title: Should young people be paid for getting tested? A national comparative study to evaluate patient financial incentives for chlamydia screening.
abstract: BACKGROUND
  Patient financial incentives ("incentives") have been widely used to promote chlamydia screening uptake amongst 15-24 year olds in England, but there is scarce evidence of their effectiveness. The objectives of the study were to describe incentives used to promote chlamydia screening in Primary Care Trusts (PCTs) in England and to evaluate their impact on coverage and positivity rate.
  
  
  METHODS
  PCTs that had used incentives between 1/1/2007 and 30/6/2009 (exposed) were matched by socio-demographic profile and initial screening coverage with PCTs that had not (unexposed). For each PCT, percentage point change in chlamydia screening coverage and positivity for the period before and during the incentive was calculated. Differences in average change of coverage and positivity rate between exposed and unexposed PCTs were compared using linear regression to adjust for matching and potential confounders.
  
  
  RESULTS
  Incentives had a significant effect in increasing average coverage in exposed PCTs (0.43%, CI 0.04%-0.82%). The effect for voucher schemes (2.35%) was larger than for prize draws (0.16%). The difference was greater in females (0.73%) than males (0.14%). The effect on positivity rates was not significant (0.07%, CI -1.53% to 1.67%).
  
  
  CONCLUSIONS
  Vouchers, but not prize draws, led to a small absolute but large relative increase in chlamydia screening coverage. Incentives increased coverage more in females than males but had no impact on reported positivity rates. These findings support recommendations not to use prize draws to promote chlamydia screening and contribute to the evidence base of the operational effectiveness of using patient incentives in encouraging public health action.
authors.affiliation: Health Protection Agency, Centre for Infections, London, UK. dominik.zenner@hpa.org.uk
authors.forename: Dominik
authors.initials: D
authors.lastname: Zenner
authors.forename: Darko
authors.initials: D
authors.lastname: Molinar
authors.forename: Tom
authors.initials: T
authors.lastname: Nichols
authors.forename: Johanna
authors.initials: J
authors.lastname: Riha
authors.forename: Mary
authors.initials: M
authors.lastname: Macintosh
authors.forename: Anthony
authors.initials: A
authors.lastname: Nardone
mesh_terms: D000293:Adolescent; D001363:Awards and Prizes; D002690:Chlamydia Infections / Q000175:diagnosis*; D004739:England; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology* / Q000706:statistics & numerical data* / Q000639:trends; D009042:Motivation; D009313:National Health Programs; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012052:Reimbursement, Incentive / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult