BMJ  2007;335:317 (18 August), doi:10.1136/bmj.39303.690752.3A

Letters

Payment for treatment adherence

Incentives help vulnerable patients to stay well

The first 150 words of the full text of this article appear below.

In the head to head debate, Shaw says that to pay patients to take medication would create perverse incentives, but in her discussion she dismisses a particularly complex group of patients, with tuberculosis, despite the public health issues involved.^{1 2} This is a group of patients for whom payment, or other forms of incentive, are of critical importance, at both the individual and the public health level. For these patients, health is very low on their list of priorities—they tend to be those suffering from social exclusion, often with histories of offending, substance abuse, mental health problems, and homelessness. They require the most complex care and are least likely to complete treatment, particularly when the course of treatment is lengthy.³

It is common practice in tuberculosis teams to carry out a standard risk assessment with each patient and to offer incentives to those who would be at high risk of non-completion . . . [Full text of this article]

Homerton University Hospital, London E9 6SR

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