Reminders, Cost Sharing, and Healthcare Use

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.

Study Overview

• Status: Completed
• Conditions: Health Behavior; Health Care Utilization; Health Care Seeking Behavior
• Intervention / Treatment: Other: Reminder (information letter)

Detailed Description

This study has two main objectives: (i) to evaluate the effect of an information nudge reminding on the importance of diagnosing and treating health problems and (ii) to evaluate the effect of providing information on the fact that primary care nurse visits have become exempt from co-payments.

• Study Type: Interventional
• Enrollment (Actual): 47398
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Finland
  • Helsinki, Finland, 00271
    • Finnish Institute for Health and Welfare

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 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.

Exclusion Criteria:

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Basic letter; 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); Reminders
Active Comparator: Co-pay; 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); Reminders
Active Comparator: GP-Co-pay; 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); Reminders
No Intervention: Control treatment; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
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 Outcome Measures

Outcome Measure	Time Frame
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

Collaborators and Investigators

• Sponsor: Finnish Institute for Health and Welfare
• Investigators: Principal Investigator: Lauri Sääksvuori, PhD, Finnish Institute for Health and Welfare and University of Turku

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2021
• Primary Completion (Actual): April 1, 2022
• Study Completion (Actual): April 1, 2022

Study Registration Dates

• First Submitted: October 5, 2021
• First Submitted That Met QC Criteria: November 2, 2021
• First Posted (Actual): November 11, 2021

Study Record Updates

• Last Update Posted (Actual): August 26, 2022
• Last Update Submitted That Met QC Criteria: August 23, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: Cost-sharing, primary care, health care utilization
• Other Study ID Numbers: THL/3181/6.02.01/2021

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: This paper uses administrative health records maintained by the Finnish Institute for Health and Welfare. Access to health records is regulated in Finland under the Act on the Secondary Use of Health and Social Data (552/2019). De-identified individual participant data will be shared subject to approval by the competent data protection authority. All statistical code used to organize and analyze the data will be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No