Vouchers tied to blood sugar targets improve diabetes outcomes, Israeli study finds
Baku, February 4, AZERTAC
An Israeli study suggests that financial incentives tied to health outcomes could dramatically improve diabetes management among low-income patients, according to TPS-IL. Researchers found that offering vouchers to offset medication costs, conditional on improved blood sugar levels, led to results comparable to adding a new drug to a patient’s regimen.
Managing Type 2 diabetes is a daily challenge that can include strict dietary and exercise regimens, along with complex medication schedules. For patients facing financial hardship, these costs can become barriers to care, leading some to skip doses or delay refills.
According to the International Diabetes Federation, more than 500 million people worldwide have Type 2 diabetes. The organization estimates that by 2045, over 700 million adults could have diabetes if trends in aging populations, sedentary lifestyles, poor diet, and obesity continue. Type 2 diabetes is a major driver of complications like heart disease, kidney failure, blindness, and amputations.
The study, conducted by the Jerusalem District of Clalit Health Services and the Hebrew University of Jerusalem, involved a multidisciplinary team including 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 researchers explored whether socioeconomically disadvantaged patients could achieve better glycemic control if the financial burden of treatment was reduced in exchange for measurable health improvements.
According to the findings — published in the peer-reviewed Annals of Family Medicine — roughly 27% of diabetes patients in Israel fail to reach their glycemic targets, with disparities most pronounced among lower-income groups, where one-fifth of patients report forgoing medications due to cost.
To test their approach, the team conducted a randomized controlled trial with 186 patients in lower-income neighborhoods of Jerusalem. Participants were divided into a control group that paid standard copayments and an intervention group offered vouchers covering up to NIS 600 ($194) in medication costs, contingent on improved HbA1c levels. HbA1c, also called glycated hemoglobin, is a blood test that measures a person’s average blood sugar levels over the past two to three months. It reflects how much glucose has attached to hemoglobin, the protein in red blood cells that carries oxygen.
After six months, patients receiving the financial incentives experienced an average 1.4% drop in HbA1c, compared with a 0.7% decrease in the control group. While seemingly modest, the difference is clinically significant and aligns with the effects of pharmacologic interventions, the study noted. Crucially, the improvement stemmed not from more intensive treatment or costlier drugs but from better adherence, persistence, and sustained disease management.
“The study illustrates the connection between quality medicine and social justice,” said Lahad, lead researcher at the Jerusalem District of Clalit Health Services and the Hebrew University Faculty of Medicine. “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.”
Prigozin-Mozenzon, a doctoral student involved in 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.”
The researchers emphasized that financial incentives need not be large to be effective. In this trial, vouchers were designed to cover the cost of one or two medications per month, offering immediate and tangible reinforcement for patients’ efforts rather than relying solely on the distant promise of improved health.
The study suggests that health plans could integrate performance-based incentives as an optional tool to improve outcomes and equity. While not a replacement for medical care, the approach demonstrates a practical strategy to reduce persistent health disparities and empower patients in disadvantaged communities to take control of their diabetes management.
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