The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis

Abstract

BackgroundFinancial incentive interventions have been suggested as one method of promoting healthy behaviour change.ObjectivesTo conduct a systematic review of the effectiveness of financial incentive interventions for encouraging healthy behaviour change; to explore whether effects vary according to the type of behaviour incentivised, post-intervention follow-up time, or incentive value.Data SourcesSearches were of relevant electronic databases, research registers, www.google.com, and the reference lists of previous reviews; and requests for information sent to relevant mailing lists.Eligibility CriteriaControlled evaluations of the effectiveness of financial incentive interventions, compared to no intervention or usual care, to encourage healthy behaviour change, in non-clinical adult populations, living in high-income countries, were included.Study Appraisal and SynthesisThe Cochrane Risk of Bias tool was used to assess all included studies. Meta-analysis was used to explore the effect of financial incentive interventions within groups of similar behaviours and overall. Meta-regression was used to determine if effect varied according to post-intervention follow up time, or incentive value.ResultsSeventeen papers reporting on 16 studies on smoking cessation (n = 10), attendance for vaccination or screening (n = 5), and physical activity (n = 1) were included. In meta-analyses, the average effect of incentive interventions was greater than control for short-term (≤six months) smoking cessation (relative risk (95% confidence intervals): 2.48 (1.77 to 3.46); long-term (>six months) smoking cessation (1.50 (1.05 to 2.14)); attendance for vaccination or screening (1.92 (1.46 to 2.53)); and for all behaviours combined (1.62 (1.38 to 1.91)). There was not convincing evidence that effects were different between different groups of behaviours. Meta-regression found some, limited, evidence that effect sizes decreased as post-intervention follow-up period and incentive value increased. However, the latter effect may be confounded by the former.ConclusionsThe available evidence suggests that financial incentive interventions are more effective than usual care or no intervention for encouraging healthy behaviour change.Trial RegistrationPROSPERO CRD42012002393

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

“…Three review papers, 24,46,47 which included consideration of financial incentives and screening, were found. One review concluded that patient financial incentives were one of the most effective intervention components to increase uptake of vaccinations and cancer screening; 46 however, the incentives considered were mainly about reducing or eliminating co-payments.…”

“…17,23 However, another review of incentives did not observe this difference in effectiveness between frequent and infrequently performed behaviours. 24 As screening usually requires discrete one-off behaviours, there is the suggestion that incentives may be particularly effective in increasing their uptake. Incentive schemes, using a variety of different payment structures, are increasingly being used to encourage preventative health behaviours, such as chlamydia screening, 25 breast cancer screening, 26 and health risk assessments through workplace wellness programmes.…”

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“…14 Patient financial incentives have been used successfully to promote other health behaviors influenced by present-biased preferences, 15 such as smoking cessation 16 and weight loss. 17 Financial incentives may be particularly salient for Medicaid beneficiaries.…”

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

“…8 Financial incentives may promote health behavior change. 9 Incentives tied to wellness program participation have been shown to affect health behaviors such as smoking [10][11][12] and reduce downstream health care costs. 13 Incentives for achieving specific health goals, such as a target glycosylated hemoglobin (HbA1c) or blood pressure, remain uncommon 14 and have not been well studied.…”