Incentive mechanisms require deeper understanding

doi:10.1136/bmj.a1135

Published 6 August 2008, doi:10.1136/bmj.a1135
Cite this as: BMJ 2008;337:a1135

Letters

Payment to look after health

Incentive mechanisms require deeper understanding

The first 150 words of the full text of this article appear below.

Cookson and Popay make some important points about the meritsand problems of using cash incentives to change health behaviourin disadvantaged populations.¹ ²

Cookson makes three moral arguments and one prudential argument.Firstly, cash incentives provide an inducement to recipientsto change their behaviour to lessen harm to third parties. Wecould go further and consider direct coercion, for instance,through criminal sanctions. We would then need an argument aboutwhy paying people is the approach to take rather than directcoercion.

Secondly, cash incentives create an obligation on recipientsto change their behaviour in ways that minimise the burden onfellow citizens. However, benefit schemes that incur an obligationon donors have a history of producing resentment in welfarerecipients, which might undermine the scheme’s effectiveness.

Thirdly, Cookson holds that the paternalistic motive for incentivisingbehaviour change is not acceptable. This is somewhat surprising,given that the trend in . . . [Full text of this article]

Richard E Ashcroft, professor of bioethics¹, Theresa M Marteau, professor of health psychology², Adam Oliver, RCUK senior academic fellow in health economics and policy³

¹ Queen Mary, University of London, School of Law, London E1 4NS, ² Psychology Department, Health Psychology Section, Guy’s Campus, London SE1 9RT, ³ LSE Health, London School of Economics, London WC2A 2AE