Niza, Claudia
(2014)
The impact of patient financial incentives to promote blood donation and compliance with health care.
PhD thesis, London School of Economics and Political Science.
Abstract
The purpose of this thesis is to examine the impact of financial incentives to promote health behaviour change. Financial incentives include tangible rewards as cash, vouchers and lotteries that are offered to individuals conditional to the fulfilment of health guidelines. Despite the growing use of such patient incentives in practice, some fundamental questions are yet to be answered: (1) Are financial incentives effective? (2)
What type and size of incentive is more effective? (3) Do patient income and past health behaviour moderate the impact of incentives? These questions are analysed in the context of (a) blood donation and (b) compliance with health care including adherence to treatment, disease screening, immunisation and appointment keeping. Behavioural economics, in particular prospect theory, provide the theoretical foundations for this work
and substantiate my hypotheses about the effect of financial incentives.
I perform the first meta-analyses in the literature to quantify the impact of patient financial incentives to promote blood donation (chapter 3) and compliance (chapter 4). These results show that financial incentives do not promote blood donation but increase compliance with health care, particularly for low income patients.
Two large field studies were developed to further examine the effect of incentives in compliance - testing pioneer incentive schemes. I test the impact of a certain (£5 voucher) versus uncertain (£200 lottery) incentive framed either as a gain or loss to promote Chlamydia screening (chapter 5). I also develop the first study ever testing preferences for sequences of events in the field – using the naturalistic setting of colorectal cancer. This
study compared the effect of a €10 incentive offered at the end of screening versus two €5 incentives offered at the beginning and end of screening (chapter 6). The former showed the voucher framed as a gain was the most effective incentive and the latter showed that
smaller two €5 incentives increase screening more than a single €10 incentive (which had a detrimental effect compared to no incentive).
I fundamentally contribute to the literature by showing that (i) patient financial incentives do not increase the quantity of blood donations and may have an adverse effect on quality, providing empirical evidence to a long-standing policy debate. Furthermore (ii) small
certain rewards around £5 are likely to be the optimal incentive for compliance with health care, (iii) higher incentives may be more effective if offered as smaller segregated incentives of the same amount and (iv) incentives have over twice the impact on low income patients than on more affluent patients.
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