Using financial incentives to achieve healthy behaviour
BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1415 (Published 09 April 2009) Cite this as: BMJ 2009;338:b1415All rapid responses
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Marteau et al’s [1] otherwise cogent examination of evidence on the
effectiveness of financial incentives in achieving health related
behaviour change slightly misinterprets the conclusions of Cahill and
Perera’s [2] systematic review of the effectiveness of competitions and
incentives for smoking cessation. Marteau et al [1] state none of the 17
included studies show higher quit rates amongst the incentives group
compared with the control group at six months whereas the reviewers
conclude efficacy is apparent at, but not beyond, six months. Their meta-
analysis of nine studies shows a significant effect in favour of the
intervention (adjusted OR: 1.44, 95% CI: 1.01 to 2.01) at six months.
Interestingly, of these nine studies, only two found significant effects.
Both paid their final ‘reward’ to coincide with the six month assessment
and for both, in later assessments, loss of remuneration was mirrored by
loss of effect. These results highlight ongoing uncertainty about why,
rather than if, reward mechanisms facilitate positive behavioural change.
It seems a key influence on the sustained effectiveness of financial
incentives, and likely arbiter of their public acceptability, is the
extent to which the behaviours they reward are desired over and above the
remuneration package. However to-date, with the possible exception of
Volpp et al’s [3] recent trial, evidence of ongoing effectiveness after
'rewards' cease is sparse.
1. Marteau T, Ashcroft R, Oliver A. Using financial incentives to
achieve healthy behaviour. BMJ 2009;338:983-985
2. Cahill K, Perera R. Competitions and incentives for smoking
cessation. Cochrane Database Syst Rev 2008;(4):CD004986
3. Volpp KG, Troxel AB, Pauly MV, Glick HA, Puig A, Asch DA, et al. A
randomised, controlled trial of financial incentives for smoking
cessation. N Engl J Med 2009;360:699-709
Competing interests:
None declared
Competing interests: No competing interests
Given the comprehensive article by Marteau et al, I was left
wondering where they felt the line of intervention should be. The current
cost-per-QUALY used by NICE, or a socially set imaginary line of moral
accepability?
In addition to this, I would certainly add to the discussion the
difference between state healthcare providers. It would be illuminating to
assess whether the fact that in a country such as the UK patients have
become so used to receiving treatments for free they have lost the
incentive of the treatment being provided at no obvious cost at the point
of use, as it is in the US.
Competing interests:
None declared
Competing interests: No competing interests
Re: The real question is why, not if, financial incentives induce healthy behaviour
Incentives,whether financial or other, have been effective in
promoting the desired outcome of the incentive-provider's mission since
the dawn of time.
I am flummoxed by the euthusiasm of the researchers in delving into
this "the emperor has no clothes on" project.
How about researching the nature of Reality : no philosopher, prophet
or cosmologist has satisfactorily solved this riddle in two millenia and
more.
Competing interests:
None declared
Competing interests: No competing interests