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In Sickness and In Health : Motivating Improved Healthcare Using Holistic Patient Contracts
This paper examines the impacts of family doctors writing an explicit “care contract” with at-risk patients for increased holistic primary care. The intervention was designed to shift the care relationship between the two parties away from episodic curative care and towards a holistic plan for patient welfare. The experiment tracked healthcare utilization, diagnosis, prescription, hospitalization, and mortality outcomes through the universe of patient records. The program caused increased screening, diagnosis and treatment of chronic health issues among enrolled patients by about 10% across these categories, with suggestive evidence that hospitalization declined by 8%. Among ‘mild-risk’ patients, the treatment group experienced annual reductions in all-cause mortality of 20%, in an analysis pre-specified as exploratory.
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