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March 25, 2019

The Uncertain Effect of Financial Incentives to Improve Health Behaviors

Author Affiliations
  • 1University of Pennsylvania, Philadelphia
  • 2Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
JAMA. 2019;321(15):1451-1452. doi:10.1001/jama.2019.2560

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. Studies in varied health domains have revealed that financial incentives work well. For example, a 2015 systematic review determined that to reduce smoking during pregnancy, financial or material incentives were more effective than other medical or behavioral strategies.2 The use of incentives is also widespread. 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.

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