Working Paper: NBER ID: w24100
Authors: Cathy J. Bradley; David Neumark; Lauryn Saxe Walker
Abstract: We conducted a randomized controlled trial, enrolling low-income uninsured adults in Virginia (United States), to determine whether cash incentives are effective at encouraging a primary care provider (PCP) visit, and at lowering utilization and costs. Subjects were randomized to four groups: untreated controls, and one of three incentive arms with incentives of $0, $25, or $50 for visiting a PCP within six months of group assignment. We used the exogenous variation generated by the experiment to obtain causal evidence on the effects of a PCP visit. We observed modest reductions in non-urgent emergency department use and increased outpatient use, but no reductions in overall costs. These findings in utilization are consistent with the expectation that PCPs offer an alternative to the emergency department for non-emergent conditions. Total costs did not decline because any savings from avoiding the emergency department were offset by increased outpatient utilization.
Keywords: primary care; health care utilization; cash incentives; randomized controlled trial
JEL Codes: I12; I14; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Increased outpatient visits (I11) | Higher overall costs (H59) |
| Increased likelihood of PCP visits (I11) | Decreased non-emergent ED visits (I19) |
| Cash incentives (M52) | Increased likelihood of PCP visits (I11) |
| Increased likelihood of PCP visits (I11) | Increased outpatient visits (I11) |