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The effect of primary care visits on other health care utilization: A randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia

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  • Bradley, Cathy J.
  • Neumark, David
  • Walker, Lauryn Saxe

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 visits and increased outpatient visits, 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.

Suggested Citation

  • Bradley, Cathy J. & Neumark, David & Walker, Lauryn Saxe, 2018. "The effect of primary care visits on other health care utilization: A randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia," Journal of Health Economics, Elsevier, vol. 62(C), pages 121-133.
  • Handle: RePEc:eee:jhecon:v:62:y:2018:i:c:p:121-133
    DOI: 10.1016/j.jhealeco.2018.07.006
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    References listed on IDEAS

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    Cited by:

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    2. Shooshan Danagoulian & Daniel Grossman & David Slusky, 2022. "Health Care Following Environmental Disasters: Evidence from Flint," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 41(4), pages 1060-1089, September.
    3. Amy Rosenwohl-Mack & Darin Smith & Meredith Greene & Karyn Skultety & Madeline Deutsch & Leslie Dubbin & Jason D. Flatt, 2022. "Building H.O.U.S.E (Healthy Outcomes Using a Supportive Environment): Exploring the Role of Affordable and Inclusive Housing for LGBTQIA+ Older Adults," IJERPH, MDPI, vol. 19(3), pages 1-15, February.
    4. Yiwei Chen & Hui Ding & Min Yu & Jieming Zhong & Ruying Hu & Xiangyu Chen & Chunmei Wang & Kaixu Xie & Karen Eggleston, 2019. "The Effects of Primary Care Chronic-Disease Management in Rural China," NBER Working Papers 26100, National Bureau of Economic Research, Inc.
    5. Bradley, Cathy J. & Saunders, Heather G., 2020. "Impact of cash incentives for low-income individuals to seek a primary care visit on mental health outcomes: Evidence from a randomized controlled trial," Social Science & Medicine, Elsevier, vol. 265(C).
    6. Milovanska-Farrington, Stefani & Farrington, Stephen, 2019. "The effect of the cost of obstetric care on antenatal and postnatal healthcare utilization: Evidence from Armenia," Research in Economics, Elsevier, vol. 73(1), pages 72-84.

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    More about this item

    Keywords

    Cash incentives; Primary care utilization; Safety net;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

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