Minimizing the Impact of Cardiovascular Disease: The Importance of Financial Incentives in Driving Secondary Prevention

BACKGROUND: Because Cardiovascular Disease (CVD) is the leading cause of mortality and morbidity globally and has a sizeable burden on health expenditures, healthcare systems have taken actions to prevent CVD onset (primary prevention). Among the different policies to promote CVD prevention, the impact of financial incentives has been less studied, although they can deliver important benefits, especially in individuals with established CVD (secondary prevention).

OBJECTIVES: This research analyses how recommendations from international organisations to improve secondary prevention of CVD have been translated into national financial incentives in different countries, assesses the impact of the different incentives, and identifies best practices for their design and implementation.

METHODS: A systematic literature review identified financial incentives for CVD secondary prevention implemented across five countries representing different healthcare systems and regions: Australia, Brazil, Canada, China, and Japan. Incentives were reviewed individually across research questions related to the design and implementation, evaluation and monitoring, and impact of stakeholders. A cross-country set of evaluation criteria was applied to each incentive to identify possible best practices in each country.

RESULTS: Across the incentives reviewed, a subset of incentives have demonstrated a higher impact on addressing risk factors and preventing CVD, although some risk factors are more consistently addressed than others. Across countries, more incentives have successfully targeted diabetes and hypertension, with less prioritisation for other risk factors (such as obesity and hypercholesterolemia) where new treatment options have been introduced more recently. Furthermore, while healthcare practitioners (HCPs) are the most frequently targeted recipients, positive outcomes have also been observed in incentives targeting patients.

CONCLUSIONS: While healthcare contexts need to be accounted for, we have identified best practices that offer global lessons for the design and implementation of CVD prevention incentives.