{"id":222,"date":"2016-12-19T11:33:37","date_gmt":"2016-12-19T11:33:37","guid":{"rendered":"http:\/\/practicalhealthpsychology.com\/?p=222"},"modified":"2025-11-04T14:50:11","modified_gmt":"2025-11-04T14:50:11","slug":"does-money-really-change-everything-using-financial-incentives-and-disincentives-to-change-health-behaviours","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/no\/2016\/12\/does-money-really-change-everything-using-financial-incentives-and-disincentives-to-change-health-behaviours\/","title":{"rendered":"Does money really change everything? Using financial incentives and disincentives to change health behaviours"},"content":{"rendered":"

Dr Jean Adams,\u00a0Centre for Diet & Activity Research<\/a>, University of Cambridge<\/strong><\/p>\n

Since October last year, by law, large retailers in England have been charging customers 5p (\u20ac0.06) for \u2018single-use plastic carrier bags\u2019<\/a> \u2013 those flimsy plastic bags you get from supermarkets to carry your groceries home. The money raised is donated by retailers to \u2018good causes\u2019. In the first six months of the scheme, plastic bag use by major supermarkets decreased by more than 90%<\/a> (that\u2019s 7bn fewer bags!) and more than \u00a329m (\u20ac32m) was donated to good causes. It\u2019s hard not to conclude that a small financial disincentive can have a big impact on our behaviour.<\/p>\n

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Do financial incentives for health behaviour change work?<\/strong><\/p>\n

So how about using financial incentives, and disincentives, to change people\u2019s health behaviours? This idea is increasingly catching on. Some countries in Central and South America have tried out large financial incentive programmes<\/a> to encourage mothers to attend antenatal care, have their children immunised, and send them to school. Each time eligible mothers achieve one of the programme\u2019s required behaviours, they receive a cash payment directly from the government. There is encouraging evidence<\/a> that these programmes can have positive impacts on child health in lower and middle income countries.<\/p>\n

Higher-income countries have been slower to embrace the idea of financial incentives for health behaviour change. But the evidence base is growing and two<\/a> systematic<\/a> reviews of literature have now concluded that these programmes can be effective and that effects can last for some time after incentives have been stopped. There is little evidence<\/a> that financial incentives undermine \u2018internal motivation\u2019 to engage in healthy behaviours, and incentives even seem to work for the so-called \u2018complex\u2019 behaviours like smoking cessation<\/a> that can be difficult to change.<\/p>\n

Why aren\u2019t financial incentives for health behaviour change used more in practice?<\/strong><\/p>\n

Whilst financial incentives for health behaviours might \u2018work\u2019 in theory, in practice they can be highly problematic. To achieve the full potential of any intervention, everybody has to be on board with the basic idea<\/a> \u2013 from the policymakers designing services, to front-line workers delivering programmes, to the public, to those on the receiving end of any intervention.<\/p>\n

When we\u2019ve talked to people<\/a> about offering financial incentives for giving up smoking, taking up regular physical activity, or turning up for immunisations<\/a> and routine cancer screening, we tend to meet with negative reactions. Generally there is an acceptance that incentives could encourage some people to engage with healthier behaviours. But, this seems to be over-ridden by stronger feelings that incentives are unfair to people who \u2018do the right thing\u2019 without an incentive. There is also concern that people will cheat and \u2018game\u2019 the system by lying about their behaviour to gain a reward they aren\u2019t entitled to. Today\u2019s financial climate seems to be behind the feeling that giving money away can\u2019t possibly be cost-effective, or even affordable and that any incentive should be small in value. There is also some concern that recipients might spend their rewards on unhealthy products. Policymakers<\/a> are also concerned that incentives don\u2019t tackle the wider social determinants<\/a> of unhealthy behaviours and that these interventions are difficult to defend to politicians and the media.<\/p>\n

In all our qualitative studies, our participants have been keen to offer alternative approaches to improving health behaviours \u2013 particularly through education and information. We\u2019ve never directly sought these. Instead, it just seems that offering a financial incentive is not an \u2018obvious\u2019 solution to most people, and that they feel that other avenues should be exhausted first.<\/p>\n

Interestingly, however, we find quite different results when we conduct on-line surveys. Twice we have found that people find health behaviour change programmes that include financial incentives to be as, or more<\/a>, appealing<\/a> than programmes without incentives. Perhaps when they\u2019re protected by the anonymity of the internet, people are more comfortable expressing their mercenary tendencies! Certainly, we might expect some \u2018social desirability\u2019 bias to influence what people feel it is acceptable to say about financial incentives in a focus group or interview.<\/p>\n

Culture and context also seem to matter, and there is some evidence that financial incentives for health behaviours are more acceptable in the USA than they are in the UK \u2013 perhaps because it is just more normal to link money to health(care) in the USA than it is in the UK (which has a nationalised healthcare system).<\/p>\n

Practical recommendations<\/strong><\/p>\n

Financial incentives can certainly be an effective way to help people change their health behaviours. But they are not universally acceptable. Any incentive programme should be implemented with due care to addressing people\u2019s concerns about these programmes. This might include:<\/p>\n