P4P for Patients (P4P4P)


Many people have argued that if we provide incentives for clinicians to make people healthy, why not provide incentives to patients to live healthier lifestyles? Large corporations have tried this with weight loss, smoking cessation, and depression, among other things, with mixed results. Many have mixed feelings regarding the efficacy of such proposals. Possibly the most frequent citation of adverse effects of P4P4P is non-smokers starting to smoke, so they can take advantage of smoking cessation benefits. Little research is available regarding this relatively new concept (286), but Volpp (301) writes that P4P4P has the ability to affect health at the population level.


P4P for Patients (P4P4P) Literature

Key Articles: 408

(286) Long JA, Helweg-Larsen M, Volpp KG. Patient Opinions Regarding ‘Pay for Performance for Patients'. Journal of General Internal Medicine. 2008: 23(10) 1647-1652.

PMID: 18663540


  • Survey of patient opinions of P4P for patients (P4P4P) programs. For example, offering positive financial incentives for smoking cessation, or charging smokers a higher premium for health insurance.
  • 53% of patients surveryed agreed or strongly agreed that people should not be paid to do things they should do anyway.
  • 36-42% thought it was a good/excellent idea, 41-44% thought it was a bad/very bad idea.

Significance to Literature:

Patient acceptance of P4P4P is not well established. More research is needed to establish benefits and burdens of P4P4P.


(301) Volpp KG, Pauly MV, Loewenstein G, Bansberg D. P4P4P: An Agenda For Research On Pay-For-Performance For Patients. Health Affairs. 2009: 28(1) 206-214.

PMID:  19124872


  • Article discusses the idea of paying patients for behavior outside of the clinic.
  • Lists programs already using patient P4P, and possible other incentive programs that could be tried.
  • Explains five primary reasons why there is not currently more patient P4P programs.

Significance to Literature:

Patient P4P is a relatively new concept that has potential to affect population health.


Key Article

(408) Asch et al. Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial. JAMA. 2015 Nov 10;314(18):1926-35. doi: 10.1001/jama.2015.14850.

PMID: 26547464


  • Multicenter cluster randomized clinical trial comparing the effect of physician financial incentives, patient financial incentives, shared physician and patient incentives, and no incentives on reducing levels of low-density lipoprotein cholesterol (LDL-C) in high cardiovascular risk patients
  • Patients were deemed eligible based on Framingham-Risk Scores, LDL-C levels, and presence of coronary artery disease
  • Primary care physicians and patients were randomly assigned to each group. Physicians were each eligible to receive up to $1024 annually per patient and patients could receive up to the same amount via entrance into daily lotteries based on medication adherence
  • Only patients in the shared physician/patient incentive group achieved significantly reduced LDL-C levels compared to the control group after 12-month intervention
  • Shared incentive average was 126.4 mg/dl compared to 136.4 mg/dl in the control group

Significance to Literature:

Promising evidence for physician and patient shared incentives in P4P primary schemes and an indication for further research