Wednesday, 22 July 2015

Financial Incentive Programs - the Use less Tax.

Can we bribe patients to adopt a healthy life style with financial Incentive Programs?

          I don't think so, but some randomized clinical trials suggest otherwise.   In one study involving 878 GE employees, incentives  worth $750  for smoking cessation tripled quit rates from 5% to 14.7%.  This led to a program developed by GE for its employees.   In another more elaborate study the authors divided the candidates into different groups.  They felt that if they could get participants to put some of their own money at risk that they could recoup, they would be more highly motivated.   No doubt, but needless to say, the participants were much more likely to accept the reward-based incentive programs (acceptance rate, 90.0%) than the deposit-based programs, in which the candidates had to put up some of their own money , which they would earn back together with  their reward (acceptance rate 13.7%).  In standard per-protocol analyses, 52.3% of those who accepted deposits versus 17.1% of those who accepted rewards had sustained abstinence through 6 months.  Not surprising, when you consider that this cohort were sufficiently motivated to  put up their own money in the first instance.

         To cut to the chase, these  studies are asking if the tax payer should be paying individuals to cease doing things that they know perfectly well are harmful to their health. It is about what we use our limited resources on.   It is asking whether people who don't sufficiently care about their  health to avoid behaviours that they know are harmful but they find pleasurable, can be bribed to change their behaviour pattern.  And if this works, even on a temporary basis, then perhaps we can extend the program.  First we could start on marijuana (worth at least 50% more than tobacco), then we could move on to the oxycodone cessation reward program (100% more), then onto the cocaine, heroine and meth reward programs.    The programs could be financed by the hard-working abstemious citizens who don't know how to enjoy themselves anyway.  Or we could put a tax on  health care foods and products  and call it the 'use less tax'.

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