The majority of NICE's independent Citizens Council advisory group made up of members of the public believes that incentive systems could be an effective way of encouraging people to change their unhealthy lifestyles providing that certain conditions are met.
While this approach is not commonly used in the UK to improve areas of public health, the council heard of examples where local incentive schemes had been piloted. These included an initiative to encourage pregnant women to stop smoking by offering supermarket vouchers, people receiving cash for losing agreed amounts of weight, and children being rewarded with toys in exchange for eating more fruit and vegetables.
Incentives should never be exchangeable for tobacco or alcohol; only offered to people who are committed to changing their health behaviours; cash incentives should be only offered as a last resort; the progress of participants must be monitored throughout; and the results of the schemes must be analysed so that more can be learnt about their effectiveness.
The Council members agreed that incentive schemes are likely to work best when they are targeted and used as part of a wider programme of support. They should also acknowledge the complex factors that motivate people to put their health at risk, such as by excessive eating or drinking, drug taking, a lack of exercise or smoking.
Sir Michael Rawlins of NICE says, “We face several public health challenges in today's society, some more obvious than others, and we must seek to improve these in ways that are likely to achieve the best health outcomes for those affected. We are now very keen to hear what the general public thinks about their conclusions.”
A Department of Health spokesperson killed the idea stone dead, "The Coalition government has committed to protect health spending but every penny must be spent more effectively. We do not believe giving people financial or paid for incentives is a desirable use of NHS money and agree that such systems should only be used as a last resort and if properly evaluated."
It sounds a mad idea, until you start factoring in that it costs more to treat the serious illness, or care for someone with a long term and possibly fatal disability, than to deal with the problem at an early stage – or better still, avoid the problem in the first place.
For the last few years several health insurers have given discounts on health clubs and goods, or offered lower renewal premiums for people who get and stay fit.
British people are the most overweight in Europe. 42% of men and 32% of women in Britain are overweight, with 24% of men and 25% of women falling into the obese category. Scottish children are the second most overweight in the world, with the US in first place.
The nice friendly government adverts of recent years, and millions spent on advertising healthier lifestyles have ended up with a nation that is fatter and less healthy than ever. Part of it is due to state control, such as not letting children run in playgrounds as they may get fat, or the tut-tutting of any form of competition. But we are now getting a generation of kids who will die up to 15 years before their time, and increasingly frequently before their parents.
Health insurers are getting worried as the less healthy the population is, the more it costs them in claims. Should more insurers differentiate between healthy and unhealthy people? But this could just end up with half the nation unacceptable to insurers at a price the customer can afford.
As something drastic must be done, is paying people to get and stay healthy such a daft idea? In commercial insurance risk reduction and risk avoidance are natural, companies are encouraged / forced to make things less likely to suffer from fire, theft and accidents. Why is health or health insurance different?
Health insurance: Hot topic: October 2010