Reminders, Cost Sharing, and Healthcare Use

NCT05117333 | Completed

• 1 other identifier: THL/3181/6.02.01/2021
• Study Type: interventional
• Target: 47,398
• Locations: 1 country
• Sites: 1

Brief Summary

The investigators conduct a large-scale randomized controlled trial in Finland by sending three types of information letters to households to examine whether the reminder letters affect healthcare use. All letters remind of the importance of seeking care to treat potential health problems. This study has two primary objectives are: to evaluate the effects of an information nudge reminding on the importance of diagnosing and treating health problems and to evaluate the effects of additionally providing information on the fact that primary care nurse visits have become exempt from copayments. Main outcomes include the number of primary care nurse visits and general practitioner (GP) visits in a six-month follow-up.

Conditions

Health Care Utilization; Health Care Seeking Behavior; Health Behavior

Keywords

Cost-sharing, primary care, health care utilization

Outcome Measures

Primary Outcomes (2)

• Number of nurse visits (as recorded in the Finnish National Register of Primary Health Care Visits)

  Six months starting from the date the letters are sent

• Number of doctor visits (as recorded in the Finnish National Register of Primary Health Care Visits)

  Six months starting from the date the letters are sent

Secondary Outcomes (2)

• Number of referrals to specialized care (as recorded in the Finnish National Register of Primary Health Care Visits)

  Six months starting from the date the letters are sent

• Number of drug prescriptions for newly initiated therapies (as recorded in the Finnish national register for prescribed medicines)

  Six months starting from the date the letters are sent

Study Arms (4)

Basic letter

ACTIVE COMPARATOR

This reminder states that if healthcare is not consumed at the right time, health may deteriorate and diagnoses and treatment may be delayed.

Other: Reminder (information letter)

Co-pay

ACTIVE COMPARATOR

This reminder states that if healthcare is not consumed at the right time, health may deteriorate and diagnoses and treatment may be delayed AND informs recipients about a new law that abolished all co-payments for all primary care nurse visits in Finland.

Other: Reminder (information letter)

GP-Co-pay

ACTIVE COMPARATOR

This reminder states that if healthcare is not consumed at the right time, health may deteriorate and diagnoses and treatment may be delayed AND informs recipients about a new law that abolished all co-payments for all primary care nurse visits in Finland, AND informs recipients that the new law did not abolish co-payments related to general practitioner visits.

Other: Reminder (information letter)

Control treatment

NO INTERVENTION

There is no intervention in the control treatment. The entire population aged 55 and above in the treatment regions will serve as a control group.

Interventions

Reminder (information letter) OTHER

Reminders

Basic letter; Co-pay; GP-Co-pay

Eligibility Criteria

• Age: 55 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Residency in one of the 25 target municipalities as of September 15, 2021.
• Born in 1966 or earlier (aged 55 or more at the end of 2021).
• Living in a household with a maximum of three individuals aged 55 or above.

You may not qualify if:

• Individuals living in households (postal address) with more than three individuals aged 55 and above.

Sponsors & Collaborators

• Finnish Institute for Health and Welfare: lead

Study Sites (1)

Finnish Institute for Health and Welfare

Helsinki, 00271, Finland

Location

MeSH Terms

Conditions

Patient Acceptance of Health Care; Health Behavior

Condition Hierarchy (Ancestors)

Treatment Adherence and Compliance; Behavior

Study Officials

• Lauri Sääksvuori, PhD

  Finnish Institute for Health and Welfare and University of Turku

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR
• Masking Details: This is a randomized experiment in which individuals receive different types of reminders. All outcome variables are based on administrative (secondary) data. Individuals receiving letters and care providers are not aware of the experiment. Investigators will not have any contact with the participants.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate professor

Model Details: This is a randomized controlled trial with three active treatment arms and a control group (not assigned to any treatment, information and services as usual).

Study Record Dates

• First Submitted: October 5, 2021
• First Posted: November 11, 2021
• Study Start: October 1, 2021
• Primary Completion: April 1, 2022
• Study Completion: April 1, 2022
• Last Updated: August 26, 2022

Record last verified: 2022-08

Data Sharing

• IPD Sharing: Will not share

Locations

FI (1)