title: "All the money in the world …" patient perspectives regarding the influence of financial incentives.
abstract: OBJECTIVE
  To analyze patient perspectives of the use of financial incentives in a hypertension intervention. Study Setting. Twelve Veterans Affairs primary care clinics over a 9-month period.
  
  
  METHODS
  Qualitative semistructured interviews conducted with 54 hypertensive veterans participating in an intervention to promote guideline-consistent therapy. Intervention components included an intervention letter requesting patients talk with their providers, an offer of U.S.$20 to bring in the letter to their provider, and a health educator phone call.
  
  
  METHODS
  Semistructured interviews were conducted. Transcripts were coded for thematic content. The financial incentive theme was then subcoded for more detailed analysis.
  
  
  RESULTS
  Most participants (n=48; 88.9 percent) stated the incentive had (or would have) no effect on their decision to initiate a discussion with their provider. Some participants articulated reservations about the effectiveness and/or appropriateness of financial incentives in health care decisions; however, a few expressed the opinion that there may be some potential benefits to the use of financial incentives if they encourage patients to be active in their health care.
  
  
  CONCLUSIONS
  The findings of this study raise questions about the appropriateness and unintended consequences of employing patient-directed financial incentives in health care settings.
authors.affiliation: The Center for Comprehensive Access and Delivery Research and Evaluation-CADRE, the Iowa City VA Medical Center, Iowa City, IA, USA. heather.reisinger@va.gov
authors.forename: Heather Schacht
authors.initials: HS
authors.lastname: Reisinger
authors.forename: Rachel Horner
authors.initials: RH
authors.lastname: Brackett
authors.forename: Colin D
authors.initials: CD
authors.lastname: Buzza
authors.forename: Monica B Williams
authors.initials: MB
authors.lastname: Páez
authors.forename: Ryan
authors.initials: R
authors.lastname: Gourley
authors.forename: Mark W Vander
authors.initials: MW
authors.lastname: Weg
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Christensen
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kaboli
mesh_terms: D000368:Aged; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006293:Health Promotion / Q000379:methods; D006302:Health Services Research; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010465:Perception; D011320:Primary Health Care / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D004232:Diuretics