starting from the date the letters are sent | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cost-sharing, primary care, health care utilization