Businesses and health authorities are increasingly rewarding people who lose weight, quit smoking or take medicine with money, despite doubts that such incentives work longer than a few months, according to a new report published online by the British Medical Journal (BMJ) on Friday.
The trend raises an ethical dilemma for some, as physicians are put in a position of offering gifts in exchange for healthier lifestyles.
Theresa Marteau, a health psychologist at King’s College London, and her colleagues analyzed the outcome of a variety of such incentive plans. The programs included a project in a suburban London county in which pregnant women were offered $28 in food vouchers if they stopped smoking for a week, $60 if they kept off cigarettes for four weeks, and an additional $60 after one year.
In Varallo, Italy, health authorities offered $67 dollars to overweight residents if they reached a target weight. The residents were given $268 if they maintained that weight for five months and another $670 after one year. In Tanzania, citizens aged 15-30 were offered $45 dollars for consistently testing negative for a sexually transmitted disease. And in East London, psychotic patients were offered between $7 and $21 for receiving an injection of antipsychotic medication.
After examining the published evidence, the report’s authors said quit-smoking incentives generally failed after six months, while weight-loss incentives typically failed beyond one year.
Weight-loss incentives that offered a larger financial reward exceeding 1.2 percent of a person’s income, and incentives targeted at low-income people who need a vaccine or TB treatments, were generally more successful.
According to the report, many physicians were concerned about the moral subtext of incentives, and whether they amounted to bribes, paternalism or a violation of doctor-patient trust.
The report argued that some incentive programs could be a useful in promoting better health and cutting costs, and called on the healthcare providers to consider which ones were acceptable and would work best.
“Ultimately, if personal financial incentives prove to be effective and acceptable in only a few contexts, they may still offer an important means by which to improve population health,” the report said.
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