Financial incentives increase uptake and perceived effectiveness of autonomous medical AI, yet patients still seek human reconfirmation.

Abstract

Artificial intelligence (AI) is increasingly used for diagnostic screening. In diabetic retinopathy screening, autonomous AI systems can identify disease without a specialist. However, patient trust in AI remains a challenge, and it remains unknown whether and how financial incentives-commonly used to promote uptake of medical services-can increase patient acceptance of AI-based care. We examined, in a randomized vignette experiment, whether eliminating a copay would increase patients' willingness to choose AI over an eye care professional's (ECP's) exam, and how patients would respond to an AI diagnosis. We conducted a randomized vignette experiment with 248 U.S. adults with type 1 diabetes, recruited online between August and December 2024. Participants were presented with a primary-care vignette in which they were due for annual diabetic eye screening. An autonomous AI tool was available as an alternative to ECP referral. Participants were randomized in a 2×2 design: (1) no copay vs. $50 copay for AI screening; (2) copay waiver sponsored by insurer vs. AI developer. Participants chose between AI or ECP screening, and rated AI effectiveness. Those choosing AI or ECP indicated their willingness to seek a second opinion (from ECP or AI, respectively) after receiving a normal vs. abnormal result. Waiving the copay significantly increased AI selection (81% vs. 43%, p < 0.001); the source of the incentive did not affect choice. No copay also improved perceived AI effectiveness (mean score 3.67 vs. 3.24, p = 0.02). Patients choosing AI (vs. ECP) were far more likely to seek reconfirmation after abnormal (mean 6.69 vs. 2.41) or even normal (3.43 vs. 2.47) results (both p < 0.001). Eliminating cost barriers increases participants' willingness to opt for AI-based screening, but they still seek human reconfirmation. Incentives can promote AI adoption, but integration strategies must address persistent preferences for ECP reconfirmation-even when AI results are normal.