Patient financial incentives for preventive care

There is strong evidence that financial incentives increase preventive care among individuals with low incomes and vulnerable populations (Khazanov 2023, Rosen 2023, Green 2019, Bradley 2017, Mehrotra 2014, Kane 2004, Stone 2002, Briss 2000, Jepson 2000, Giuffrida 1997, Seal 2003, Slater 2005).

Financial incentives can improve patients’ use of primary care (Bradley 2017). Incentives can also increase participation in vaccination programs (Stone 2002, Briss 2000, Seal 2003, Giuffrida 1997), including for new vaccines (Khazanov 2023, Rosen 2023). Programs can increase screening for cervical cancer (Stone 2002, Jepson 2000) and breast cancer (Stone 2002, Slater 2005), and testing for tuberculosis (Kane 2004, Giuffrida 1997, Perlman 2003).

Financial incentives alone can increase screening for colorectal cancer in some instances (Stone 2002) and when combined with other supports such as mailed screening kits (Green 2019) or paired with patient navigation and reminders (Hardin 2020). However, results vary and small financial incentives (e.g., $5-$10) may not increase colorectal cancer screening rates (Lieberman 2019, Mehta 2019).

Financial incentives also improve adherence to treatments for tuberculosis (Giuffrida 1997, Kominski 2007, Malotte 2001) and getting patients to follow through for referrals related to sexually transmitted infections (STIs) (Kane 2004, Haukoos 2005, Carey 2005). Financial incentives may not sustain long-term medication adherence for patients with chronic medication needs beyond the time when the incentives are provided (Higgins 2012). Financial incentives can increase the number of prenatal appointments pregnant teens attend (Giuffrida 1997, Kane 2004) and reduce smoking during pregnancy (Cochrane-Lumley 2004, Cochrane-Chamberlain 2017).

Patients are most likely to attend appointments or receive services such as screenings or testing if incentives include reduced out-of-pocket costs, free services (Briss 2000, Stone 2002, Jepson 2000, Slater 2005), or a large reward (Bradley 2017, Haukoos 2005, Kane 2004, Giuffrida 1997). Experts suggest that by increasing the likelihood that adults with low incomes visit primary care providers, incentive programs may improve health outcomes and lower overall costs of care (Bradley 2017).

Financial incentives for preventive care have the potential to decrease disparities in the use of preventive care by patients with lower incomes or from vulnerable populations, if they are designed to reach those populations (Khazanov 2023, Green 2019, Rosen 2023).

Available evidence suggests that efforts which include financial incentives can increase colorectal cancer screenings among some vulnerable populations, including Medicaid populations (Green 2019) and individuals experiencing homelessness (Hardin 2020). However, small financial incentives (e.g., $5-$10) may not increase screening for patients who are uninsured (Lieberman 2019). Studies of incentive programs offered during the initial rollout of COVID-19 vaccines suggest financial incentives may increase the uptake of new vaccines among individuals with lower incomes (Khazanov 2023) and those experiencing homelessness (Rosen 2023), and that patients who are Black, Asian, or Hispanic may be more responsive to financial incentives for vaccinations than patients who are white (Khazanov 2023).

The use of preventive care and screenings vary by race, income, and insurance status, and among vulnerable populations such as adolescents and those with disabilities or mental health conditions (AHRQ-Health equity 2018). For example, people who are Black, Hispanic, Asian, American Indian and Alaska Native (AIAN), or Native Hawaiian and Other Pacific Islander (NHPI) are less likely to be up to date on colorectal cancer screenings, while adults who are Hispanic, Asian, AIAN, or NHPI are less likely to be up to date on mammograms (KFF-Ndugga 2024). Patients who are Black are less likely to receive cervical cancer screening than white patients (Spencer 2023).

Patients attempting to access preventive care encounter barriers at multiple levels, including from health care providers, the health care system itself, and broader structural barriers (AHRQ-Health equity 2018). For example, individuals without health insurance are less likely to receive colorectal cancer screenings, and physicians may be less likely to recommend screenings if they assume a patient is unable to pay or if there are fewer specialists in the area (Rutter 2021).

Some experts have raised ethical concerns regarding the use of financial incentives for preventive care, particularly when programs are focused on increasing care among vulnerable populations, as they have the potential to be coercive (Rosen 2023, Hoskins 2019).

The use of financial incentives to support health-related behavior change, initially for substance use and weight loss, began in the 1960s. In the 1990s, the use of financial incentives expanded to promote medication adherence for people who use drugs and treatment of tuberculosis and HIV (Higgins 2012). Financial incentives today are often provided by employers and health insurance companies, such as Kaiser Permanente and Blue Cross Blue Shield (KP-FEHB Rewards, BCBS-MyBlue), or through some state Medicaid programs (CMS-MIPCD).

Systemic racism contributes to under-resourced health care facilities, inequitable policies, and disparities in access to care (Spencer 2023). Experts indicate that national and state level policies are needed to reduce disparities in the use of preventive care by improving access to screening, follow up for abnormal results, and education for patients about the importance of screening, along with support by health care systems and organizations (Rutter 2021).

• What are the disparities in access to preventive care in your community? Which groups are most affected?
• What partnership opportunities exist in your community to fund financial incentives for preventive care programs in the long-term?

Private and public health insurance providers may offer financial incentives to subscribers to complete preventive screenings, receive preventive care such as dental cleanings, or participate in wellness programs (CWF-Incentives). For example, Kaiser Permanente’s Federal Health Plan, available in eight states and Washington, D.C., offers subscribers completing annual total health assessments and online health classes (i.e., eat healthier, lose weight, or quit tobacco) a $150 incentive that can be used for qualified medical expenses (e.g., co-pays, prescription glasses or contacts, dental treatments, etc.) (KP-FEHB Rewards). Blue Cross Blue Shield’s nationwide wellness incentive program, MyBlue, offers $50 for a Blue Health Assessment and up to $120 for achieving health goals through activities related to health conditions or concerns such as asthma, hypertension, nutrition, and stress and balanced living; earned funds can be used for qualified medical expenses (BCBS-MyBlue).

A variety of financial incentives were offered when COVID-19 vaccinations first became available to increase vaccination rates, many in partnership with state lottery programs. Some state-wide examples included Arkansas ($20 for fishing/hunting licenses), Colorado ($100 Walmart gift card and $50 Colorado Parks and Wildlife vouchers), Illinois (Six Flags tickets), Maryland ($100 for state employees), Minnesota ($100), and West Virginia ($100 savings bond or gift card) (NGA-COVID-19 Vaccine incentives).

In 2011, the Affordable Care Act created the Medicaid Incentives for the Prevention of Chronic Disease grant program (MIPCD), which awarded five year grants to ten states to provide incentives to Medicaid beneficiaries who participated in prevention programs, adopted healthier behaviors, and improved their health. The ten states included California, Connecticut, Minnesota, Montana, Nevada, New Hampshire, New York, Texas, and Wisconsin; each state selected focus areas to help beneficiaries quit using tobacco, lose weight, lower cholesterol or blood pressure, or avoid or manage diabetes. Early evaluations of the individual programs became available in 2017 (CMS-MIPCD, RTI-Hoerger 2017).

CMS-MIPCD - Centers for Medicare & Medicaid Services (CMS). Medicaid incentives program for the prevention chronic diseases model.

RTI-Hoerger 2017 - Hoerger T, Boland E, Acquah JK, et al. Medicaid incentives for prevention of chronic diseases: Final evaluation report. Research Triangle Park, NC: RTI International for the Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services (CMS); 2017.

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AHRQ-Health equity 2018 - Agency for Healthcare Research and Quality (AHRQ). (2018, August 31). Achieving health equity in preventive services: Systematic evidence review.

BCBS-MyBlue - Blue Cross and Blue Shield (BCBS). (n.d.). MyBlue: Wellness incentive program. Retrieved June 4, 2025.

Bradley 2017 - Bradley CJ, Neumark D. Small cash incentives can encourage primary care visits by low-income people with new health care coverage. Health Affairs. 2017;36(8):1376-1384.

Briss 2000* - Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. American Journal of Preventive Medicine. 2000;18(1 Suppl 1):97-140.

Carey 2005 - Carey MP, Vanable PA, Senn TE, Coury-Doniger P, Urban MA. Recruiting patients from a sexually transmitted disease clinic to sexual risk reduction workshops: Are monetary incentives necessary? Journal of Public Health Management and Practice. 2005;11(6):516-521.

CMS-MIPCD - Centers for Medicare & Medicaid Services (CMS). Medicaid incentives program for the prevention chronic diseases model.

Cochrane-Chamberlain 2017* - Chamberlain C, O’Mara-Eves A, Porter J, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews. 2017;(2):CD001055.

Cochrane-Lumley 2004* - Lumley J, Oliver S, Chamberlain C, Oakley L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews. 2004;(4):CD001055.

CWF-Incentives - The Commonwealth Fund (CWF). (n.d.). States in Action: Public programs are using incentives to promote healthy behavior. Retrieved June 4, 2025.

ETF-Well Wisconsin - Wisconsin Department of Employee Trust Funds (ETF). (2025). Well Wisconsin for Members. Retrieved June 4, 2025.

Giuffrida 1997* - Giuffrida A, Torgerson DJ. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997;315(7110):703-707.

Green 2019 - Green, B. B., Anderson, M. L., Cook, A. J., Chubak, J., Fuller, S., Kimbel, K. J., Kullgren, J. T., Meenan, R. T., & Vernon, S. W. (2019). Financial incentives to increase colorectal cancer screening uptake and decrease disparities: A randomized clinical trial. JAMA Network Open, 2(7), e196570.

Hardin 2020 - Hardin, V., Tangka, F. K. L., Wood, T., Boisseau, B., Hoover, S., DeGroff, A., Boehm, J., & Subramanian, S. (2020). The effectiveness and cost to improve colorectal cancer screening in a federally qualified homeless clinic in Eastern Kentucky. Health Promotion Practice, 21(6), 905–909.

Haukoos 2005* - Haukoos JS, Witt MD, Coil CJ, Lewis RJ. The effect of financial incentives on adherence with outpatient human immunodeficiency virus testing referrals from the emergency department. Academic Emergency Medicine. 2005;12(7):617-621.

Higgins 2012* - Higgins, S. T., Silverman, K., Sigmon, S. C., & Naito, N. A. (2012). Incentives and health: An introduction. Preventive Medicine, 55, S2–S6.

Hoskins 2019* - Hoskins, K., Ulrich, C. M., Shinnick, J., & Buttenheim, A. M. (2019). Acceptability of financial incentives for health-related behavior change: An updated systematic review. Preventive Medicine, 126, 105762.

Jepson 2000* - Jepson R, Clegg A, Forbes C, et al. The determinants of screening uptake and interventions for increasing uptake: A systematic review. Health Technology Assessment. 2000;4(14).

Kane 2004* - Kane RL, Johnson PE, Town RJ, Butler M. A structured review of the effect of economic incentives on consumers’ preventive behavior. American Journal of Preventive Medicine. 2004;27(4):327-352.

KFF-Ndugga 2024 - Ndugga, N., Hill, L., & Artiga, S. (2024, June 11). Key data on health and health care by race and ethnicity. KFF. Retrieved June 4, 2025.

Khazanov 2023* - Khazanov, G. K., Stewart, R., Pieri, M. F., Huang, C., Robertson, C. T., Schaefer, K. A., Ko, H., & Fishman, J. (2023). The effectiveness of financial incentives for COVID-19 vaccination: A systematic review. Preventive Medicine, 172, 107538.

Kominski 2007* - Kominski GF, Varon SF, Morisky DE, et al. Costs and cost-effectiveness of adolescent compliance with treatment for latent tuberculosis infection: Results from a randomized trial. Journal of Adolescent Health. 2007;40(1):61-68.

KP-FEHB Rewards - Kaiser Permanente (KP). (n.d.). Federal Employees and Retirees: Rewards and benefits for federal employees. Retrieved June 4, 2025.

Lieberman 2019 - Lieberman, A., Gneezy, A., Berry, E., Miller, S., Koch, M., Ahn, C., Balasubramanian, B. A., Argenbright, K. E., & Gupta, S. (2019). Financial incentives to promote colorectal cancer screening: A longitudinal randomized control trial. Cancer Epidemiology, Biomarkers & Prevention, 28(11), 1902–1908.

Malotte 2001* - Malotte CK, Hollingshead JR, Larro M. Incentives vs outreach workers for latent tuberculosis treatment in drug users. American Journal of Preventive Medicine. 2001;20(2):103-107.

Mehrotra 2014 - Mehrota A, Brannen T, Sinaiko AD. Use patterns of a state health care price transparency web site: What do patients shop for? The Journal of Health Care Organization, Provision, and Financing. 2014:1-3.

Mehta 2019 - Mehta, S. J., Pepe, R. S., Gabler, N. B., Kanneganti, M., Reitz, C., Saia, C., Teel, J., Asch, D. A., Volpp, K. G., & Doubeni, C. A. (2019). Effect of financial incentives on patient use of mailed colorectal cancer screening tests: A randomized clinical trial. JAMA Network Open, 2(3), e191156.

NGA-COVID-19 Vaccine incentives - National Governors Association (NGA). (2021, October 19). COVID-19 Vaccine incentives. Retrieved June 4, 2025.

Perlman 2003 - Perlman DC, Friedmann P, Horn L, et al. Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange- based tuberculin skin testing. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2003;80(3):428-437.

Results for America-Financial incentives - Results for America. (n.d.). Financial incentives for preventative care. Economic Mobility Catalog. Retrieved June 5, 2025.

Rosen 2023* - Rosen, A. D., Howerton, I., Brosnan, H. K., Stefanescu, A., Gomih, A., Ngo, C., Chang, A. H., Nguyen, A., & Thomas, E. H. (2023). Financial incentives for COVID-19 vaccines among people experiencing homelessness. American Journal of Preventive Medicine, 65(1), 12–18.

RTI-Hoerger 2017 - Hoerger T, Boland E, Acquah JK, et al. Medicaid incentives for prevention of chronic diseases: Final evaluation report. Research Triangle Park, NC: RTI International for the Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services (CMS); 2017.

Rutter 2021 - Rutter, C. M., Knudsen, A. B., Lin, J. S., & Bouskill, K. E. (2021). Black and white differences in colorectal cancer screening and screening outcomes: A narrative review. Cancer Epidemiology, Biomarkers & Prevention, 30(1), 3–12.

Seal 2003* - Seal KH, Kral AH, Lorvick J, et al. A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug and Alcohol Dependence. 2003;71(2):127-131.

Slater 2005* - Slater JS, Henly GA, Ha CN, et al. Effect of direct mail as a population-based strategy to increase mammography use among low-income underinsured women ages 40 to 64 years. Cancer Epidemiology, Biomarkers & Prevention. 2005;14(10):2346-2352.

Spencer 2023 - Spencer, J. C., Kim, J. J., Tiro, J. A., Feldman, S. J., Kobrin, S. C., Skinner, C. S., Wang, L., McCarthy, A. M., Atlas, S. J., Pruitt, S. L., Silver, M. I., & Haas, J. S. (2023). Racial and ethnic disparities in cervical cancer screening from three U.S. healthcare settings. American Journal of Preventive Medicine, 65(4), 667–677.

Stone 2002* - Stone EG, Morton SC, Hulscher ME, et al. Interventions that increase use of adult immunization and cancer screening services: A meta-analysis. Annals of Internal Medicine. 2002;136(9):641.

WI DHS-MIPDC - Wisconsin Department of Health Services (WI DHS). Medicaid Incentives for the Prevention of Chronic Disease (MIPDC): Wisconsin Striving to Quit, implementation report. University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) and Wisconsin Women’s Health Foundation; 2016.