Can cash incentives change unhealthy behaviour?
By Liz Lockhart
An investigation has set out to discover whether financial incentives could encourage people to change their 
unhealthy behaviours and use preventive health care services.
The Australian study investigates this new approach and notes that it has already transformed many business behaviours including doctor’s practices.
Dr. Marita Lynagh and her colleagues from the University of Newcastle in Australia determined that the approach works in some cases, especially for altering ‘simple behaviours’. An example of this would be the receipt of immunisations, particularly among socially disadvantaged groups.
The practice of paying health care providers for their clinical performance is emerging as a potentially beneficial strategy as health reform advances across the world. An obvious option when looking to extend this practice is to expand the principal of positive-reinforcement for individual health behavioural change, according to the study.
Lynagh and her colleagues wanted to find out if this is fair and does it work? They reviewed recent research which had looked at the effectiveness of personal financial incentives which aimed to change health behaviour, in particular in the areas of smoking cessation and weight loss.
They discovered that the effectiveness of incentives depends on which types of behaviours were targeted.
Behaviours which are termed ‘simple’, discrete and time limited appear to be the most easily affected by incentives. Examples of this would be the take up of immunisation and attendance at health and education services. With behaviours such as smoking, diet and exercise which are considered to be ‘complex’, incentives appear to be less effective.
Health educators recommend, for the more complex behaviours, augmenting the financial incentives with social support and skill training. This combination significantly increases the likelihood of success.
The researchers further discovered that financial incentives are effective when applied to socially disadvantaged groups, particularly when the incentives address real barriers to change such as medication, child-care and transportation costs.
There appears to be a lack of evidence for long-term behavioural change with one-time incentives. However, evidence does exist that regular reinforcement, along with a measured schedule of incentives, is more effective at both initiating and maintaining behaviour change. An example of this would be to escalate the size of financial incentive with frequent monitoring and rewards.
In the case of more complex behaviours this particularly applies. Typical complex behaviours include smoking cessation and drug abuse treatment as these issues need long-term change and represent a real challenge.
In cases such as these, the researchers believe that financial incentives can help but are only one way of encouraging healthy individual behaviour.
‘We need effective public health interventions that clinicians can adopt easily to encourage people to change their health behaviours, to produce improved health outcomes for populations and a reduced burden on health care systems,’ says Lynagh.
‘Financial incentives are not the panacea to all health risk behaviours, but do hold promise for encouraging certain population groups to modify particular health behaviours.’
The results of the study can be found online in Springer’s International Journal of Behavioural Medicine.
Source: Springer
