Changing behavior is difficult

On Tuesday, I posted on how removing cost sharing for primary care didn’t seem to increase its use. I theorized that cost-sharing may be an effective stick, but not an effective carrot. Yesterday, I saw an article which added some weight to that belief:

Give people free prescription drugs and many of them still won’t bother to take their medicine.

Doctors were stunned to see that happen in a major study involving heart attack survivors. The patients were offered well-established drugs to prevent a recurrence of heart trouble, including cholesterol-lowering statins and medicines that slow the heart and help it pump more effectively.

“My God, we gave these people the medicines for free and only half took it,” said one of the study’s authors, Dr. Elliott Antman of Harvard-affiliated Brigham and Women’s Hospital in Boston.

In fact, the researchers couldn’t even give the stuff away: They had trouble just signing up patients to take part in the study.

It’s very hard to get people to do what we want. For that reason, I’ve argued that putting cost barriers in the way of care we want patients to get is not such a good idea. Especially in light of the fact that people regularly report cost as a reason they don’t take medications they need. But we shouldn’t lose sight of the fact that cost isn’t the only reason that patients don’t do the right thing:

The study enrolled 5,855 Aetna members who had a drug plan as part of their benefits and were going home from the hospital after a heart attack. They were 53 years old on average, and three-fourths were men.

The researchers had hoped to recruit 7,500 patients but scaled back when so few signed on.

Preventive medicines were offered free to 2,845 patients and prescribed with the usual copayments for the rest. Copays for these drugs run around $50 a month.

Roughly a year later, the share of patients who filled their prescriptions ranged from 36 percent to 49 percent in the copay group, depending on the drug, and was only 4 to 6 percentage points higher in the group that had no copays.

The difference wasn’t statistically significant. I’m not sure it would even be clinically significant. As noted above, half of patients still weren’t taking their medications even when they were free. We need to do better.

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