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Incentives in Healthcare - What Does it Take For Us to Do What We Know Is Good for Us?

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Invariably a New Year brings a barrage of media hype around "New Year, new you", and gives us all the opportunity to make resolutions to live healthier lives in the coming year. However, it begs the question; why if we do this every New Year do we always seem to end the year disappointed by our efforts and ready to make amends the following year? What does really it take to get us to do what we know is good for us, both in the short term and the long term? Just as a puppy is not just for Christmas, living a healthier life is not just for January.

The latest research demonstrates that incentives are the key. Anyone who has promised themselves (or indeed a family member, friend or work colleague) that extra treat if they do a certain task, knows intuitively that incentives work to get us to do things that we do not necessarily want to do. Published evidence by PruHealth shows that this also works when it comes to improving our health. It showed that when people took part in a comprehensive incentive based programme, where they were given Vitality points for doing healthy activities (like going to the gym), and then given significant discounts on rewards (like holidays, travel, entertainment and other activities) according to the number of Vitality points they accrued, people:

  • Did more healthy activities over a five year period
  • The proportion of inactive individuals decreased by nearly 10%
  • The proportion of 'medium-engagement' individuals increased by over 40%
  • The proportion of 'high-engagement' increased by 30%
  • Got healthier
  • Those who remained highly active had a significantly lower probability of hospital admission, and lower hospital admissions costs if they were admitted, compared with those who remained inactive
  • Those who became more active (whether it was 'inactive' to 'active', or 'active' to 'more active') had a significantly lower probability of hospital admission, and lower hospital costs if admitted, compared with those who kept their current status.
  • Those who added two additional gym visits had a 13% lower chance of hospital admission, regardless of the base from which they started.
  • This is the first piece of concrete evidence that a comprehensive, incentive-based health promotion programme can be associated with increased participation in physical activity over time and that this translates into positive benefits for both individuals and for the healthcare industry, with both lower hospital admissions and lower hospital costs.

In a time of ever increasing healthcare costs, this is a significant finding. In December last year Cancer Research UK showed that nearly 40% of all cancers are due to lifestyle and environment alone, with about a third being accounted for by just four lifestyle factors of smoking, diet, alcohol and obesity. So investing in changing our behaviours really will make a difference to our health. Soon after this research, Laing and Buisson estimated that the costs of diagnosis and treatment of cancer are likely to increase by 62% from today to 2021, from £9.4 billion to £15.3 billion. So investing in changing our behaviours is critical in managing the cost of healthcare in the UK going forwards.

But the impact of lifestyle intervention does not just stop at cancer. Lifestyle factors are major risk factors for cardiovascular disease (still the largest killer in Europe), lung disease, and metabolic diseases such as diabetes, so improving our lifestyles will have a significant impact on our health and the cost of our healthcare across a range of diseases.

At PruHealth we firmly believe that encouraging people to become more healthy is key and we're about to announce a new range of incentives in January this year to support this, including 50% discount off holidays to discount tickets via Ticketmaster - By having something that appeals to everyone, we hope that people of all ages will be inspired to get healthier, and be well rewarded for doing so.

All healthcare providers need to think about how they can incentivise individuals to look after their own health if we have even a chance of managing the overall healthcare costs in the UK in the future. In these times of austerity across the public and private sectors this is critical to the sustainability of our healthcare system. But also individuals need to think through how they can set up incentives around them to really ensure they stick to their plans this New Year.

Incentives that they really want, that come at the right time to keep them motivated both in the short term and the long term. Armed with these, you may have more success in 2012 than in 2011 at sticking to those resolutions.

Around the Web

Incentives and Choice in Health Care - The MIT Press

Financial Incentives for Health Care Providers and Consumers ...

Alan Krinsky: Perverse Incentives in Healthcare

The National Healthcare Incentives Institute: Home