Rather Wealthy Than Healthy?

30 Jun

A couple of weeks ago, I came across an article in the New York Times that described an experimental program designed to increase patient adherence to prescription regimens by, get this, paying them to take their pills like they are supposed to. Be glad you weren’t sitting across from me when I read this, because I would have shot coffee out of my mouth in your general direction at a high rate of speed. It’s not that providing rewards to incentivize certain behaviors is a crazy idea, it’s that for so many patients improved health is not a powerful enough incentive, but cold, hard cash apparently is.

Now, from a policy perspective, this seemingly backwards approach actually makes some sense: a small payment is enough to get people to take their medications with regularity, and that avoids the expense of worse health conditions down the road that occur when the medication isn’t taken as directed. In fact, the article puts that cost at upwards of $100 billion annually. In essence, then, if you can eliminate that $100 billion expense by paying people a total of $1 billion annually in incentive payments, you realize a net savings of $99 billion. Sounds good, doesn’t it?

But putting the numbers aside for a moment, I have some real issues with this. Why should someone who doesn’t take their medication as directed stand to get paid for that, while someone who is faithful in following their doctor’s orders gets nothing but better health? After all, why wouldn’t I just try to convince people that I hate taking my medicine, get into one of these programs, and then resume taking my medication regularly and cashing the checks? I think this is exactly what people will do, and that would spell the end of what is really a very unjust solution to a vexing problem.

I’m also really bothered by the fact that people are willing to do something for money that they aren’t willing to do for improvements in their health. Is suffering with an illness really so trivial as to be overcome by the possibility of winning $10? I think that further inquiry into the psychology of this is warranted, because it seems to be practical evidence that much of what the field of decision sciences considers to be the monetary value of a year of good quality life may be quite over-inflated.


Posted by on June 30, 2010 in Uncategorized


2 responses to “Rather Wealthy Than Healthy?

  1. The Stephmeister

    June 30, 2010 at 5:27 pm

    As a fellow health policy researcher and someone also very interested in behavioral patterns of people (society), I wanted to share some insight that I picked up during my undergrad days studying behavioral psych. A lot of research has been done on patterns of behavior – think rats and lever pressing in response to food pellets or the infamous Pavlov experiments. Humans are essentially the same way, slightly more complex. People respond much faster and with more vigor to a stimulus when there is a closer (in time) and pleasurable response vs. considering long term consequences. For example, this is why obesity is so prevalent and people still smoke. If you tell someone that the next cigarette or piece of cake will definitely kill them, they probably wouldn't partake. This isn't to say that there aren't those who are more disciplined in their approach to considering the long term consequences of their behaviors but we know that the majority (emphasis here) of people will not. To relate this back to your blog, I actually think it's a brilliant idea to provide an immediate positive reinforcement (cash) for good behavior (take medicine). Unfortunately, it just doesn't sit well for those of us (or you out there) who make healthy lifestyle decisions because you care about your longevity and your impact on society. Let's face it, humans are not exactly a race of "giving" people though. If we accept the notion of survival of the fittest in a raw sense here (not who is literally fit), we engage in selfishly motivated behaviors. I think this particular situation can easily be boiled down into a cost benefit analysis. Is the overall cost to society less by providing small monetary incentives for positive behaviors than it is to not provide these incentives. Of course, I don't know the data but I would certainly hypothesize here that if we can get diabetics/CAD patients/etc… to regularly take their medicine, then we may have less intensive health costs in the long run. Great longitudinal study in the making here.

  2. Anonymous

    July 1, 2010 at 4:39 pm

    I don't understand your confusion about human behavior. Pretty basic health economics.


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