Key stakeholders in healthcare, including governments, insurers and employers, are showing increasing interest in the use of financial incentives for health-related behavioural change. In addition, a variety of creative initiatives allow individuals to join healthy-living reward programs or use their own money as an incentive to achieve health goals.
To control costs of lifestyle-related diseases, governments are interested in ways to motivate citizens to be healthier. The United Kingdom has established a “nudge unit,” formally known as the Behavioural Insights Unit, within its Cabinet Office to “develop and apply lessons from behavioural economics and behavioural science to public policy making” (Cabinet Office 2010
). The UK National Health Service partnered with a weight loss incentive firm, Weight Wins, to trial the Pounds for Pounds program, where participants who achieve and maintain weight-loss targets under medical supervision receive payments up to £425. Six hundred obese participants, with an average starting weight of 218 pounds, lost an average of 14 pounds in six months and 29 pounds over 12 months if they stayed active in the program (Weight Wins Fact Sheet 2009
In Germany, health insurers permit individuals to accumulate points for healthy behaviour, such as participating in nutrition classes, fitness programs or tests of endurance, strength and coordination (Schmidt et al. 2009
). Points are redeemable for rewards such as bicycle helmets, sports watches or Wii Fit consoles. People can qualify for cash payments if they meet body mass index, blood pressure and cholesterol targets. The largest national health insurer in South Africa, Discovery Health, offers a health promotion program in which members are eligible for discounted gym memberships and accumulate points for engaging in fitness activities. This tier-based incentive program – with bronze, silver, gold and diamond status categories – entitles the member to discounts on products and services from nationally participating businesses (see www.discovery.co.za
for details). A study analyzing five years of data from the program revealed that “engagement in fitness-related activity increases with continued membership [in] an incentives and rewards-based health promotion program” (Patel et al. 2011
). Additionally, members with higher levels of physical activity had fewer health insurance claims and lower hospital admission rates for cardiovascular, endocrine and metabolic diseases and cancers (Patel et al. 2010
Companies are also offering incentives for employees to adopt healthier lifestyles. A major US healthcare company, Indiana University Health (formerly Clarian Health) offers a bonus of up to $30 each pay period for employees who meet specified health targets. IBM created a childhood obesity prevention initiative that offers parents up to $150 for completing a 12-week program aimed at improving nutrition and physical activity in families with children.
In Canada, a private company is partnering with organizations like the Canadian Obesity Network and Dietitians of Canada to offer the Best Life Rewarded program. Launched in late 2010, members earn points for healthier behaviours and redeem points for rewards, including fitness equipment, consultations with professionals such as kinesiologists and dietitians, and healthy-living magazines and books. The company receives funding “from health interest brands such as healthy food brands, vitamins, pharmaceutical products, employer groups, fitness centres, diagnostic companies, etc.” (See Frequently Asked Questions at www.bestliferewarded.com
Some private fitness centres allow people to invest their own money in weight-loss incentives, for example, by putting in $200 and receiving a portion back as they achieve incremental weight-loss goals. Websites like stickK.com
operate on the same basis in the online environment.