Carrots, Sticks, and Health Care Reform — Problems with Wellness Incentives

Schmidt, Harald; Voigt, Kristin; Wikler, Daniel

doi:10.1056/nejmp0911552

Cited by 93 publications

(67 citation statements)

References 3 publications

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“…Instead, these authors view HPFI as coercive (Blumenthal-Barby and Burroughs, 2012). The 'fair exchange' of HPFI is also contested by some who argue that HPFI discriminate against those who pursue healthy behaviours without the need for incentives and those who are unable to comply with behavioural change programmes (see Box 1c) (Schmidt, Voigt and Wikler, 2009). …”

Section: Theme 1: Fair Exchangementioning

confidence: 99%

Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods

Giles

Robalino

Sniehotta

et al. 2015

Preventive Medicine

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ObjectiveFinancial incentives are effective in encouraging healthy behaviours, yet concerns about acceptability remain. We conducted a systematic review exploring acceptability of financial incentives for encouraging healthy behaviours. MethodDatabase, reference, and citation searches were conducted from the earliest available date to October 2014, to identify empirical studies and scholarly writing that: had an English language title, were published in a peer-reviewed journal, and explored acceptability of financial incentives for health behaviours in members of the public, potential recipients, potential practitioners or policy makers. Data was analysed using thematic analysis. ResultsEighty one papers were included: 59 pieces of scholarly writing and 22 empirical studies, primarily exploring acceptability to the public. Five themes were identified: fair exchange, design and delivery, effectiveness and cost-effectiveness, recipients, and impact on individuals and wider society. Although there was consensus that if financial incentives are effective and cost effective they are likely to be considered acceptable, a number of other factors also influenced acceptability. ConclusionFinancial incentives tend to be acceptable to the public when they are effective and costeffective. Programmes that benefit recipients and wider society; are considered fair; and are delivered to individuals deemed appropriate are likely to be considered more acceptable.

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Section: Theme 1: Fair Exchangementioning

confidence: 99%

Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods

Giles

Robalino

Sniehotta

et al. 2015

Preventive Medicine

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“…Increasingly more governments are facing the choice between the two equally unpopular policies of either increasing fiscal pressure, or rationing healthcare. In particular, in publicly funded health systems, there is a recurrent debate on the possibility to ration healthcare treatments based on individual health behaviour (2)(3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Should I pay for your risky behaviours? Evidence from London

Miraldo¹,

Galizzi²,

Merla³

et al. 2014

Preventive Medicine

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We investigate the extent to which respondents from a general population sample in London (JulyAugust 2011) agree or disagree with the NHS covering the healthcare costs related to five risky health behaviours: overeating, unhealthy diet, sedentary life, excess of alcohol, and smoking. For each behaviour, we also directly explore the main factors associated with the likelihood to agree or disagree. Half of the respondents (N=146) manifest agreement with the idea. Wider agreement exists for covering the costs associated to smoking, heavy drinking, and sedentary lives than to overeating, or poor diets. With the exception of alcohol drinking and sedentaray life, there is an almost one-to-one relationship between the agreement that the NHS should pay the healthcare costs associated to a specific behaviour, and the respondents' actual engagement in that behaviour. Those at higher risk of depending on publicly funded healthcare, are more likely to agree.

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“…Regardless of legal compliance and laudatory objectives, other critics assert that wellness programs, even incentive-based ones, are unfair because they can disadvantage some people most in need of healthcare and also they, in effect, penalize employees who legitimately struggle to attain wellness objectives, but who fail or regress, particularly since it is recognized that major lifestyle changes are difficult to achieve (17). As such, employers must be careful when it comes to implementing wellness programs so they can be in legal compliance and fair to their employees (18).…”

Section: Carrot and Sticks Of Wellness Programsmentioning

confidence: 99%