You may not know it, but some governments have begun to dole out money in an attempt to promote the health behaviors of certain citizen groups. Good idea? Bad idea?
First, some context by way of a 2019 Journal of the American Medical Association report (Thirumurthy, et al 2019) entitled "The Uncertain Effect of Financial Incentives to Improve Health Behaviors." Among other things, the article detailed several relevant studies. In one, 1503 cardiovascular patients were chosen from three American health care systems. For 12 months, the subjects were entered into a lottery in which they could win more than $1000, if they took their statin medication and lowered their LDL-C cholesterol. Three other studies focused on HIV positive patients in an attempt to increase their compliance with antiretroviral therapies so as to improve their abilities to suppress the virus. All three HIV studies provided their participants with financial incentives. In neither the cardiovascular study nor in any of the HIV studies did monetary rewards produced their desired outcomes.
After noting that some other studies had inferred health compliance benefit from financial inducements, Thirumurthy and his colleagues offered suggestions about how one might pay patients to take better care of their own health. Among other things, the authors cautioned against what they cited as the "Peanuts Effect" in which patients are paid too little to incentivize them. To quote, "These considerations suggest not being stingy with financial incentives when great value is at stake—or at least not assuming that incentives cannot be effective when small incentives do not succeed." After addressing several factors regarding patient monetary incentives, the authors subsequently reached the common sense conclusion that the manner in which a financial reward patient program is "designed" is central to its success.
What do you think? Should some big institution--almost always a government agency--pay people to behave in ways that profit those very same people? The United States tried paying children to attend school, and that mostly ended with fraud by the administrators and no significantly improved attendance by the students. Nevertheless, there still are pay-to-attend-school crusaders. Foremost among these is Brentin Mock (2017) who, writing for City Lab-- owned by The Atlantic, one of America's oldest literary magazines--asserted that "We need to pay high school students to go to school. I don’t mean some punk-ass weekly or monthly allowance, or a gift card for Dave & Busters. I’m talking about a deposit of somewhere in the ballpark of $50 to $100, every school day. That’s not for making honor roll; it’s just for making it to school in the morning and staying until the end of the day. Yes, compensated just for showing up. Think Universal Basic Income—but for kids." Critically evaluate that for a moment: If instituted, the recommendation would cost between $9,000 and $18,000 for each and every student. Based on 2013-2014 enrollment statistics, for Wyoming, the state with least students, the yearly cost would have ranged from 833 million, 67 thousand dollars at the low end to 1 billion, 666 million, 134 thousand dollars at the high end. For California, the state with most students, the yearly cost would have ranged from a low of 53 billion, 962 million, 686 thousand dollars at the low end to 107 billion, 925 million, 372 thousand dollars at the high end. Those new educational expenses, of course, would have to be added to Wyoming's usual pupil yearly expenditures of 1 billion, 560 million,764 thousand dollars, and added to California's usual pupil yearly expenditures of 72 billion, 641 million, 244 thousand dollars.
References
Dweck, C. (2006). Mindset: The New Psychology of Success. New York: Random House
Mock, B. (2017). We Will Pay High School Students To Go To School. And We Will Like It.
April 3. https://www.citylab.com/equity/2017/04/lets-just-pay-high-school-students-to-go-to-school/521694/
Ryan R. M., Deci E. L. (2017). Self-determination theory: Basic Psychological Needs in Motivation Development and Wellness. New York, NY: Guilford Press
Thirumurthy, H., Asch, D., & Volpp, K. (2019) The Uncertain Effect of Financial Incentives to Improve Health Behaviors. JAMA. 2019;321(15):1451-1452. doi:10.1001/jama.2019.2560
First, some context by way of a 2019 Journal of the American Medical Association report (Thirumurthy, et al 2019) entitled "The Uncertain Effect of Financial Incentives to Improve Health Behaviors." Among other things, the article detailed several relevant studies. In one, 1503 cardiovascular patients were chosen from three American health care systems. For 12 months, the subjects were entered into a lottery in which they could win more than $1000, if they took their statin medication and lowered their LDL-C cholesterol. Three other studies focused on HIV positive patients in an attempt to increase their compliance with antiretroviral therapies so as to improve their abilities to suppress the virus. All three HIV studies provided their participants with financial incentives. In neither the cardiovascular study nor in any of the HIV studies did monetary rewards produced their desired outcomes.
After noting that some other studies had inferred health compliance benefit from financial inducements, Thirumurthy and his colleagues offered suggestions about how one might pay patients to take better care of their own health. Among other things, the authors cautioned against what they cited as the "Peanuts Effect" in which patients are paid too little to incentivize them. To quote, "These considerations suggest not being stingy with financial incentives when great value is at stake—or at least not assuming that incentives cannot be effective when small incentives do not succeed." After addressing several factors regarding patient monetary incentives, the authors subsequently reached the common sense conclusion that the manner in which a financial reward patient program is "designed" is central to its success.
What do you think? Should some big institution--almost always a government agency--pay people to behave in ways that profit those very same people? The United States tried paying children to attend school, and that mostly ended with fraud by the administrators and no significantly improved attendance by the students. Nevertheless, there still are pay-to-attend-school crusaders. Foremost among these is Brentin Mock (2017) who, writing for City Lab-- owned by The Atlantic, one of America's oldest literary magazines--asserted that "We need to pay high school students to go to school. I don’t mean some punk-ass weekly or monthly allowance, or a gift card for Dave & Busters. I’m talking about a deposit of somewhere in the ballpark of $50 to $100, every school day. That’s not for making honor roll; it’s just for making it to school in the morning and staying until the end of the day. Yes, compensated just for showing up. Think Universal Basic Income—but for kids." Critically evaluate that for a moment: If instituted, the recommendation would cost between $9,000 and $18,000 for each and every student. Based on 2013-2014 enrollment statistics, for Wyoming, the state with least students, the yearly cost would have ranged from 833 million, 67 thousand dollars at the low end to 1 billion, 666 million, 134 thousand dollars at the high end. For California, the state with most students, the yearly cost would have ranged from a low of 53 billion, 962 million, 686 thousand dollars at the low end to 107 billion, 925 million, 372 thousand dollars at the high end. Those new educational expenses, of course, would have to be added to Wyoming's usual pupil yearly expenditures of 1 billion, 560 million,764 thousand dollars, and added to California's usual pupil yearly expenditures of 72 billion, 641 million, 244 thousand dollars.
Just for the moment, set aside the expense. Instead, be aware that research over the decades has proven that external rewards destroy intrinsic motivation (Ryan & Deci, 2017). So paying people to force them into physical and mental health easily could backfire. For instance, studies (Dweck, 2006) have found that when external rewards are withdrawn, those previously rewarded tend to return to their pre-existing behaviors. And what about those who already had the intrinsic motivation to behave healthfully before financial incentives were offered? Might they not rebel, demanding to be paid as much, or more, than the slackers in order to continue behaving healthfully?
References
Dweck, C. (2006). Mindset: The New Psychology of Success. New York: Random House
Mock, B. (2017). We Will Pay High School Students To Go To School. And We Will Like It.
April 3. https://www.citylab.com/equity/2017/04/lets-just-pay-high-school-students-to-go-to-school/521694/
Ryan R. M., Deci E. L. (2017). Self-determination theory: Basic Psychological Needs in Motivation Development and Wellness. New York, NY: Guilford Press
Thirumurthy, H., Asch, D., & Volpp, K. (2019) The Uncertain Effect of Financial Incentives to Improve Health Behaviors. JAMA. 2019;321(15):1451-1452. doi:10.1001/jama.2019.2560
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