For Forgetful, Cash Helps the Medicine Go Down

(New York Times) It has long been one of the most vexing causes of America’s skyrocketing health costs: people not taking their medicine.

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker.

Now, a controversial, and seemingly counterintuitive, effort to tackle the problem is gaining ground: paying people money to take medicine or to comply with prescribed treatment. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization.

“It’s better to spend money on medication adherence for patients, rather than having them boomerang in and out of the hospital,” said Valerie Fleishman, executive director of the New England Healthcare Institute, a research organization, who said that about one-tenth of hospital admissions and one-quarter of nursing home admissions result from incorrect adherence to medication. “Financial incentives are a critical piece of the solution.”

In a Philadelphia program people prescribed warfarin, an anti-blood-clot medication, can win $10 or $100 each day they take the drug — a kind of lottery using a computerized pillbox to record if they took the medicine and whether they won that day.

Before the program, Chiquita Parker, a 25-year-old single mother with lupus, too ill to continue her job with special needs children, repeatedly made medication mistakes, although she knows she depends on warfarin to prevent clots than can cause strokes, paralysis, or death.

“I would forget to take it,” and feel “like I couldn’t breathe,” she said. Or she would “take two in a day,” and develop bruises from uncontrolled internal bleeding.

But in the six-month lottery program, she pocketed about $300. “You got something for taking it,” Ms. Parker said. Suddenly, she said, “I was taking it regularly, I was doing so good.”

Skeptics question if payments can be coercive or harm doctor-patient relationships. “Why should people who don’t want to take medication be paid, when prudent people who take medication are not?” said Dr. George Szmukler, a psychiatry professor at King’s College London.

Joanne Shaw, who runs a department of Britain’s National Health Service, asked: “Will others think, ‘If I behave like a potential noncomplier, I’ll get money for taking medication?’ And once you start paying people to take medication, when do you stop paying them?”

Health experts wonder if people will realize their health has improved and maintain medication without money. Or must payments be continued indefinitely, even increased?

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