Time's ticking! Effects of deadline on the utilization of health services: Evidence from a cluster-randomized controlled trial.

The low utilization of health services in rural areas is an essential factor affecting the health level of rural residents. Based on insights from behavioral economics, this study evaluates the average treatment effect of imposing a deadline on vision-care vouchers (i.e., the voucher-deadline intervention) on the utilization of health services. Using the vision health as a case study, a non-masked cluster-randomized controlled trial was conducted in 13 rural schools of a county in Shaanxi Province of China during 2018-2019. Among 1270 baseline sample students with myopia, 610 students from 6 schools were randomly assigned to receive vouchers with no deadline (i.e., the Control group), and 660 students from 7 schools to receive vouchers with a 30-day deadline (i.e., the Deadline group). The results showed that the voucher-deadline intervention significantly improved the vision-center visiting rate by 13.2 percentage points within 30 days and shortened the interval between visits (i.e., increased timeliness) by 18.7 days. In comparison, the vision-center visiting rate and the interval between visits among the control group were 16.7% and 30.5 days, respectively. However, considering a longer time frame (6 months), we found that intervention only shifted students' utilization to before the voucher expires without improving overall utilization rate. The loss aversion and time pressure induced by the voucher deadline are possible explanations for the treatment effects. This study suggests insights from behavioral economics can enhance the design of public health programs to improve the utilization and the cost-effectiveness of health-service programs. TRIAL REGISTRATION: isrctn.org Identifier ISRCTN03252665.