The QCare Gift Card

A proposal for Minnesota’s state-sponsored health plan to provide $20 gift cards as financial incentives to diabetics who control their glucose levels and smokers who quit the habit has resulted in a few news stories and some outrage from the public.¹

The plan is relatively simple. Senator Linda Berglin, who leads the health budget panel, proposes offering $1 million in incentives to patients covered by subsidized programs including the MinnesotaCare plan for the working poor, pointing out that “These quality guidelines are not reached simply by the doctor. There has to be the patient involved in it, too.”

The incentives would be part of the QCare program, which offers bonuses to health plans and providers that score well on treating costly chronic conditions like diabetes and heart disease.
The Associated Press story ends with “It was unclear Wednesday whether there would be restrictions on what gift card recipients could buy with them.”

Commentary

While the Associated Press story worked the angle of offering gift cards² for patient compliance, I submit that the core issue from the healthcare perspective is simply “Will the incentives efficaciously improve the health of the patients?”

Anyone following this blog probably knows that offering incentives for adherence, a tactic that has come and gone a few times in medicine over the past decades, is currently in ascendancy. On AlignMap.com alone, are posts about Incentives To Enhance Compliance With Addiction Treatment, Cash For Compliance & Other Ethical Dilemmas, and Shopping Discounts As Incentives For HIV Screening Compliance, among others. (Running a search for “incentives” at the site pulls up a half-dozen other posts.)

The question may well be why it isn’t more consistently popular. The fundamental paper on the topic in the medical literature is probably “Should we pay the patient? Review of financial incentives to enhance patient compliance,” by Giuffrida and Torgerson (British Medical Journal. 1997;315:703-707. 20 September), who reviewed “randomised trials with quantitative data concerning the effect of financial incentives (cash, vouchers, lottery tickets, or gifts) on compliance with medication, medical advice, or medical appointments” and found “10 of the 11 studies showed improvements in patient compliance with the use of financial incentives.”

Moreover, the improvements in compliance should save far more money than the program would cost.

I would suggest that the opposition to financial incentives has less to do with the effectiveness of that strategy than with social mores, politics, and personal philosophies.

As a political conservative, I’m not convinced that government should be micromanaging healthcare; as a pragmatist, I’m not convinced that any other currently existing agency with sufficient power to coordinate care for large populations is likely to do any better.

My concerns about the government’s involvement in healthcare and my recognition of the gap between the lofty goals of a plan and its execution notwithstanding, I am impressed with the stated objective of Minnesota’s QCare Program: … To apply QCare standards and align payments and es for all state purchased health care.

I am, you see, big on the alignment thing.

Sources:
Gift Cards Proposed as Health Incentive

State of Minnesota: Information on Quality Care and Rewarding Excellence (QCare)

Footnotes

1. A sense of the response from at least a portion of the populace can be ascertained from scanning the comments to the news story at http://www.freerepublic.com/focus/f-news/1808798/posts [back]
2. I’m not wild about gift cards myself; I can only guess that Minnesota will but them at a discount or that offering cash (my preference) would be bad politics. [back]

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