Latest edition of "You can't make this stuff up"

[Ursa Majoris]

Apparently there are programs now that pay people to take their medications.

 

Will bribes get people to take meds?

 

A large share of patients never fill prescriptions or don't take their medicine properly.

 

It has long been one of the most vexing causes of America's skyrocketing health costs: people not taking their medicine.

 

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion in health costs annually because those patients often get sicker.

 

Now, a controversial, and seemingly counterintuitive, effort to tackle the problem is gaining ground: paying people money to take medicine or to comply with prescribed treatment. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives can save much larger costs of hospitalization.

 

"It's better to spend money on medication adherence for patients, rather than having them boomerang in and out of the hospital," said Valerie Fleishman, executive director of the New England Healthcare Institute, a research organization. Fleishman said about one-tenth of hospital admissions and one-quarter of nursing home admissions result from incorrect adherence to medication. "Financial incentives are a critical piece of the solution."

 

In a Philadelphia program people prescribed warfarin, an anti-blood clot medication, can win $10 or $100 each day they take the drug: a kind of lottery using a computerized pillbox to record if they took the medicine and whether they won that day.

 

Before the program, Chiquita Parker, a 25-year-old single mother with lupus, too ill to continue her job with special-needs children, repeatedly made medication mistakes, although she knows she depends on warfarin to prevent clots than can cause strokes, paralysis or death.

 

"I would forget to take it," and feel "like I couldn't breathe," she said. Or she would "take two in a day," and develop bruises from uncontrolled internal bleeding.

 

But in the six-month lottery program, she pocketed about $300. "You got something for taking it," Parker said. Suddenly, "I was taking it regularly, I was doing so good."

 

Skeptics question if payments can be coercive or harm doctor-patient relationships. "Why should people who don't want to take medication be paid, when prudent people who take medication are not?" said Dr. George Szmukler, a psychiatry professor at King's College London.

 

Joanne Shaw, who runs a department of Britain's National Health Service, asked: "Will others think, 'If I behave like a potential noncomplier, I'll get money for taking medication?' And once you start paying people to take medication, when do you stop paying them?"

 

Health experts wonder if people will realize their health has improved and maintain medication without money. Or must payments be continued indefinitely, even increased?

 

Still, with patients forgetting medication, finding it inconvenient, fearing side effects or considering it unnecessary if they feel better, important players are turning to financial rewards. Aetna, the insurer, helped pay for part of the Philadelphia experiment, and is considering using that or another method.

 

"We've made our best efforts to say, 'If you didn't take your beta blocker or asthma medicine, you have a greater chance of ending up with a heart attack or dead or hospitalized,'" said Dr. Lonny Reisman, Aetna's chief medical officer. "It's going to take more. It's going to take incentives."

 

Aetna has begun paying doctors bonuses for prescribing medication likely to prevent problems: beta blockers to prevent heart attacks, statins for diabetes sufferers. Currently, 93,000 doctors are in Aetna's "pay for performance" program; bonuses average 3 to 5 percent of a practice's base income.

 

CVS Caremark began by discounting copayments for employees of some corporations in its drug plans to encourage prescription filling and is studying "the 'I'll-pay-you-$10-a-month-to-be-adherent' approach, the lottery approach," and other incentives, said Dr. Troy Brennan, its chief medical officer.

 

[Ursa Majoris]

Big John, please alter title to "edition". Thanks.

[SEC=UGA]

Big John, please alter title to "edition". Thanks.

 

Forget yer meds today?

 

Chiquita sounds like one sharp cookie. She has, from what I gather, 1 med to take and continually forgets to take it. It is even a med without which she suffers seemingly severe symptoms from her lupus... To top it off, she once worked with special needs kids. Just what we need, a person too forgetful to take her meds looking after mentally challenged people (BJ, how would you cope with us if you forgot to take your meds?) But, fortunately, due to her disability she is no longer capable of working with the mentally challenged, or even capable, apparently of holding down any job. So, she currently has about four things to remember per day: Take Pill, Breathe, Eat, and Poop, sounds like a tough schedule, no wonder she forgets her meds.

 

ETA: Christ, I missed the part about her having a child on the first read. Can DFACS go and get custody of that kid, it doesn't have a chance.

Edited June 15, 2010 by SEC=UGA