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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Early Prenatal Care.

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Strategy. Patient Financial Incentives for Preventive Care

Approach. Offer financial incentives for pregnant women to attend prenatal visits.

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Overview. Financial incentives such as payments and vouchers are often used to encourage patients to undergo preventive care such as screenings, vaccinations, and other brief interventions. Incentives are often focused on women of low socioeconomic status[1, 2, 3] and high risk individuals such as those who are homeless[3] or use drugs.[4, 5, 6]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of pregnant women who are eligible for and offered financial incentives through Title V partnerships for prenatal visit attendance. (Shows the reach and tailoring of the approach)
  • Number of prenatal visits attended by pregnant women who receive financial incentives through Title V partnerships. (Indicates the utilization and volume of services incentivized by the approach)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of prenatal care providers trained by Title V who consistently document and track the delivery of financial incentives to eligible pregnant women. (Shows the fidelity and accountability of the approach process)
  • Percent of community-based organizations and partners engaged in promoting financial incentives for prenatal visits to eligible pregnant women. (Shows the extent of multi-sector collaboration to support the approach)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of financial incentives for prenatal visits that are delivered in a form and manner that is responsive to the needs and preferences of the population served as a result of training delivered by Title V. (Indicates the contextual appropriateness of the approach)
  • Number of referrals made to supportive services supported by Title V (e.g., transportation, childcare) to help pregnant women overcome barriers to attending incentivized prenatal visits. (Indicates the approach's integration with enabling services)

OUTCOME MEASURES:

  • Number of healthcare dollars saved as a result of improved prenatal care adherence and reduced complications among pregnant women receiving financial incentives through Title V partnerships. (Indicates the approach's cost-effectiveness and return on investment)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of financial incentives for prenatal visits that are designed and implemented with input from pregnant women and community partners. (Shows the level of patient and community engagement in the approach development process)
  • Percent of financial incentive programs for prenatal visits that are evaluated for their impact on health outcomes. (Indicates the approach's focus on reducing differences in health outcomes and addressing upstream factors)

OUTCOME MEASURES:

  • Percent reduction in differences in prenatal care utilization and birth outcomes among pregnant women participating in financial incentive programs through Title V partnerships, compared to baseline or population-level data. (Shows the approach's contribution to advancing health outcomes)
  • Percent of healthcare organizations that successfully sustain and institutionalize financial incentive programs for prenatal visits beyond the initial implementation period. (Indicates the long-term viability and integration of the approach into standard care practices)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Slater 2005 - Slater JS, Henly GA, Ha CN, et al. Effect of direct mail as a population-based strategy to increase mammography use among low-income underinsured women ages 40 to 64 years. Cancer Epidemiology, Biomarkers & Prevention. 2005;14(10):2346-2352.

2 Jepson 2000 - Jepson R, Clegg A, Forbes C, et al. The determinants of screening uptake and interventions for increasing uptake: A systematic review. Health Technology Assessment. 2000;4(14).

3 Giuffrida 1997 - Giuffrida A, Torgerson DJ. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997;315(7110):703-707.

4 Seal 2003 - Seal KH, Kral AH, Lorvick J, et al. A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug and Alcohol Dependence. 2003;71(2):127-131.

5 Malotte 200[1] - Malotte CK, Hollingshead JR, Larro M. Incentives vs outreach workers for latent tuberculosis treatment in drug users. American Journal of Preventive Medicine. 2001;20(2):103-107.

6 Perlman 2003 - Perlman DC, Friedmann P, Horn L, et al. Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange- based tuberculin skin testing. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2003;80(3):428-437.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.