BMJ  2007;335:233 (4 August), doi:10.1136/bmj.39286.422639.BE

Feature

Is it acceptable for people to be paid to adhere to medication? No

NHS Direct, London EC1V 9PS

Plans to give drug users shopping vouchers to attend treatment programmes and stay clean have been unveiled by NICE. Joanne Shaw believes that payment creates perverse incentives, whereas Tom Burns says rewarding patients for cooperation is consistent with good medical practice

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

At first glance the idea of paying patients to take therapeutic drugs seems absurd. After reflecting on the high cost of non-adherence to individuals and society, however, it may not seem such a ridiculous idea after all. But don't be fooled—your first thought was right.

Given the known costs of non-adherence, paying certain people to take their drugs may look like sound economics. If health professionals are willing to take on a coercive role, and society is prepared to pay a hefty price, which includes considerable loss of personal dignity and privacy, the practical problems can be overcome. But payment for adherence is never the answer, because it creates perverse incentives and undermines the therapeutic alliance between patients and doctors that is needed for successful long term health care.

For anyone concerned about the consequences of non-adherence, the possibility of paying certain people to take their drugs looks worthy of . . . [Full text of this article]

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This article has been cited by other articles:

• Halpern, S. D., Madison, K. M., Volpp, K. G. (2009). Patients as Mercenaries?: The Ethics of Using Financial Incentives in the War on Unhealthy Behaviors. Circ Cardiovasc Qual Outcomes 2: 514-516 [Full text]  
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• Collinson, S. (2007). Incentives help vulnerable patients to stay well. BMJ 335: 317-317 [Full text]  
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Rapid Responses:

Read all Rapid Responses

Paying addicts

Richard J Stevenson
bmj.com, 7 Aug 2007 [Full text]

Is it acceptable for people to be paid to adhere to medication?

Trevor Turner
bmj.com, 14 Aug 2007 [Full text]

Financial incentives for adherence

Ana B Emiliano, et al.
bmj.com, 16 Jul 2009 [Full text]

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