Intended for healthcare professionals


Should we pay the patient? Review of financial incentives to enhance patient compliance

BMJ 1997; 315 doi: (Published 20 September 1997) Cite this as: BMJ 1997;315:703
  1. Antonio Giuffrida, research fellowa (agia{at},
  2. David J Torgerson, research fellowa
  1. a National Primary Care Research and Development Centre, Centre for Health Economics, University of York, York YO1 5DD
  1. Correspondence to: Mr Giuffrida
  • Accepted 28 May 1997


Objective: To determine whether financial incentives increase patients' compliance with healthcare treatments.

Data sources: Systematic literature review of computer databases—Medline, Embase, PsychLit, EconLit, and the Cochrane Database of Clinical Trials. In addition, the reference list of each retrieved article was reviewed and relevant citations retrieved.

Study selection: Only randomised trials with quantitative data concerning the effect of financial incentives (cash, vouchers, lottery tickets, or gifts) on compliance with medication, medical advice, or medical appointments were included in the review. Eleven papers were identified as meeting the selection criteria.

Data extraction: Data on study populations, interventions, and outcomes were extracted and analysed using odds ratios and the number of patients needed to be treated to improve compliance by one patient.

Results: 10 of the 11 studies showed improvements in patient compliance with the use of financial incentives.

Conclusions: Financial incentives can improve patient compliance.

Key messages

Key messages

  • Non-compliance with medical treatment is a widespread problem

  • Non-compliance may lead to increased treatment costs in future

  • Financial incentives can significantly reduce non-compliance

  • Incentives can be cost effective, particularly for treatment of infectious disease

  • Research in the context of the United Kingdom is required

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