Can You Pay People To Be Healthy?
With a modest allowance and a little coaching on how to use it to improve their health, Medicaid patients may take better care of themselves and save the public expense of frequent trips to the emergency room.
My research tracks 625 disabled Medicaid enrollees in the Houston area. We give them $1,150 debit cards to spend on their health annually and a coach to guide their choices. They can spend it on gym memberships, smoking cessation programs, cook books for healthy eating, treadmills and more. One woman bought a Kindle to distract her from the pain she experienced when she walked, and she now exercises much more frequently.
Halfway through our four-year study, the research participants report greater improvements in their physical and mental health and fewer ER visits than our control group.
These results could have huge implications for the U.S. healthcare system.
About 15 percent of Medicaid recipients account for 70 percent of all spending in Medicaid. Giving these “superutilizers” the financial resources and guidance to take greater control of their health shows promise as a tool to reduce scheduled and unscheduled visits to doctors.
There are tight controls on the allowances. Money is loaded onto the debit cards only after research participants and coaches agree on how it is to be spent.
And because these low-income people have wide latitude on how to spend the money, they’re picking up money management skills and finding creative ways to improve their health.
Consider the man who used his debit card to buy a basketball backboard and hoop. Not only has he improved his own health by shooting and dribbling, but his driveway has become a neighborhood gathering spot for games that improve a whole community’s health.
Can a conditional economic bump help improve overall health?
Dr. Betsy Shenkman, professor and department chair of The University of Florida’s Department of Health Outcomes and Policy, is tracking the effects of money spent specifically on one’s health.
Dr. Elizabeth Shenkman is Chair of Health Outcomes and Policy and Director of the Institute for Child Health Policy. In addition, she is a health outcomes researcher working to achieve two goals: (1) determine which combinations of health care delivery, community, and patient factors influence quality and outcomes of care; and (2) develop corresponding evidence-based health care delivery system and patient-centric interventions to improve outcomes of care. Her particular focus is on adults and children with chronic conditions and those in public insurance programs.
Dr. Shenkman also serves as Co-Director of the Implementation Science Program within UF’s NIH-funded Clinical and Translational Science Institute (CTSI). In this role, Dr. Shenkman collaborates with faculty and staff to provide technical assistance in developing implementation science and patient-centered outcomes studies.Dr. Shenkman’s research has been funded by the Agency for Health Care Research and Quality, the Robert Wood Johnson Foundation, the Centers for Medicare and Medicaid Services, the Texas Health and Human Services Commission, and the Florida Agency for Health Care Administration. Her work is published in journals such as Pediatrics, Health Services Research, Clinical Epidemiology, Pediatric Blood and Cancer, and the American Journal of Public Health. Dr. Shenkman is an elected member of the Society for Pediatric Research and the American Pediatric Society.