Carrot or bribe? Rewards for healthier lifestyle stir debate

April 10, 2009

Health authorities and corporations are increasingly offering money to people who quit smoking, lose weight or take medicine, despite uncertainty that such incentives work beyond a few months, doctors said on Friday.

In a paper published online by the British Medical Journal (BMJ), they said the trend also posed an ethical dilemma, as physicians were being urged to dangle gifts in exchange for a healthier lifestyle.

Health psychologist Theresa Marteau of the King's College London and colleagues reviewed the outcome of a range of "incentive" schemes.

Such programmes include a project in the suburban London county of Essex, in which pregnant women were offered food vouchers worth 20 pounds (28 dollars, 22 euros) if they stopped smoking for a week; 40 pounds if they kept off cigarettes for four weeks, and another 40 pounds after a year.

In Varallo, Italy, authorities offered the equivalent of 67 dollars to overweight residents if they achieved a target weight, rising to 268 dollars if they sustained the goal for five months and 670 dollars for 12 months.

In Tanzania, men and women aged 15-30 were offered the equivalent 45 dollars if they regularly tested negative for a sexually transmitted disease.

In East London, psychotic patients were offered between five and 15 pounds (seven to 21 dollars, 5.5 to 16 euros) for getting an injection of antipsychotic drugs.

Looking at the published evidence, the paper said incentives in smoking cessation programmes generally failed after six months or beyond a year or so in weight-loss experiments.

Incentives that stood a better chance of working were those in weight-loss programmes that offered a big financial carrot -- a bonus of more than 1.2 percent of an individual's income -- and those targeted at low-income people who needed a vaccine for a disease or treatment for TB.

Many doctors, it said, also worried about the moral context of incentives: whether these amounted to bribes, an act of paternalism or a breach of trust between healthcare provider and patient.

The paper argued that some incentive schemes could be a useful way of promoting better health and reducing costs, and urged the medical community to reflect on which ones could work and were acceptable.

"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," it said.

(c) 2009 AFP

• earls - Apr 10, 2009
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  Forget rewards, how about punishment? Fat people should be harvested for biofuel.
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• ArtflDgr - Apr 10, 2009
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  how about us people who didnt harm themselves first?
  
  i know, i start smoking, so i can stop!!!!
  
  that way i can get the benifit for being healthy!!!
  
  otherwise, poor me will not get anything for doing the right thing from the start.
  
  [basically your going to have people try to work this, and they are going to end up addicted, fat or other things... ]
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• factandveritas - Apr 11, 2009
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  It is unacceptable as totally unfair for taxpayers' money rewarding people to stop their unhealthy habits. How about rewarding with money students to attend school or prostitutes to stay off the streets.
  
  The way forward is through information and education, education and more education rather than this totally irresponsible bureaucratic invention.
  
  Spend our money to educate them not bribe them Messrs Civil Servants.
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