title: Testing novel patient financial incentives to increase breast cancer screening.
abstract: OBJECTIVE
  To examine the effects of 3 types of low-cost financial incentives for patients, including a novel "person-centered" approach on breast cancer screening (mammogram) rates.
  
  
  METHODS
  Randomized controlled trial with 4 arms: 3 types of financial incentives ($15 gift card, entry into lottery for $250 gift card, and a person-centered incentive with choice of $15 gift card or lottery) and a control group. Sample included privately insured Tufts Health Plan members in Massachusetts who were women aged 42 to 69 years with no mammogram claim in ≥ 2.6 years.
  
  
  METHODS
  A sample of 4700 eligible members were randomized to 4 study arms. The control group received a standard reminder letter and the incentive groups received a reminder letter plus an incentive offer for obtaining a mammogram within the next 4 months. Bivariate tests and multivariate logistic regression were used to assess the incentives' impact on mammogram receipt. Data were analyzed for 4427 members (after exclusions such as undeliverable mail).
  
  
  RESULTS
  The percent of members receiving a mammogram during the study was 11.7% (gift card), 12.1% (lottery), 13.4% (person-centered/choice), and 11.9% (controls). Differences were not statistically significant in bivariate or multivariate full-sample analyses. In exploratory subgroup analyses of members with a mammogram during the most recent year prior to the study-defined gap, person-centered incentives were associated with a higher likelihood of mammogram receipt.
  
  
  CONCLUSIONS
  None of the low-cost incentives tested had a statistically significant effect on mammogram rates in the full sample. Exploratory findings for members who were more recently screened suggest that they may be more responsive to person-centered incentives.
authors.forename: Elizabeth Levy
authors.initials: EL
authors.lastname: Merrick
authors.affiliation: Brandeis University, Institute for Behavioral Health, Heller School for Social Policy and Management, 415 South St, Mailstop 035, Waltham, MA 02454-9110. E-mail: hodgkin@brandeis.edu.
authors.forename: Dominic
authors.initials: D
authors.lastname: Hodgkin
authors.forename: Constance M
authors.initials: CM
authors.lastname: Horgan
authors.forename: Laura S
authors.initials: LS
authors.lastname: Lorenz
authors.forename: Lee
authors.initials: L
authors.lastname: Panas
authors.forename: Grant A
authors.initials: GA
authors.lastname: Ritter
authors.forename: Paul
authors.initials: P
authors.lastname: Kasuba
authors.forename: Debra
authors.initials: D
authors.lastname: Poskanzer
authors.forename: Renee Altman
authors.initials: RA
authors.lastname: Nefussy
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*