Paying Patients to Perform
The problem:
One-third to one-half of all patients do not take medications as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker…about one-tenth of hospital admissions and one-quarter of nursing home admissions result from incorrect adherence to medication.
Aetna’s solution:
[Patients] can win $10 or $100 each day they take the drug — a kind of lottery using a computerized pillbox to record if they took the medicine and whether they won that day.
Pay-for-performance for doctors:
Aetna has begun paying doctors bonuses for prescribing medication likely to prevent problems: beta blockers to prevent heart attacks, statins for diabetes sufferers. Currently, 93,000 doctors are in Aetna’s “pay for performance” program; bonuses average three percent to five percent of a practice’s base income.
Full article on paying people money to take their medicine.
I’m a little skeptical that not filling prescriptions leads to $100 billion in additional medical costs annually.
Nonetheless, non-adherence to treatment protocols is a serious problem. I would argue the more serious problems isn’t drugs not filled and taken, it’s ignoring your doctors’ advice on lifestyle changes – such as advice to quit smoking, lose weight, change your diet and get off the couch and exercise.
NCPA has long advocated that certain conditions and drug treatments need different cost-sharing depending on the nature of the condition. For instance, antihistamines probably need significant cost-sharing because there are numerous treatments on the market and the condition is not life threatening. On the other hand, beta blockers for a diabetics should probably be free.
It’s interesting to see how insurers are taking different approaches to the problem. They should be allowed to experiment and find out what works. What works for one condition may not work for another. Past research has found that medical non-adherence varies by condition.
It’s not so far-fetched. After all, insurance is a type of lottery, no?
I don’t think this is a bad idea. But when the insurance company is creating the incentive system, it has an incentive to structure it so that it maximizes insurance company profits. And the end goal is not the same as maximizing the patient’s wellbeing.
Ken, that’s why the health Savings Account is a better approach. You have financial incentives that are as strong or stronger and the decision maker is the patient so he has the patient’s best interest at heart.
This is a bogus claim! My dentist fixed a tooth of mine that cracked and gave me a prescription for antibiotics “just in case” I got an infection. I did not get this filled because I know how dangerous such blase’ use of antibiotics can cause more problems. I never got an infection and would have taken them for nothing, causing possible gastrointestinal problems (yeast overgrowth).
I blew a disk in my back 3 1/2 years ago and did take prescribed medications for 3 weeks (Vicidin, Flexeril, and a steroid), but then refused to take them anymore as the first two are highly addictive and can cause liver problems, and the last one can depress the immune system. I had a lot of pain (none of this took away pain anyway!) for the next 7 months, then went to a Chiropractor where I was given Decompression Therapy, a therapy without drugs, and became pain free.
Prescriptions are not always the answer!!! They do not always keep us healthy.
LoriSm makes a good point. The broader point is: why do you want Aetna to be your doctor?
You can probably get senior citizens to take meds by just making the pill box look like a bingo card. 🙂