P4P4P: An Agenda For Research On Pay-For-Performance For Patients
Open accessAbstract
Unhealthy behavior is a major cause of poor health outcomes and high health care costs. In this paper we describe an agenda for research to guide broader use of patient-targeted financial incentives, either in conjunction with provider-targeted financial incentives (pay-for-performance, or P4P) or in clinical contexts where provider-targeted approaches are unlikely to be effective. We discuss evidence of proven effectiveness and limitations of the existing evidence, reasons for underuse of these approaches, and options for achieving wider use. Patient-targeted incentives have great potential, and systematic testing will help determine how they can best be used to improve population health.
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Experiments testing financial incentives to improve health behaviors demonstrate that financial incentives can improve health behaviors in the short term, especially when financial incentives are larger.
“These studies demonstrate that financial incentives can improve health behaviors in the short term, especially when financial incentives are larger.216–219”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [217]
Incentives led to greater participation and completion rates, successful cessation in smoking cessation programs at 3 months, and greater weight loss ranging from 0.9 to 2.25 kg at 3 months, but these differences generally did not persist at longer follow-up (e.g., 6 months) after completion of the incentive programs.
“Generally, incentives led to greater participation and completion rates, successful cessation in smoking cessation programs at 3 months, and greater weight loss ranging from 0.9 to 2.25 kg at 3 months. However, these differences generally did not persist at longer follow-up (eg, 6 months) after completion of the incentive programs.”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [217]
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References 51 · Cited by 136
Research works printed but not linked: 5
- [10]Stiglitz JE Economics of the Public Sector 1988 2nd Edition ed. New York/ London W. W. Norton & Company
- [26]Higgins J Consult Clin Psychol 2000 ibid. 11142539 Higgins ST Silverman K Motivating Behavior Change Among Illicit Drug Abusers: Research on Contingency Management Interventions 1999 Washington, DC American Psychological Association
- [28]Lussier JP Heil SH Mongeon JA Badger GJ Higgins ST A meta-analysis of voucher-based reinforcement therapy for substance use disorders Addiction 2006 2 101 2 192 203 16445548
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- Authors
- Volpp, K. G., Pauly, M. V., Loewenstein, G., & Bangsberg, D.
- Affiliations
- Leonard Davis Institute of Health Economics (US)
- University of Pennsylvania (US)
- Carnegie Mellon University (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2009-01
- Volume
- 28
- Issue
- 1
- Pages
- 206-214
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- PMC
- PMC3507539
- OpenAlex
- W1984359064
- Cited by
- 136
- References
- 51
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 4 · 2021: 7 · 2020: 11 · 2019: 4 · 2018: 10 · 2017: 5 · 2016: 11 · 2015: 12 · 2014: 11 · 2013: 9 · 2012: 15
- FWCI
- 25.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k24aa015287-03)
- U.S. Public Health Service (54907, 015287, 64388, 66654)
- National Institute on Alcohol Abuse and Alcoholism (K-24 AA015287)
- National Institute of Mental Health (R01MH064388, R01MH054907, R03MH066654)
- National Center for Chronic Disease Prevention and Health Promotion (R01 DP000100-01, R01 DP000100)
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- performance-based pay, health care costs, health outcomes, harmful habits, population health, research agenda, evidence of effectiveness
- MeSH terms
- Health Services Research, Humans, Quality Assurance, Health Care, Reimbursement, Incentive, United States
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