Money Talks: Healthy Behavior with Financial Incentives?

Ideally, medical care and financial rewards should not go hand in hand.  However, the medical world has undergone a drastic change in recent times and health care professionals have joined the ‘incentive’ bandwagon.  With the ‘pay for performance’ initiatives, government regulators introduced monetary incentives to improve quality and safety of patient care.  As a result, hospital systems have to achieve practice guidelines to earn compensation.  Demonstration projects across the nation proved that doctors performed better when offered monetary benefits. 

Health care planners are looking to monetary incentives and disincentives to provide better health care and control costs.  This concept is good for federal regulators and hospital managements, but our own health is too precious to be in the hands of regulators and we must make sensible lifestyle choices.

So, can monetary incentives prevail when medical advice and common sense have failed?  Surprisingly, two studies have confirmed that the answer is a resounding YES! 

Two of the most common lifestyle problems are smoking and obesity.  Although smoking rates have declined, the progress is slowing according to the Centers for Disease Control and Prevention.  Obesity rates have continued to rise in America despite attention to the problem.

Smoking
Smoking accounts for nearly 438,000 deaths annually and continues to be the leading cause of preventable death in America, although smokers have access to nicotine replacement therapy and smoking cessation counseling.

Researchers studied 878 employees of a large multinational company to find out if monetary incentives can boost quitting rates.  Half the employees received smoking cessation information and the others received a series of financial incentives that included $100 for completion of a cessation program, $250 for quitting in six months, and $400 if they stayed off cigarettes for another six months.  The results were astounding and proved that ‘paying’ does pay off.  The incentive group was more likely to enroll than the information-only group (15.4% versus 5.4%), and they were more likely to quit within six months (20.9% versus 11.8%).  They were also more likely to remain nonsmokers six months after quitting (14.7% versus 5.0%).

This incentive program cost the company $750 for each successful employee, and saved the company $3,400 a year in increased productivity, fewer illnesses, and decreased absenteeism – now, that is a bargain for the company. 

Obesity
America has seen unprecedented rise in obesity rates in the last decade with nearly two-thirds of the adult population being overweight or obese.  Obesity has severe consequences with increased risk of diabetes, hypertension, heart disease, arthritis, depression, and premature death.  Health care experts predict that if this trend continues, obesity and related illnesses can overtake smoking as the number one cause of preventable death in the country. 

Will financial incentives motivate weight loss in the real world, or is this a concept only for reality television?  Researchers set out to find the impact of monetary incentives on weight loss and recruited 57 obese volunteers aged 30 to 70 years old.  All volunteers had a body mass index (BMI – correlates with body fat, does not measure body fat) between 30 and 40, but otherwise healthy.  Participants had a one-hour nutrition consultation and were given an accurate weighing scale and divided into three groups.  One group did not get financial incentives, one group participated in a contract program that could pay them between $0 and $250 a month depending on how much weight they lost, and the third group participated in a lottery that allowed each member who lost weight to win up to $100 a day. 

At the end of the four-month trial, members of the contract program and lottery had lost significant weight (14.0 and 13.1 pounds respectively) than members of the group that did not receive any financial incentives.  It was evident that people listened when they were paid.

These two studies prove that financial incentives can motivate some people to achieve their goals, but they cannot be the only solution to solve health problems.  Healthy behavioral changes are necessary to maintain optimal health and remain disease-free.

You can promote healthy behavior changes among family, friends, and co-workers and inspire them without financial incentives.  When you exhibit good health and radiance, it may motivate them to join the trend of healthy behavioral changes.  Preaching is not motivating; instead make it pleasurable by stressing that fitness can be fun and a proactive means of promoting healthy behavioral changes.  Organize fitness-oriented fun activities and walking tours in interesting neighborhoods.  Dance classes can be a fun aerobic activity.  Organize healthy cooking classes and introduce herbs and spices that are rarely used in American kitchens.  Introduce the concept of healthy snacking with nuts, fruits, and yogurt.  These are only some of the healthy behavioral changes that can take you a long way on the road to aging gracefully while staying healthy and fit.