It pays to be healthier
22 November 2011, 16:37
Targeted financial incentives for patients can lead to health behaviour change.
Financial incentives work for doctors. Could they work for patients,
too? Could they encourage them to change unhealthy behaviours and use
preventive health services more?
In some cases, yes, according to Dr Marita Lynagh from the University of Newcastle in Australia, and colleagues.
Their work, looking at why financial incentives for patients could be a
good thing to change risky health behaviours, indicates that incentives
are likely to be particularly effective at altering 'simple'
behaviours, e.g. take-up of immunizations, primarily among socially
Their article is published online in Springer's International Journal of Behavioral Medicine.
Following the proliferation of pay-for-performance programme for health
care providers, the application of the same principles for individual
behaviour change is becoming an attractive option.
But is it fair and does it work? To answer these questions, Lynagh and
colleagues reviewed recent research looking at the effectiveness of
personal financial incentives aiming to change health behaviour,
principally in the fields of smoking cessation and weight loss.
They found that the effectiveness of incentives depends on the types of
behaviours targeted. Incentives appear to be most effective at altering
behaviours which are simple, discrete and time-limited, such as take up
of immunisation and attendance at health and education services, and
less effective for complex and entrenched behaviours such as smoking,
diet and exercise.
However, in the case of these more complex behaviours, supporting the
financial incentive with social support and skill training significantly
increases the likelihood of success.
Financial incentives are also more likely to work with socially
disadvantaged groups, particularly when the incentives address real
barriers to change, such as transport, medication and child-care costs.
However, there is currently little evidence for long-term behaviour
change with one-time incentives. Regular reinforcement with a measured
schedule of incentives (i.e. escalating size of incentive with frequent
monitoring and rewards) is more effective at both initiating and
maintaining behaviour change.
This especially applies in the case of more complex behaviours like
drug treatment and smoking cessation, where long-term change is the real
The authors conclude: "We need effective public health interventions
that clinicians can adopt easily to encourage people to change their
health behaviours, to produce improved health outcomes for populations
and a reduced burden on health care systems.
Financial incentives are not the panacea to all health risk behaviours,
but do hold promise for encouraging certain population groups to modify
particular health behaviours."
(EurekAlert, November 2011)