Paying Patients?

Photo by Ibrahim Boran on Unsplash

I read an article in Psychology Today called “Paying Patients Improves Mental Health Treatment Engagement“. It made a convincing case that monetary incentives would improve mental healthcare. It compared 39 papers on the topic and found that there were large effects from financial incentives. It also addressed several of the possible objections. Finally, it talked about some next steps that can be taken. I still have some questions, though.

The biggest effect was simple follow-through. With incentives, patients are more likely to show up to appointments and take their medications. Those are both general challenges in the mental health field. It’s easy to stop seeing a therapist or stop medication when you are feeling better. That greatly increases the possibility of relapse, though.

There were three possible objections raised. First, incentives may reduce autonomy. Second, it may reduce motivation (along the lines of the typical Republican response to any social safety net). Third, people might object that it costs too much. The first two objections are dismissed because there was no evidence for either of them in the studies. The third is because these programs are shown to be cost effective. They save more money than they payout in reduced healthcare costs and reduced incarceration.

There are six next steps. 1. Currently incentive programs are only available for substance abuse patients. They should be expanded. 2. Behavioral economics should be used to tailor the program to individual patients. 3. Corporate partnerships should be used to reduce costs. 4. Regulatory hurdles need to be removed. 5. States should provide direct funding. 6. Financial incentives should be used alongside other strategies.

Now for my questions. First, the article never says what the incentives are. Are we talking $1, $20, $50, or $100? Second, how is the program actually implemented? How do they monitor whether a patient is showing up for appointments and taking their medications? Third, how often are the incentives delivered? Is it per appointment or monthly or what? Finally, what about people who already do show up and take their meds? Are we able to participate, too?

I wonder if the actual studies address my questions. Either way, this is a promising intervention. It will be interesting to see if any of the recommendations are ever implemented.

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