Hostname: page-component-7bb8b95d7b-495rp Total loading time: 0 Render date: 2024-10-04T11:09:25.315Z Has data issue: false hasContentIssue false

Incentives, health promotion and equality

Published online by Cambridge University Press:  21 September 2010

Kristin Voigt*
Affiliation:
Department of Politics, Philosophy & Religion, Lancaster University, Lancaster, UK
*
*Correspondence to: Kristin Voigt, Department of Politics, Philosophy & Religion, Lancaster University, Lancaster, UK. Email: k.voigt@lancaster.ac.uk

Abstract

The use of incentives to encourage individuals to adopt ‘healthier’ behaviours is an increasingly popular instrument in health policy. Much of the literature has been critical of ‘negative’ incentives, often due to concerns about equality; ‘positive’ incentives, however, have largely been welcomed as an instrument for the improvement of population health and possibly the reduction of health inequalities. The aim of this paper is to provide a more systematic assessment of the use of incentives from the perspective of equality. The paper begins with an overview of existing and proposed incentive schemes. I then suggest that the distinction between ‘positive’ and ‘negative’ incentives – or ‘carrots’ and ‘sticks’ – is of limited use in distinguishing those incentive schemes that raise concerns of equality from those that do not. The paper assesses incentive schemes with respect to two important considerations of equality: equality of access and equality of outcomes. While our assessment of incentive schemes will, ultimately, depend on various empirical facts, the paper aims to advance the debate by identifying some of the empirical questions we need to ask. The paper concludes by considering a number of trade-offs and caveats relevant to the assessment of incentive schemes.

Type
Articles
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bains, N., Pickett, W., Laundry, B.Mercredy, D. (2000), ‘Predictors of smoking cessation in an incentive-based community intervention’, Chronic Diseases in Canada, 21(2): 5461.Google Scholar
Ballard, P.Radlet, A. (2009), ‘Give it up for baby: a smoking cessation intervention for pregnant women in Scotland’, Cases in Public Health Communication & Marketing, 3: 147160.Google Scholar
Barbeau, E., Wolin, K., Naumova, E.Balbach, E. (2005), ‘Tobacco advertising in communities: associations with race and class’, Preventive Medicine, 40(1): 1622.CrossRefGoogle ScholarPubMed
Bishop, G.Brodkey, A. (2006), ‘Personal responsibility and physician responsibility—West Virginia’s Medicaid plan’, New England Journal of Medicine, 355(8): 756758.CrossRefGoogle ScholarPubMed
Braun, B., Reiners, H., Rosenwirth, M.Schlette, S. (2006), Anreize zur Verhaltenssteuerung im Gesundheitswesen: Effekte bei Versicherten und Leistungsanbietern, Gütersloh: Bertelsmann Stiftung.Google Scholar
Cahill, K.Perera, R. (2008), ‘Competitions and incentives for smoking cessation’, Cochrane Database of Systematic Reviews, 3 Art. No.: CD004307, doi:10.1002/14651858.CD004307.pub3.CrossRefGoogle Scholar
Carrell, S. (2008), ‘Pupils earn just reward for healthy eating’, The Guardian, 3 November.Google Scholar
Claassen, D. (2007), ‘Financial incentives for antipsychotic depot medication: ethical issues’, Journal of Medical Ethics, 33(4): 189193.CrossRefGoogle ScholarPubMed
Claassen, D., Fakhoury, W., Ford, R.Priebe, S. (2007), ‘Money for medication: financial incentives to improve medication adherence in assertive outreach’, Psychiatric Bulletin, 31(1): 47.CrossRefGoogle Scholar
Cookson, R. (2008), ‘Should disadvantaged people be paid to take care of their health? Yes’, British Medical Journal, 337: 140.CrossRefGoogle Scholar
Daniels, N. (2008), Just Health: Meeting Health Needs Fairly, Cambridge: Cambridge University Press.Google Scholar
Daniels, N. (forthcoming), ‘Individual and Social Responsibility for Health’, in C. Knight and Z. Stemplowska (eds), Distributive Justice and Responsibility, Oxford and New York: Oxford University Press.Google Scholar
Daniels, N.Sabin, J. (2008), Setting Limits Fairly: Learning to Share Resources for Health, 2nd edn, New York: Oxford University Press.Google Scholar
Das, J., Do, Q.Ozler, B. (2005), ‘Reassessing conditional cash transfer programs’, The World Bank Research Observer, 20(1): 5780.CrossRefGoogle Scholar
Devine, C. M., Jastran, M., Jabs, J., Wethington, E., Farell, T. J.Bisogni, C. A. (2006), ‘ “A lot of sacrifices”: work-family spillover and the food choice coping strategies of low-wage employed parents’, Social Science and Medicine, 63(10): 25912603.CrossRefGoogle ScholarPubMed
Dudley, R., Tseng, C., Bozic, K., Smith, W.Luft, H. (2007), Consumer Financial Incentives: A Decision Guide for Purchasers, Rockville, MD: Agency for Healthcare Research and Quality, AHRQ Publication No. 07(08)-0059.Google Scholar
Dworkin, R. (1981), ‘What is equality? Part 2: equality of resources’, Philosophy & Public Affairs, 10(4): 283345.Google Scholar
Eckholm, E. (2006), ‘Medicaid plan prods patients toward health’, New York Times, 1 December.Google Scholar
Families USA (2008a), ‘Mountain Health Choices: An Unhealthy Choice for West Virginians’, http://www.familiesusa.org/assets/pdfs/state-plan-amendments/wv-mountain-health-choices.pdf [4 June 2009].Google Scholar
Families USA (2008b), ‘Reward/Penalty Plans for Wellness: Coming Soon to an Office Near You?’ http://www.familiesusa.org/assets/pdfs/wellness-plans.pdf [14 February 2010].Google Scholar
Federal Register (2006), ‘Nondiscrimination and wellness programs in health coverage in the group market; final rules’, Federal Register, 71(239): 7501475055, December 13.Google Scholar
Florida Agency for Health Care Administration (2005), ‘Florida Medicaid Reform Application for 1115 Research Demonstration and Waiver’, http://ahca.myflorida.com/medicaid/medicaid_reform/waiver/pdfs/medicaid_reform_waiver_final_101905.pdf [15 February 2010].Google Scholar
Forde, I.Zeuner, D. (2009), ‘Financial incentives to promote social mobility’, British Medical Journal, 339: 544546.CrossRefGoogle ScholarPubMed
Graham, H. (1993), When Life’s a Drag: Women, Smoking and Disadvantage, London: Department of Health.Google Scholar
Greene, J. (2007), Medicaid Efforts to Incentivize Healthy Behaviors, Center for Health Care Strategies, Inc., http://www.chcs.org/usr_doc/Medicaid_Efforts_to_Incentivize_Healthy_Behaviors.pdfGoogle Scholar
Guttman, N.Ressler, W. (2001), ‘On being responsible: ethical issues in appeals to personal responsibility in health campaigns’, Journal of Health Communication, 6(2): 117136.CrossRefGoogle ScholarPubMed
Guttman, N.Salmon, C. T. (2004), ‘Guilt, fear, stigma and knowledge gaps: ethical issues in public health communication interventions’, Bioethics, 18(6): 531552.CrossRefGoogle ScholarPubMed
Hand, L. (2009), ‘Carrots and sticks: employers prod workers to adopt behaviors to improve health’, Harvard Public Health Review, Winter 2009: 49.Google Scholar
Hilzenrath, D. (2009), ‘Wellness incentives could create health-care loophole’, Washington Post, 16 October.Google Scholar
Jetter, K.Cassady, D. (2006), ‘The availability and cost of healthier food alternatives’, American Journal of Preventive Medicine, 30(1): 3844.CrossRefGoogle ScholarPubMed
Jochelson, K. (2007), Paying the Patient: Improving Health Using Financial Incentives, London: King’s Fund.Google Scholar
Kahneman, D.Tversky, A. (1979), ‘Prospect theory: an analysis of decision under risk’, Econometrica, 47(2): 263291.CrossRefGoogle Scholar
Kerpelman, L., Connell, D.Gunn, W. (2000), ‘Effect of a monetary sanction on immunization rates of recipients of aid to families with dependent children’, The Journal of the American Medical Association, 284(1): 5359.CrossRefGoogle ScholarPubMed
Khaw, K.-T., Wareham, N., Bingham, S., Welch, A., Luben, R.Day, N. (2008), ‘Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study’, PLoS Medicine, 5(1): 3947.Google ScholarPubMed
Lagarde, M., Haines, A.Palmer, N. (2007), ‘Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries’, The Journal of the American Medical Association, 298(16): 19001910.CrossRefGoogle ScholarPubMed
Laken, M.Ager, J. (1995), ‘Using incentives to increase participation in prenatal care’, Obstetrics & Gynecology, 85(3): 326329.Google ScholarPubMed
Le Grand, J.Srivastava, D. (2009), Incentives for Prevention, London: Health England.Google Scholar
Marcus, A. C., Crane, L. A., Kaplan, C. P., Reading, A. E., Savage, E., Gunning, J., Bernstein, G.Berek, J. S. (1992), ‘Improving adherence to screening follow-up among women with abnormal pap smears: results from a large clinic-based trial of three intervention strategies’, Medical Care, 30(3): 216230.CrossRefGoogle ScholarPubMed
Marmot, M.Wilkinson, R. G. (eds) (2005), Social Determinants of Health, 2nd edn, Oxford: Oxford University Press.CrossRefGoogle ScholarPubMed
Marteau, T. M., Ashcroft, R. E.Oliver, A. (2009), ‘Using financial incentives to achieve healthy behaviour’, British Medical Journal, 338: b1415.CrossRefGoogle ScholarPubMed
McColl, K. (2008), ‘New York’s road to health’, British Medical Journal, 337: a673.CrossRefGoogle ScholarPubMed
Mechanic, D. (2002), ‘Disadvantage, inequality, and social policy’, Health Affairs, 21(2): 4859.CrossRefGoogle ScholarPubMed
Mello, M.Rosenthal, M. (2008), ‘Wellness programs and lifestyle discrimination—the legal limits’, New England Journal of Medicine, 359(2): 192199.CrossRefGoogle ScholarPubMed
Okie, S. (2007), ‘The employer as health coach’, New England Journal of Medicine, 357(15): 14651469.CrossRefGoogle ScholarPubMed
Oliver, A. (2009), ‘Can financial incentives improve health equity?’, British Medical Journal, 339: 705706.CrossRefGoogle ScholarPubMed
Oliver, A. (forthcoming), ‘Reflections on the development of health inequalities policy in the United Kingdom’, Health Care Analysis.Google Scholar
Phillips, A. (2004), ‘Defending equality of outcome’, Journal of Political Philosophy, 12(1): 119.CrossRefGoogle Scholar
Popay, J. (2008), ‘Should disadvantaged people be paid to take care of their health? No’, British Medical Journal, 337(7662): 141.CrossRefGoogle ScholarPubMed
Post, E., Cruz, M.Harman, J. (2006), ‘Incentive payments for attendance at appointments for depression among low-income African Americans’, Psychiatric Services, 57(3): 414416.CrossRefGoogle ScholarPubMed
Redmond, P., Solomon, J.Lin, M. (2007), Can Incentives for Health Behavior Improve Health and Hold Down Medicaid Costs?, Washington, DC: Center on Budget and Policy Priorities.Google Scholar
Schmidt, H. (2007), ‘Personal responsibility for health—developments under the German Healthcare Reform 2007’, European Journal of Health Law, 14(3): 241250.CrossRefGoogle ScholarPubMed
Schmidt, H. (2008), ‘Bonuses as incentives and rewards for health responsibility: a good thing?’, Journal of Medicine & Philosophy, 33(3): 198220.CrossRefGoogle ScholarPubMed
Schmidt, H. (2009), ‘Personal responsibility in the NHS Constitution and the social determinants of health approach: competitive or complementary?’, Health Economics, Policy and Law, 4(2): 129138.CrossRefGoogle ScholarPubMed
Schmidt, H., Gerber, A.Stock, S. (2009), ‘What can we learn from German health incentive schemes?’, British Medical Journal, 339: 725728.CrossRefGoogle ScholarPubMed
Schmidt, H., Voigt, K.Wikler, D. (2010), ‘Carrots, sticks, and health care reform – problems with wellness incentives’, New England Journal of Medicine, 362(2): e3(1)e3(3).CrossRefGoogle ScholarPubMed
Schnee, M. (2007), ‘Neue Versorgungs- und Versicherungsformen in der GKV: Wer kennt sie und wer nutzt sie?’, Gesundheitsmonitor, 2: 19.Google Scholar
Sindelar, J. (2008), ‘Paying for performance: the power of incentives over habits’, Health Economics, 17(4): 449451.CrossRefGoogle ScholarPubMed
Sutherland, K., Leatherman, S.Christianson, J. (2008), Paying the Patient: Does It Work? A Review of Patient-targeted Incentives, London: The Health Foundation.Google Scholar
Tester, J.Baker, R. (2009), ‘Making the playfields even: evaluating the impact of an environmental intervention on park use and physical activity’, Preventive Medicine, 48(4): 316320.CrossRefGoogle Scholar
Voigt, K., Schmidt, H. (2010), ‘Wellness programs: a threat to fairness and affordable care’, Hastings Center Health Care Cost Monitor, http://healthcarecostmonitor.thehastingscenter.org/kristinvoigt/wellness-programs-a-threat-to-fairness-and-affordable-care/ [13 January 2010].Google Scholar
Volpp, K. G., Troxel, A. B., Pauly, M. V., Glick, H. A., Puig, A., Asch, D. A., Galvin, R., Zhu, J., Wan, F., DeGuzman, J., Corbett, E., Weiner, J.Audrain-McGovern, J. (2009), ‘A randomized, controlled trial of financial incentives for smoking cessation’, New England Journal of Medicine, 360(7): 699709.CrossRefGoogle ScholarPubMed
Wanless, D. (2003), Securing Good Health for the Whole Population: Population Health Trends, London: HMSO.Google Scholar
Warner, K.Murt, H. (1984), ‘Economic incentives for health’, Annual Review of Public Health, 5(1): 107133.CrossRefGoogle ScholarPubMed
Wikler, D. (1978), ‘Persuasion and coercion for health: ethical issues in government efforts to change life-styles’, Millbank Memorial Fund Quarterly, 56(3): 303327.CrossRefGoogle ScholarPubMed
Wilkinson, E. (2008), ‘Can you pay people to be healthy?’, Lancet, 371(9621): 13251326.CrossRefGoogle ScholarPubMed