Researchers: Amnon Lahad¹, Amir Shmueli¹

Background: The prevalence of diabetes mellitus is increasing in Israel and worldwide. According to the National Diabetes Registry, 19% of diabetic patients in Israel in 2019 did not achieve glycemic control. Financial incentives for patients are being studied and applied increasingly in healthcare settings.
The effectiveness of monetary benefits on medication adherence in chronic patients with hyperlipidemia and diabetes was studied in four RCTs. However, only one study found an improvement in a group of where incentives were shared by physicians and patients.

Objectives: The purpose of this study is to examine the effect of a conditional reduction in medication cost on HbA1c levels, compared to standard copayment.

Method: Uncontrolled type 2 diabetic patients were recruited from low socioeconomic neighborhoods. Participants (n=186) were randomly assigned into an intervention group, in which they were offered a discount in drug expenses if they improve their HbA1c, and a standard treatment group.

Findings: Sixty-seven per cent of the participants were men, average age was 58, and average HbA1c at baseline was 9.1 mg%. The average HbA1c reduction in the intervention group was 1.5 mg%, and 0.9 mg% in the control group. Multivariate linear regression demonstrated a significant difference in HbA1c reduction between the intervention group and the control group (P=0.012). intention-to-treat analysis showed similar results (P=0.001).

Conclusions: Financial incentives improve health outcomes and diabetic control in low socioeconomic populations.

Recommendations: The new drugs for diabetes are purchased as part of the supplemental health insurance. Their cost could be a burden on the patient and a barrier to treatment. Incentives require recipients to undergo regular testing, while encouraging a better adaptation of treatment to achieve the goal. Incentives can be integrated into the Israeli health system as optional programs for chronic patients, which would benefit both patients and society.

Research end date: 05/2023