Public view cash incentives for health goals as unfair
14 June 2011
Financial incentives are increasingly being used to encourage patients to stick to drug abstinence, weight loss and smoking cessation programmes, despite mixed or limited evidence that these financial 'carrots' really work, say the authors. Even when they do work, they are not always accepted as a valid treatment option and have been criticised in the media for unfairly rewarding bad behaviour.
In a bid to find out what the public actually think of such reward schemes, researchers at King's College London and Queen Mary University of London carried out a small online survey of 88 UK and 100 US participants, drawn from databases of people willing to take part in research. To date, the UK and the USA are the countries where financial incentive schemes have been used most often.
Participants, who were paid a token sum on completion of the survey, were asked to rate the acceptability and fairness of using cash rewards and penalties compared with pills and injections for improving health outcomes in five different sets of circumstances.
These included weight loss, giving up smoking, sticking to treatment for drug addiction, serious mental illness and physiotherapy after knee surgery. Participants were advised that financial and medical interventions were equally effective.
Both UK and US participants felt that financial incentives were significantly less acceptable and less fair than medical interventions. They tended to believe that an intervention should only be funded when it is fair.
Participants were also asked to judge the perceived pleasantness, or otherwise, of the interventions on offer and the degree to which they deemed individuals were personally responsible for their health.
Unsurprisingly, participants in both countries felt that a weekly injection was less pleasant than a pill and that a financial penalty was less pleasant than a reward. Rewards were favoured over penalties only for patients wanting to lose weight and those with mental health issues.
Respondents also felt that smokers and drug addicts were responsible for their condition, while those with mental health issues were not. Opinions on those who were overweight or who required knee surgery were much more mixed.
UK respondents more strongly supported funding treatment for groups who were not perceived to be responsible for their condition.
Marianne Promberger, who led the study from King's College London, commented: "These results are from a small online survey and do not necessarily reflect the opinion of the general public as a whole. Before such opinions are used to inform discussions of whether to introduce incentive schemes or not, we need to further explore the thinking and motivations behind them."
The authors speculate that people might be more accepting of financial incentives if they were clearly more effective or given in the form of vouchers rather than cash; however, some people may just dislike the idea of offering money to people who have developed an avoidable health problem through their own behaviour, they suggest.
The findings are published online today in the 'Journal of Medical Ethics'.
Image: ‘Money’, by Community Friend on Flickr.
Reference
Promberger M et al. Acceptability of financial incentives to improve health outcomes in UK and US samples. J Med Ethics 2011 [epub ahead of print]
