It pays to be healthier

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 disadvantaged groups.

Attractive option

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.

Complex behaviours

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 challenge.

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)