- Joanne Shaw, vice chairman NHS Direct
- NHS Direct, London EC1V 9PS
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 …