Financial incentives to promote social mobility

Forde, Ian; Zeuner, Dagmar

doi:10.1136/bmj.b3219

Cited by 12 publications

(11 citation statements)

References 12 publications

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“…These schemes can supplement household income by up to 20%, 30 are generally targeted at families with young children, and require behaviours such as regularly attending antenatal care, vaccination of children and regular school attendance. A recent Cochrane review reported that such conditional cash transfer schemes in low-income countries are generally successful in improving clinic attendance and the uptake of vaccinations.…”

Section: Previous Research On the Effectiveness Of Health-promoting Imentioning

confidence: 99%

“…28,40 A number of authors have concluded that, in high-income countries, incentives may be useful in promoting 'simple' one-off behaviours, but that their use in achieving more 'complex', long-term behaviour change may be minimal. 25,28,30,34 Attendance for preschool vaccinations is a series of discrete behaviours over a time-limited period. As such, it is the type of behaviour that would be expected to be responsive to incentives.…”

Section: Previous Research On the Effectiveness Of Health-promoting Imentioning

confidence: 99%

“…25 For instance, the introduction of a cash transfer, conditional on attendance for antenatal care, in Honduras was associated with an increase in the birth rate. 30 In one study exploring stated acceptability of financial incentives versus hypothetical injections or tablets of equal effectiveness, incentives were rated as universally less acceptable and less fair by respondents in both the UK and the USA. 51 However, media coverage of health-promoting incentives in the UK is generally more positive, with only 13% of articles published in the popular and medical press on this topic during 2005-10 being entirely unfavourable.…”

Section: Previous Research On Acceptability Of Health-promoting Incenmentioning

confidence: 99%

“…25,28,30,34 However, in the UK in particular, childhood vaccination has (because of well-rehearsed historical incidents) 92 become a loaded and contested area that must be carefully negotiated. The association of vaccination with bribery or coercion thus raises moral and ethical implications, which, for both groups of participants, seemed to potentially outweigh the hypothesised benefits of financial incentives.…”

Section: Comparison With Previous Workmentioning

confidence: 99%

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Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Adams

Bateman

Becker

et al. 2015

Health Technol Assess

101

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BackgroundUptake of preschool vaccinations is less than optimal. Financial incentives and quasi-mandatory policies (restricting access to child care or educational settings to fully vaccinated children) have been used to increase uptake internationally, but not in the UK.ObjectiveTo provide evidence on the effectiveness, acceptability and economic costs and consequences of parental financial incentives and quasi-mandatory schemes for increasing the uptake of preschool vaccinations.DesignSystematic review, qualitative study and discrete choice experiment (DCE) with questionnaire.SettingCommunity, health and education settings in England.ParticipantsQualitative study – parents and carers of preschool children, health and educational professionals. DCE – parents and carers of preschool children identified as ‘at high risk’ and ‘not at high risk’ of incompletely vaccinating their children.Data sourcesQualitative study – focus groups and individual interviews. DCE – online questionnaire.Review methodsThe review included studies exploring the effectiveness, acceptability or economic costs and consequences of interventions that offered contingent rewards or penalties with real material value for preschool vaccinations, or quasi-mandatory schemes that restricted access to ‘universal’ services, compared with usual care or no intervention. Electronic database, reference and citation searches were conducted.ResultsSystematic review – there was insufficient evidence to conclude that the interventions considered are effective. There was some evidence that the quasi-mandatory interventions were acceptable. There was insufficient evidence to draw conclusions on economic costs and consequences. Qualitative study – there was little appetite for parental financial incentives. Quasi-mandatory schemes were more acceptable. Optimising current services was consistently preferred to the interventions proposed. DCE and questionnaire – universal parental financial incentives were preferred to quasi-mandatory interventions, which were preferred to targeted incentives. Those reporting that they would need an incentive to vaccinate their children completely required around £110. Those who did not felt that the maximum acceptable incentive was around £70.LimitationsSystematic review – a number of relevant studies were excluded as they did not meet the study design inclusion criteria. Qualitative study – few partially and non-vaccinating parents were recruited. DCE and questionnaire – data were from a convenience sample.ConclusionsThere is little current evidence on the effectiveness or economic costs and consequences of parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Universal incentives are likely to be more acceptable than targeted ones. Preferences concerning incentives versus quasi-mandatory interventions may depend on the context in which these are elicited.Future workFurther evidence is required on (i) the effectiveness and optimal configuration of parental financial incentive and quasi-mandatory interventions for preschool vaccinations – if effectiveness is confirmed, further evidence is required on how to communicate this to stakeholders and the impact on acceptability; and (ii) the acceptability of parental financial incentive and quasi-mandatory interventions for preschool vaccinations to members of the population who are not parents of preschool children or relevant health professionals. Further consideration should be given to (i) incorporating reasons for non-vaccination into new interventions for promoting vaccination uptake; and (ii) how existing services can be optimised.Study registrationThis study is registered as PROSPERO CRD42012003192.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Previous Research On the Effectiveness Of Health-promoting Imentioning

confidence: 99%

Section: Previous Research On the Effectiveness Of Health-promoting Imentioning

confidence: 99%

Section: Previous Research On Acceptability Of Health-promoting Incenmentioning

confidence: 99%

Section: Comparison With Previous Workmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Adams

Bateman

Becker

et al. 2015

Health Technol Assess

101

View full text Add to dashboard Cite

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“…17,21,49,50 Marteau et al 21 suggest a psychological perspective that can help us think about the appropriateness of using incentives. It is known that individuals do not always act in ways that are best for them or that with hindsight they would prefer.…”

Section: Acceptability Of Incentivesmentioning

confidence: 99%

Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial: a three-armed randomised controlled trial of financial incentives

Judah

Darzi

Vlaev

et al. 2017

Health Serv Deliv Res

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Background: The UK national diabetic eye screening (DES) programme invites diabetic patients aged > 12 years annually. Simple and cost-effective methods are needed to increase screening uptake. This trial tests the impact on uptake of two financial incentive schemes, based on behavioural economic principles. Objectives: To test whether or not financial incentives encourage screening attendance. Secondarily to understand if the type of financial incentive scheme used affects screening uptake or attracts patients with a different sociodemographic status to regular attenders. If financial incentives were found to improve attendance, then a final objective was to test cost-effectiveness. Design: Three-armed randomised controlled trial. Setting: DES clinic within St Mary ’ s Hospital, London, covering patients from the areas of Kensington, Chelsea and Westminster. Participants: Patients aged ≥ 16 years, who had not attended their DES appointment for ≥ 2 years. Interventions: (1) Fixed incentive – invitation letter and £10 for attending screening; (2) probabilistic (lottery) incentive – invitation letter and 1% chance of winning £1000 for attending screening; and (3) control – invitation letter only. Main outcome measures: The primary outcome was screening attendance. Rates for control versus fixed and lottery incentive groups were compared using relative risk (RR) and risk difference with corresponding 95% confidence intervals (CIs). Results: A total of 1274 patients were eligible and randomised; 223 patients became ineligible before invite and 1051 participants were invited (control, n = 435; fixed group, n = 312; lottery group, n = 304). Thirty-four (7.8%, 95% CI 5.29% to 10.34%) control, 17 (5.5%, 95% CI 2.93% to 7.97%) fixed group and 10 (3.3%, 95% CI 1.28% to 5.29%) lottery group participants attended. Participants offered incentives were 44% less likely to attend screening than controls (RR 0.56, 95% CI 0.34 to 0.92). Examining incentive groups separately, the lottery group were 58% less likely to attend screening than controls (RR 0.42, 95% CI 0.18 to 0.98). No significant differences were found between fixed incentive and control groups (RR 0.70, 95% CI 0.35 to 1.39) or between fixed and lottery incentive groups (RR 1.66, 95% CI 0.65 to 4.21). Subgroup analyses showed no significant associations between attendance and sociodemographic factors, including gender (female vs. male, RR 1.25, 95% CI 0.77 to 2.03), age ( ≤ 65 years vs. > 65 years, RR 1.26, 95% CI 0.77 to 2.08), deprivation [0 – 20 Index of Multiple Deprivation (IMD) decile vs. 30 – 100 IMD decile, RR 1.12, 95% CI 0.69 to 1.83], years registered [mean difference (MD) – 0.13, 95% CI – 0.69 to 0.43], and distance from screening location (MD – 0.18, 95% CI – 0.65 to 0.29). Limitations: Despite verification, some address details may have been outdated, and high ethnic diversity may have resulted in language barriers for participants. Conclusions: Those receiving incentives were not more likely to attend a DES than those receiving a usual invitation letter...

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Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff

McNaughton

Adams

Shucksmith

2016

Vaccine

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FI for preschool immunisation may not be acceptable, within a UK context. Introducing FI could have detrimental effects on uptake if it were associated with bribery and coercion. Quasi-mandatory schemes, mandating immunisation for universal service entry, was the most acceptable option and could contribute to the normalising of immunisation. Future work would be needed to assess how this could be successfully implemented and if it did indeed increase uptake.

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Financial incentives to promote social mobility

Cited by 12 publications

References 12 publications

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial: a three-armed randomised controlled trial of financial incentives

Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff

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