Experiments in a community mental health center: increasing client payments for outpatient services.

The team tested a new payment rule at a community mental health center.

Clients had to pay cash for the first three visits. After that, they got a monthly bill.

The researchers used an ABAB design. They turned the rule on and off to see if it worked.

Collection rate jumped from 20% to 96.6%.

Attendance stayed the same. The clinic lost no money and gained steady cash flow.

Davison et al. (1984) ran a similar reversal study. They gave a small discount for follow-up visits. Both studies show a tiny money tweak lifts compliance without hurting service use.

Winters et al. (2026) tried the opposite move. They paid patients to attend HIV care. Attendance rose while cash flowed, but stopped the moment payments ended. T et al. asked clients to pay up front, and the gain held.

Cordova et al. (1993) mailed reminders and parking passes to pediatric families. Cancellations rose, yet kept appointments did not budge. Their soft cues failed where a firm prepayment rule succeeded.

If your clinic fights late or missing fees, try the three-visit cash rule. No extra staff, no gift cards, no forever incentives. You collect almost every dollar and clients still show up. Start Monday: ask new clients to pay at the front desk for visits one, two, and three. Then switch to monthly statements and watch your revenue climb.