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Paying people to change their behaviour can work, at least in the short term – so says a review of the use of financial incentives in health, published today in the online version of the British Medical Journal.
Personal financial incentives are increasingly being used to motivate patients and general populations to change their behaviour, most often as part of schemes aimed at reducing rates of obesity, smoking, and other addictive behaviours. Opinion on their use varies, with incentives being described both as “key to reducing smoking, alcohol and obesity rates” and as “a form of bribery” and “rewarding people for unhealthy behaviour.” So do financial incentives work? Theresa Marteau, professor of health psychology at Kings College, London, lead author of the review suggests there are many unanswered questions about this approach link to read the report
Examples of some current cash incentive schemes
Smoking Pregnant women in Essex offered £20 food vouchers for giving up for one week; £40 after one month; £40 after one year.
Obesity Overweight residents, Varallo, offered Italy $67 for achieving target weight; $268 and $670 if maintained for 5 and 12 months, respectively
Managing chronic conditions Diabetic employees, US offered $200-$600 towards healthcare costs for treatment adherence
Healthy eating School pupils, East Ayrshire offered
Points earned by eating healthy school meals which are exchanged for farm animals, medical supplies, and classroom equipment for Save the Children projects abroad.
Avoiding sexually transmitted diseases Young people aged 15 to 30 in Tanzania offered $45 (£30), equivalent to one quarter of annual income for some, if they test negative for sexually transmitted diseases over three years in $1.8m trial sponsored by the World Bank.
Child development Households in the PROGRESA programme, Mexico offered financial incentives to families for engaging in behaviours to improve health and educational attainments.
Most people don’t want to be overweight or keep smoking but find it difficult to do anything about it. We do not always act in ways that, with hindsight, we most prefer. So, for example, most people would prefer to eat more healthily and to be more physically active than they actually are. Similarly, most smokers would prefer not to be smokers. So is paying people to change their behaviours a good idea? Or do such incentives reward adverse behaviours (and indeed encourage them, so that individuals become entitled to the incentives). Tell us what you think?
Source: BMJ 2009;338:b1415
