A provocative new study out of Australia investigates the novel approach of providing financial incentives to individuals if they change their health behavior.
Investigators note that financial incentives transform many business behaviors, including the way physicians practice. For that reason, Dr. Marita Lynagh and her colleagues from the University of Newcastle in Australia set out to investigate if financial incentives could encourage individuals to change unhealthy behaviors and use preventive health services.
The researchers determined that the approach works in some cases — especially for altering ‘simple’ behaviors e.g. receipt of immunizations, primarily among socially disadvantaged groups.
The results of the study are published online in Springer’s International Journal of Behavioral Medicine.
As health reform advances across the world, a new model of paying providers for their clinical performance is emerging as a potentially beneficial strategy.
Expansion of the principal of positive-reinforcement for individual health behavioral change is an obvious 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 behavior, principally in the fields of smoking cessation and weight loss.
They found that the effectiveness of incentives depends on the types of behaviors targeted.
Incentives appear to be most effective at altering behaviors which are simple, discrete and time-limited such as take up of immunization and attendance at health and education services, and less effective for complex and entrenched behaviors such as smoking, diet and exercise.
For the more complex behaviors, health educators recommend augmenting the financial incentive with social support and skill training – a combination that significantly increases the likelihood of success.
Researchers also determined financial incentives are effective when working with socially disadvantaged groups, particularly when the incentives address real barriers to change such as transport, medication and child-care costs.
A significant caveat to the use of incentives is the absence of evidence for long-term behavior change with one-time incentives.
Evidence does exist that 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 behavior change.
This especially applies in the case of more complex behaviors like drug treatment and smoking cessation, where long-term change is the real challenge.
Researchers believe financial incentives can help but are only one aspect toward encouraging healthy individual behavior.
“We need effective public health interventions that clinicians can adopt easily to encourage people to change their health behaviors, 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 behaviors, but do hold promise for encouraging certain population groups to modify particular health behaviors.”