Intended for healthcare professionals


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

BMJ 2007; 335 doi: (Published 02 August 2007) Cite this as: BMJ 2007;335:233
  1. Joanne Shaw, vice chairman NHS Direct
  1. 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

    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 …

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