Penn Study: Paying Patients, Doctors Leads to Lower Cholesterol

Financial rewards for medicine adherence work, researchers say.

(Irenaphoto/Shutterstock )

(Irenaphoto/Shutterstock )

What’s the best way to lower people’s cholesterol? Offer financial rewards to both patients and doctors when people take their allotted medications at the appropriate times. That was the main finding from a recently published University of Pennsylvania-led study.

It’s easy to understand why a financial reward gives patients incentives to take their medicine (typically statins like Lipitor). But why pay doctors too?

“When we just paid the patients a financial incentive, their adherence to medication went up, but not enough to get the LDL (low-density lipoprotein) cholesterol down sufficiently,” said Dr. David Asch, professor of medicine at the University of Pennsylvania who conducted the study on 350 primary care physicians and 1,500 patients. He led the study with Dr. Kevin Volpp.

When the researchers just paid physicians, the amount of prescriptions for statins increased, but the patient’s cholesterol levels still didn’t decrease sufficiently.

But when both were rewarded, the all-important cholesterol measurement fell significantly.

The patients in the study were paid either $100 or $10 via daily lotteries. All patients got an electronic pill bottle which transferred information to researchers about if, and when, the patients took their medicine. But if the patient didn’t take their medication, they didn’t win anything — even if their number was selected.

“That introduces this notion of regret. People hate that more than anything,” said Asch. “I could have won $100 if I just took my medicine — but I didn’t.”

Another caveat is that every quarter, the patients got their blood drawn and only got to keep their prize money if their cholesterol went down.

“That introduces loss aversion,” said Asch. “People don’t want to lose things that they’ve already earned.”

For physicians, the payments came in the form of quarterly bonuses for helping patients hit their cholesterol goals.

The average payment for both patient and physician was $512.

But why should doctors be paid for a job well done? Isn’t it already in their best interest to make sure patients get healthier?

“From the physician side, there’s a lot of interest in pay-for-performance. People don’t like the alternative idea that physicians get paid the same amount whether they’re successful or not,” said Asch. He also made it clear that the study doesn’t favor one brand over another. It’s just about adherence and health.

“In the end, we want people to be treated,” he said. “That’s why we make these medicines. We’re not trying to get people to take one brand of laundry detergent or another. We’re trying to improve health.”