Members of the UK and US public disapprove of using cash incentives to spark changes in health behaviours among patients, deeming these methods to be unfair, reveals research published online in the Journal of Medical Ethics.

Financial incentives are increasingly being used to encourage patients to stick to drug abstinence, weight loss, and smoking cessation programmes, despite mixed or limited evidence that these financial carrots really work, say the authors. But even when they do work, they are not always accepted as a valid treatment option.

In a bid to find out what people actually think of such reward schemes, the authors carried out an online survey of 88 UK and 100 US participants, drawn from databases of people willing to take part in research. The UK and the US are the countries where financial incentive schemes have most often been used, to date.

Participants (who were paid a token sum on completion) were asked to rate the acceptability and fairness of using cash rewards and penalties and pills and injections for improving health outcomes in five different sets of circumstances.

These included weight loss, giving up smoking, sticking to treatment for drug addiction, serious mental illness, and physiotherapy after knee surgery. Participants were advised that financial and medical interventions were equally effective.

Both UK and US participants felt that financial incentives were significantly less acceptable and less fair than medical interventions. They tended to believe that an intervention should only be funded when it is fair.

Participants were also asked to judge the perceived pleasantness (or otherwise) of the interventions on offer and the degree to which they deemed individuals were personally responsible for their health.

Unsurprisingly, participants in both countries felt that a weekly injection was less pleasant than a pill, and that a financial penalty was less pleasant than a reward. However, rewards were favoured over penalties only for patients wanting to lose weight and those with mental health issues.

Respondents also felt that smokers and drug addicts were responsible for their condition, while those with mental health issues were not. Opinions on those who were overweight or who required knee surgery were much more mixed.

UK respondents more strongly supported funding treatment for groups who were not perceived to be responsible for their condition.

The authors speculate that financial incentives might possibly be deemed more acceptable if they were clearly more effective or given in the form of vouchers rather than cash.

On the other hand, some people may just abhor the idea of offering money to people who have developed an avoidable health problem through their own behaviour, they suggest.

Click here to view the paper in full.

Source:
Dr Marianne Promberger,
Health Psychology,
King's College London,
Guy's Hospital,
London,
UK.