Do Wellness Incentives Work?

In a recent Health Care Cost Monitor post, Kristin Voigt and Harald Schmidt contend that offering employees who use wellness programs in the workplace reduced insurance premiums and deductibles threatens the fairness and affordability of health insurance for those most in need. Depending on how the program is structured, this is not necessarily the case, but Voigt and Schmidt provide compelling support for their assertion.

More fundamentally, however, we ought to ask ourselves whether financial incentives to improve health-related behaviors work. If they do not work, then they will clearly fail to reduce health care costs. The evidence is decidedly mixed.

There is some evidence that financial incentives can affect simple behavior changes, such as medical compliance. For example, in a systematic review of 11 randomized controlled trials that had used financial incentives, 10 demonstrated a positive effect. In these studies, the incentives ranged from $5 to $1,000 for interventions including adherence to a tuberculosis medical regimen, dental care for children, immunization, postpartum appointments among indigent adolescents, the completion of a treatment program for cocaine dependency, and antihypertensive treatment.

Other studies have found a positive effect from small financial incentives for mammography, required hepatitis B vaccines among drug users, and keeping clinic appointments for depression. But other studies have failed to find financial incentives effective for medical compliance.

For complex behavior change of the type often included in wellness programs, such as smoking cessation and weight loss, there is almost no good evidence for a sustained, positive effect. For example, in a systematic review of 17 studies on financial incentives for smoking cessation, none of the studies found significantly higher quit rates after six months among people who had financial rewards compared with those who did not.

However, a large trial published last year randomized 878 people to either a control group or an incentives group that received $100 for completing a smoking cessation program, a further $250 for being abstinent six months into the trial, and an additional $400 if they remained abstinent six months after that. At 18 months from the initiation of the trial, the quit rate in the incentive group was significantly higher than that for the controls – 9.4% versus 3.6%.

That trial is but a single study. A sustained effect has also rarely been observed for weight loss. For instance, a systematic review of nine randomized trials on the use of incentives to reduce obesity rates found that the larger incentives produced better results, but that the difference was not statistically significant. People offered financial incentives of less than 1.2% of their disposable incomes had a mean weight change of precisely zero after 12 months. People who received financial incentives of 1.2% or more of their disposable income had a mean weight loss of 2.4 pounds at 12 months, and only 1.5 pounds at 18 months.

The same researchers who conducted the smoking cessation trial also conducted a study of financial incentives for weight loss, but their long-term results were not overly auspicious. For instance, seven months after the initiation of the trial, the mean weight loss in the control group was 4.4 pounds, compared with between 6.2 and 9.2 pounds in the incentive groups.

Overall, therefore, financial incentives for specific areas of medical compliance appear to show some promise, but there is insufficient good evidence that they work in any sustained way to alter broader lifestyle behaviors. It may be that the literature to date uses incentives over too short a time frame to affect these complex behaviors. It is also possible that the size of the incentives offered in the studies was too small. Moreover, the cost, let alone the cost-effectiveness of the incentives, is rarely explicitly recorded.

But what is clear is that the lack of good evidence that financial incentives generate a meaningful positive effect on complex behavior suggests that we cannot conclude that they will save health care costs. Therefore, governments should be cautious in endorsing them.

Adam Oliver is RCUK Senior Academic Fellow in Health Economics and Policy at the London School of Economics and Political Science. Formerly, he was a Japanese Ministry of Educa­tion research scholar at Keio University in Tokyo and a Commonwealth Fund Harkness Fellow at Columbia University. He was also founding coeditor of the journal Health Economics, Policy, and Law. a.​j.​oliver@​lse.​ac.​uk; 44 (0)20 7955 6471.

| Print Print | Download as PDF | 17 Comments
The Health Care Cost Monitor is made possible by Supporting Members of The Hastings Center. Please give today.
  • Recommend this Post on Facebook

15 Comments

  1. […] There is no solid scientific, sociologic or economic evidence that this type of reward system works to change behavior in the long-term. We at EHS believe that using incentives to motivate behavior […]

  2. Undeniably believe that which you said. Your favorite justification appeared to be on the net the easiest thing to be aware of. I say to you, I certainly get irked while people think about worries that they just do not know about. You managed to hit the nail upon the top and defined out the whole thing without having side-effects , people can take a signal. Will probably be back to get more. Thanks

  3. […] wellness programs, although they’re more likely to motivate change in certain situations. A recent article by The Hastings Center, an independent research company, identifies several specific types of healthy behaviors that […]

  4. What i do not realize is if truth be told how you’re no longer really much more smartly-preferred than you might be right now. You are very intelligent. You already know thus significantly in the case of this topic, produced me in my view consider it from a lot of numerous angles. Its like men and women are not interested except it’s one thing to accomplish with Woman gaga!
    Your individual stuffs outstanding. At all times deal
    with it up!

  5. Howdy! This article couldn’t be written any better! Looking through this post reminds me of my previous roommate! He always kept talking about this. I most certainly will send this information to him. Fairly certain he’s going to have a great read.
    Many thanks for sharing!

  6. Now I am going away to do my breakfast, once having my breakfast coming again
    to read additional news.

  7. synaptol says:

    Good info. Lucky me I ran across your site by accident (stumbleupon).

    I have saved as a favorite for later!

  8. great submit, very informative. I’m wondering why the other experts of
    this sector don’t understand this. You should proceed your writing.
    I’m sure, you’ve a huge readers’ base already!

  9. Wow! At last I got a weblog from where I be able to genuinely get helpful facts concerning my study and knowledge.

    Here is my webpage … download walk of shame

  10. George says:

    If you like reading a blog, what kind of interesting things that make you like that blog? Give me your favorite blog links too..

  11. Thanks for ones marvelous posting! I definitely enjoyed reading it, you can be a great
    author.I will remember to bookmark your blog and will come back very soon.
    I want to encourage that you continue your great posts, have a nice holiday weekend!

    Here is my web site watch belle online

  12. If you would like to improve your knowledge just keep visiting this website and be updated with the hottest news posted here.

    Also visit my page :: jurassic park builder cheats ipad

  13. Hello! I’m at work surfing around your blog from my new iphone 4!
    Just wanted to say I love reading through your blog and look forward to all your posts!

    Carry on the excellent work!

    My web site: can you escape cheat

  14. I seldom drop comments, however after looking
    at through a few of the comments on Do Wellness
    Incentives Work? — Health Care Cost Monitor.

    I actually do have some questions for you if you
    do not mind. Is it simply me or do a few of the
    remarks appear as if they are written by brain dead visitors?
    :-P And, if you are posting on other places, I’d like to keep up with
    you. Would you list of all of your shared sites like your Facebook page,
    twitter feed, or linkedin profile?

  15. I’m not sure why but this weblog is loading incredibly slow for me.
    Is anyone else having this problem or is it a issue on my end?
    I’ll check back later on and see if the problem still exists.

    Take a look at my page — rust pc download no survey

2 Trackbacks

  1. […] There is no solid scientific, sociologic or economic evidence that this type of reward system works to change behavior in the long-term. We at EHS believe that using incentives to motivate behavior […]

  2. […] wellness programs, although they’re more likely to motivate change in certain situations. A recent article by The Hastings Center, an independent research company, identifies several specific types of healthy behaviors that […]

Post a Comment

Required fields are marked *. We will not publish your email address.

*
*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>