Should the NHS offer us incentives to improve our health?
30 April 2009
Giving people financial incentives to change their behaviour or adhere to medication regimens is becoming a more frequent approach adopted by healthcare providers around the world, often attracting controversy.
For example, some Primary Care Trusts (PCTs) in the UK offer vouchers to pregnant women who manage to give up smoking for a set period of time; and some patients receive around £10 each time they receive prescribed medication for psychotic disorders.
The Centre for the Study of Incentives in Healthcare (CSI Health) is a collaboration between King’s College London, the London School of Economics and Political Science (LSE), and Queen Mary, University of London (QMUL). It is funded by an £800 000 Strategic Award in Biomedical Ethics from the Wellcome Trust.
Research at CSI Health will address the use of incentives to change people’s behaviour from the perspectives of three main disciplines - philosophy, psychology and economics - with the aim of evaluating whether financial incentives are an effective and acceptable means by which to improve population health.
The Director of the new Centre is Theresa Marteau, Professor of Health Psychology at King’s College London. “Financial incentives provide immediate rewards for behaviours that may only otherwise reap rewards in the future,” says Professor Marteau. “These include stopping smoking or eating fruit, for example.
“They also capitalise on ‘present bias’ - a tendency most of us have to pursue small immediate rewards rather than more distant ones, even those that are far more highly valued. The theory is that by establishing new behaviours using the power of rewards, these new behaviours will become habitual.”
Incentives have proved effective, particularly in developing countries where they have been used to encourage one-off behaviours like clinic attendance or vaccinations. Changing habitual behaviours has proved more difficult.
Adam Oliver, health economist at LSE and co-director of CSI Health, says: “The failure of incentives to change behaviour in the long term could be because the schemes have not drawn upon psychological or behavioural economic theory.
“There are objections to the use of incentives,” says Richard Ashcroft, Professor of Biomedical Ethics at QMUL and co-director of CSI Health. “These objections seem to derive from a view that incentives are a form of bribery or coercion, or that it is unfair to ‘reward’ people who have previously chosen to engage in less healthy behaviour. So at CSI Health we will go beyond asking simply whether incentives work. We will examine whether incentives produce sustained health benefits, and what impact they have beyond the individual patient.”
Clare Matterson, Director of Medicine, Society and History at the Wellcome Trust, says: “Research into ethical issues surrounding medical science and healthcare is essential if people are going to be able to make informed decisions about their own behaviour and its impact on their health.
"By funding the Centre for the Study of Incentives in Health, we expect Professor Marteau and her colleagues to really move research on in this field over the next five years, extending international collaborations and developing new ways of multidisciplinary working in what is a complicated and controversial area of health policy.”
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Credit: Tessa Oksanen, Wellcome Images
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Notes for editors
The Wellcome Trust is the largest charity in the UK. It funds innovative biomedical research, in the UK and internationally, spending around £600 million each year to support the brightest scientists with the best ideas. The Wellcome Trust supports public debate about biomedical research and its impact on health and wellbeing.
King’s College London is one of the top 25 universities in the world (Times Higher 2007) and the fourth oldest in England. A research-led university based in the heart of London, King's has 19 300 students from more than 130 countries, and 5000 employees. King's has an outstanding reputation for providing world-class teaching and cutting-edge research. The College is in the top group of UK universities for research earnings and has an annual income of approximately £400 million. An investment of £500 million has been made in the redevelopment of its estate.
King's has a particularly distinguished reputation in the humanities, law, social sciences, the health sciences, natural sciences and engineering, and has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA. It is the largest centre for the education of healthcare professionals in Europe and is home to five Medical Research Council Centres - more than any other university.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are working together to create the UK's largest Academic Health Science Centre (AHSC). The AHSC will bring together the widest range of clinical and research expertise in the UK – strengths that will be used to drive improvements in care for patients, allowing them to benefit from breakthroughs in medical science and receive leading edge treatment at the earliest possible opportunity.
Queen Mary, University of London is one of the UK's leading research-focused higher education institutions with some 13 000 undergraduate and postgraduate students. Amongst the largest of the colleges of the University of London, Queen Mary’s 2800 staff deliver world class degree programmes and research across 21 academic departments and institutes, within three sectors: Science and Engineering; Humanities, Social Sciences and Laws; and the School of Medicine and Dentistry. Over 80 per cent of Queen Mary’s research staff work in departments where research is of international or national excellence (RAE 2001). The College has a strong international reputation, with around 20 per cent of students coming from over 100 countries and 2000 students on a unique collaborative degree programme in Beijing. Queen Mary has an annual turnover of £200 million, research income worth £43 million, and generates employment and output worth £500 million to the UK economy each year. Queen Mary, as a member of the 1994 Group of research-focused universities, has made a strategic commitment to the highest quality of research, but also to the best possible educational, cultural and social experience for its students. The College is unique amongst London's universities in being able to offer a completely integrated residential campus, with a 2000-bed award-winning Student Village on its Mile End campus.
The London School of Economics and Political Science (LSE) studies the social sciences in their broadest sense, with an academic profile spanning a wide range of disciplines, from economics, politics and law, to sociology, information systems and accounting and finance.
The School has an outstanding reputation for academic excellence and is one of the most international universities in the world. Its study of social, economic and political problems focuses on the different perspectives and experiences of most countries. From its foundation LSE has aimed to be a laboratory of the social sciences, a place where ideas are developed, analysed, evaluated and disseminated around the globe.