If intrinsic motivations alone were enough to influence health behaviors, individuals would not smoke, all drivers would wear seat belts, and patients with chronic conditions would take their medications. Yet approximately half of patients prescribed single-drug therapy for hypertension discontinue their medications within a year,1  even though presumably they want to avoid strokes and hopefully know that taking their medication is one way to reduce health risks. To supplement the intrinsic motivations apparently insufficient to the task, economists and others have long proposed extrinsic motivations in the form of financial rewards. These rewards offer the added benefit of being immediate rather than the typically delayed intrinsic rewards of better health sometime in the future. . . In 2018, 86% of US employers offered some financial incentives for healthy behavior,3  and in lower-income countries, conditional cash transfer programs rewarded utilization of preventive services.
Nevertheless, providing financial incentives to patients does not always work. Recent studies raise important questions about why incentives sometimes fail to achieve behavior change. . .
In the study from University of Pennsylvania in JAMA, incentives varying from $70, $335 and $1000 to people in various types of studies failed to result in convincing results. Many factors were theorized including people being in varying states of motivation at the time of the study.
In our cigarette withdrawal programs in our office, we had people that withdrew because in another program in our community, they were told that they could keep smoking during and after the program. Ours were free and the competing programs had a significant enrollment charge which would suggest that money was not a deterrent if the life-limiting habit could be continued.
As a pulmonologist, we saw a huge number of cigarette smokers. We would do a pulmonary function test and then graphically point to their reduction in breathing, which frequently was severe but not acknowledge. After drawing their life—death curves on a white board followed by a vivid demonstration of being short of breath, and the type of a dying experience they would have, we had very few patients that ever smoked again.
We are not surprised at the equivocal experience of the Pennsylvania research experience, which did not mention the source of their monetary incentives. But we think money incentives for health purposes are counter-intuitive in a medical practice. Maybe it’s even close to medical bribery with which we should not be associated.
We have also observed similar results in Ischemic Heart disease and Diabetes.
We must remember that our patient’s health is their personal concern. We enter their lives as medical consultants. We will be better known and respected if we maintain that relationship.
Read the original in JAMA. 2019;321(15):1451-1452. doi:10.1001/jama.2019.2560
Medical Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles
and Co-payments on Every Service.
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