A new study examined whether providing financial vouchers to offset medication costs, conditional on improved blood sugar levels, could enhance glycemic control. The results demonstrated that participants receiving these performance-based incentives achieved a significantly larger reduction in HbA1c levels compared to a control group, an improvement clinically comparable to adding a new pharmacological treatment. Based on these findings, the authors conclude that incorporating financial incentives into health insurance plans could serve as an effective, optional tool to improve health outcomes and equity for low-income populations.

Managing Type 2 diabetes is a demanding daily task involving diet, exercise, and often a complex regimen of medications. For patients facing financial hardship, the cost of these life-saving drugs can become a barrier to health, leading many to skip doses or delay refills.

The study was conducted under the leadership of researchers from the Jerusalem District of Clalit Health Services and the Hebrew University of Jerusalem, and included a multidisciplinary team: Dr. Ayelet Prigozin- Mozenzon, Prof. Matan Cohen, Prof. Ofri Mosenzon, Hila Mendelovich, Ahlam Natsheh, Prof. Amir Shmueli, Dr. Anat Tsur, and Prof. Amnon Lahad. The findings suggest that a creative solution, tying medication discounts to measurable health outcomes, could be a key to better diabetes management.

Published in Annals of Family Medicine, the study explores whether offering conditional financial incentives to socioeconomically disadvantaged patients can improve blood sugar control. The results indicate that relieving the financial burden of treatment, when linked to health improvements, yields clinical benefits comparable to prescribing additional pharmaceutical drugs.

The Cost of Health
Despite the availability of effective treatments, approximately 27% of diabetes patients in Israel do not reach their glycemic control goals. This gap is widest in lower socioeconomic strata, where one-fifth of patients report forgoing medication due to high costs.

To address this disparity, the researchers conducted a randomized controlled trial involving 186 patients with uncontrolled Type 2 diabetes living in lower-income neighborhoods in the Jerusalem area. Participants were divided into two groups: a control group that paid the standard medication copayment, and an intervention group offered a unique incentive.

Patients in the intervention group received vouchers to cover medication costs — up to 600 New Israeli Shekels (approximately $156) — conditional on demonstrating improvement in their HbA1c levels. The control group continued with the usual payment structure without an incentive.

Significant Clinical Improvements

The results were distinct. After six months, patients eligible for the financial incentives saw their HbA1c levels drop by an average of 1.4%, compared to a 0.7% drop in the control group.

While a 0.7% difference between groups might sound small to a layperson, in diabetes management it is clinically substantial. The study authors note that this reduction aligns closely with the effect of pharmacologic therapies, such as adding a new class of medication to a patient’s regimen.

Importantly, the researchers emphasize that the improvement was not due to more intensive drug treatment or the use of more expensive medications, but rather to better patient adherence, persistence, and long-term ability to manage the disease.

A Simple Solution for Complex Problems

The study highlights that financial incentives do not need to be massive to be effective, provided they are meaningful and directly connected to patients’ healthcare needs. The vouchers were designed to cover the cost of one or two medications per month, making the benefit tangible and achievable.

The researchers suggest this approach works by framing healthy behavior as less burdensome and costly, offering an immediate reinforcement rather than only the distant promise of better health in the future.

Financial incentives have the potential to enhance diabetes control in populations with low socioeconomic status and could be integrated into health plans as an optional program.

Moving Forward

The research team emphasizes that while financial incentives are a powerful tool, they should be viewed as complementary to optimal medical care rather than a stand-alone measure. For health providers looking to close persistent gaps in health disparities, this model offers a practical path forward.

Prof. Amnon Lahad, lead researcher at the Jerusalem District of Clalit Health Services and the Faculty of Medicine at the Hebrew University, said: “This study illustrates the connection between quality medicine and social justice. At Clalit Jerusalem District, we work every day to reduce health disparities, and these data show that smart incentives can be part of the solution — not instead of medical treatment, but as a complement that strengthens it.”

Dr. Ayelet Prigozin- Mozenzon, a doctoral student on the study, added: “Equality also means equality of opportunity. The study showed that when an incentive is adapted to a patient's real need, it functions as more than just a financial boost—it can lead to better and more significant results”