Witman Allison, Acquah Joseph, Alva Maria, Hoerger Thomas, Romaire Melissa
University of North Carolina Wilmington, Wilmington, NC.
RTI International, Research Triangle Park, NC.
Health Serv Res. 2018 Dec;53(6):5016-5034. doi: 10.1111/1475-6773.12994. Epub 2018 Jun 12.
To test the effectiveness of financial incentives for smoking cessation in the Medicaid population.
Secondary data from the Medicaid Incentives for Prevention of Chronic Disease (MIPCD) program and Medicaid claims/encounter data from 2010 to 2015 for five states.
Beneficiaries were randomized into receipt or no receipt of financial incentives. We ran multivariate regression models testing the impact of financial incentives on the use of counseling services, smoking behavior, and Medicaid expenditures and utilization.
Participating states provided Medicaid eligibility, claims and encounters, program enrollment, and incentivized service use data.
Participants who received incentives were more likely to call the Quitline and complete counseling sessions. Incentive receipt was positively associated with self-reported quit attempts, self-reported quits, or passing cotinine tests of smoking cessation in most programs, although results were only statistically significant in a subset. There was no systematic evidence that incentives affected health care use or spending.
Financial incentives are a promising policy lever to motivate behavioral change in the Medicaid population, but more evidence is needed regarding optimal incentive size, effectiveness of process-versus outcome-based incentives, targeting of incentives, and long-run cost-effectiveness.
检验经济激励措施对医疗补助计划人群戒烟的有效性。
来自慢性病预防医疗补助激励计划（MIPCD）的二手数据，以及2010年至2015年五个州的医疗补助报销/就诊数据。
将受益人随机分为接受或不接受经济激励两组。我们运行多变量回归模型，以检验经济激励对咨询服务使用、吸烟行为、医疗补助支出及利用率的影响。
参与研究的州提供了医疗补助资格、报销及就诊情况、项目登记以及受激励服务使用数据。
接受激励的参与者更有可能拨打戒烟热线并完成咨询疗程。在大多数项目中，接受激励与自我报告的戒烟尝试、自我报告的戒烟或通过戒烟可替宁测试呈正相关，不过结果仅在部分子集中具有统计学意义。没有系统证据表明激励会影响医疗保健的使用或支出。
经济激励是促使医疗补助计划人群行为改变的一个有前景的政策杠杆，但在最佳激励规模、基于过程与基于结果的激励措施的有效性、激励措施的针对性以及长期成本效益方面，还需要更多证据。
