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March 5, 2014

Reward-Based Incentives for Smoking Cessation: How a Carrot Became a Stick

Author Affiliations
  • 1Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
  • 2Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Philadelphia
  • 3Equity Healthcare, The Blackstone Group, Philadelphia, Pennsylvania
  • 4Department of Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA. 2014;311(9):909-910. doi:10.1001/jama.2014.418

Health care payers have an increasing interest in using financial incentives to change personal health behaviors, with an estimated 82% of employers using financial incentives for healthy behavior in 2013.1 Several factors are fueling this increased interest: steadily increasing costs that have been resistant to traditional forms of control, the realization that the majority of costs are driven by chronic conditions, which are themselves in large part a result of lifestyle choices, and emerging reports that incentives have successfully modified behaviors in a variety of contexts.2,3 In addition, the Affordable Care Act allows employers to use up to 30% of total premiums (50% if programs include smoking) for outcomes-based rewards or penalties.4