Menus Subscribe Search

Is It Worth Paying People to Be Healthy?

• April 03, 2012 • 2:01 PM

Researchers are crafting studies to see whether cash incentives might be a better way to spend money to ensure people lead healthy lives.

The Supreme Court spent a significant share of last week’s oral arguments on the Affordable Care Act debating the role of money in public health. Can the government rightly fine people for not buying health-care coverage? And what happens if such rebels face no penalty? Would we all, as a result, wind up less healthy?

This line of thinking — the fine as a stick used to punish people who won’t get health care — isn’t the only potential contribution of money on public well being. Health researchers and behavioral economists are increasingly pondering the reverse: cash as carrot. Would people be healthier if we paid them to be? Would they stop smoking, or lose weight, or turn up for an HIV test if we dangled cold, hard currency?

This idea is gaining steam in areas ranging from clinical medicine, to public health, to international development. A few early studies suggest it might work in some contexts.

[class name="dont_print_this"]

Idea Lobby

THE IDEA LOBBY
Miller-McCune's Washington correspondent Emily Badger follows the ideas informing, explaining and influencing government, from the local think tank circuit to academic research that shapes D.C. policy from afar.

[/class]

“Before you go out and roll out an extensive program of paying people to do something, you want to make sure that it’s going to be effective, you want to make sure it’s going to be cost-effective, you want to make sure it’s not going to wind up producing unexpected, unanticipated adverse consequences,” said Alex John London, director of the Center for Ethics and Policy at Carnegie Mellon University. “It’s important that we do research on these programs to determine whether they live up to the high expectations that some people have for them.”

There is one catch, however, in executing these important studies: cash, deployed in a research context, has long raised ethical red flags. Sure, researchers can pay subjects to validate their parking or compensate them for taking time off from work to participate in health studies. But cash payments to make specific decisions in research can cross the line into coercion, enticing subjects to pursue a treatment or a medication they might not otherwise have chosen. In the language of research ethics committees, money may undermine the autonomy of people to make their own decisions.

London points out that in this conversation, the research community has never really distinguished between money to participate in studies, and money as the intervention itself. This is because we’ve only recently begun talking about the potential curative powers of cash. London has written in PLoS Medicine, along with David A. Borasky Jr. and Anant Bhan, that it’s time to reconsider the ethics of money in health research.

The three are members of the Ethics Working Group of the HIV Prevention Trials Network, which is testing cash incentives in a pair of ongoing trials. One study in the U.S. is looking at the effectiveness of financial incentives to expand HIV testing and link patients to care. The other, in South Africa, is offering cash transfers to young women in exchange for attending school (in the hopes that may decrease their HIV risk).

In both of these cases, the cash isn’t luring people to make poor decisions in the interest of science. It’s motivating them to achieve goals from which they directly benefit — and which they might already desire. A similar scenario applies to a program offering you money to lose those last 10 pounds. You want to lose that weight. You’ve been trying to for some time now.

“Part of the goal of the incentive there is to get them over this motivational hump,” London said. And what’s unethical about that?

The authors acknowledge there are still potential unethical uses of cash in health research. They do want to open a dialogue about how the role of money in science may be more nuanced than current ethical guidelines allow for. This is the first step in the much broader conversation about implementing this idea in the real world (if research bears out that it works).

There are other ethical questions involved in rolling out such cash incentives as health policy (again, assuming they’re effective). If your employer offers you a nice check to quit smoking, is that fair to your coworker who’s never touched a cigarette? And what about the equity issues involving whole communities that can’t afford to encourage better health through cash payments? (As a related note, London suggests it might not be ethical to research cash payments in communities that can’t realistically sustain such an intervention in the real world.)

We may get to these ethical questions in time. But first, we need to figure out if that’s a conversation worth having.

“I personally don’t know whether in 10 years we’re going to be paying people to do a lot of things, or whether we’re going to say, ‘Well, that turned out not to be a good way to go. What’s next?’” London said. “I don’t know. But the only way to find out is to study some of these things carefully.”

Emily Badger
Emily Badger is a freelance writer living in the Washington, D.C. area who has contributed to The New York Times, International Herald Tribune and The Christian Science Monitor. She previously covered college sports for the Orlando Sentinel and lived and reported in France.

More From Emily Badger

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

August 21 • 4:00 PM

Julie Chen Explains Why She Underwent Westernizing Surgery

The CBS news anchor and television personality’s story proves that cosmetic surgeries aren’t always vanity projects, even if they’re usually portrayed that way.


August 21 • 2:37 PM

How the Brains of Risk-Taking Teens Work

There’s heightened functional connectivity between the brain’s emotion regulator and reason center, according to a recent neuroscience paper.


August 21 • 2:00 PM

Cracking Down on the Use of Restraints in Schools

Federal investigators found that children at two Virginia schools were being regularly pinned down or isolated and that their education was suffering as a result.


August 21 • 12:00 PM

What Makes You So Smart, School Principal?

Noah Davis talks to Evan Glazer about why kids aren’t getting smarter and what his school’s doing in order to change that.



August 21 • 10:00 AM

Why My Neighbors Still Use Dial-Up Internet

It’s not because they want to. It’s because they have no other choice.


August 21 • 8:15 AM

When Mothers Sing, Premature Babies Thrive

Moms willing to serenade pre-term infants help their babies—and themselves.


August 21 • 8:00 AM

To Fight the Obesity Epidemic Americans Will Have to First Recognize That They’re Obese

There is a void in the medical community’s understanding of how families see themselves and understand their weight.


August 21 • 6:33 AM

One Toxic Boss Can Poison the Whole Workplace

Office leaders who bully even just one member of their team harm everyone.


August 21 • 6:00 AM

The Fox News Effect

Whatever you think of its approach, Fox News has created a more conservative Congress and a more polarized electorate, according to a series of recent studies.


August 21 • 4:00 AM

Do Children Help Care for the Family Pet?

Or does mom do it all?


August 20 • 4:00 PM

Why Can’t Conservatives See the Benefits of Affordable Child Care?

Private programs might do a better job of watching our kids than state-run programs, but they’re not accessible to everyone.


August 20 • 2:00 PM

Oil and Gas Companies Are Illegally Using Diesel Fuel in Hundreds of Fracking Operations

An analysis by an environmental group finds hundreds of cases in which drillers used diesel fuel without obtaining permits and sometimes altered records disclosing they had done so.


August 20 • 12:00 PM

The Mystery of Britain’s Alien Big Cats

In a nation where the biggest carnivorous predator is a badger, why are there so many reported sightings of large cats?


August 20 • 10:00 AM

Death Row in Arizona: Where Human Experimentation Is the Rule, Not the Exception

Recent reports show that chemical roulette is the state’s M.O.


August 20 • 9:51 AM

Diversity Is in the Eye of the Beholder

Perception of group diversity depends on the race of the observer and the extent to which they worry about discrimination.


August 20 • 8:40 AM

Psychopathic or Just Antisocial? A Key Brain Difference Tells the Tale

Though psychopaths and antisocial people may seem similar, what occurs in their brains isn’t.


August 20 • 8:00 AM

What the Cost of Raising a Child in America Tells Us About Income Inequality

You’ll spend nearly a quarter of a million dollars to raise a kid in the United States, or about five times the annual median income.


August 20 • 6:00 AM

In Praise of ‘American Greed’

While it remains semi-hidden on CNBC and can’t claim the car chases of Cops, American Greed—now with eight seasons in the books—has proven itself a worthy endeavor.


August 20 • 4:00 AM

Of Course I Behaved Like a Jerk, I Was Just Watching ‘Jersey Shore’

Researchers find watching certain types of reality TV can make viewers more aggressive.


August 20 • 2:00 AM

Concluding Remarks About Housing Affordability and Supply Restricitions

Demand, not supply, plays the dominant role in explaining the housing affordability crisis. The wages are just too damn low.


August 19 • 4:00 PM

Can Lawmakers Only Make Laws That Corporations Allow?

There’s a telling detail in a recent story about efforts to close loopholes in corporate tax laws.




August 19 • 12:00 PM

How ‘Contagion’ Became Contagious

Do ideas and emotions really spread like a virus?


Follow us


How the Brains of Risk-Taking Teens Work

There's heightened functional connectivity between the brain's emotion regulator and reason center, according to a recent neuroscience paper.

When Mothers Sing, Premature Babies Thrive

Moms willing to serenade pre-term infants help their babies—and themselves.

One Toxic Boss Can Poison the Whole Workplace

Office leaders who bully even just one member of their team harm everyone.

Diversity Is in the Eye of the Beholder

Perception of group diversity depends on the race of the observer and the extent to which they worry about discrimination.

Psychopathic or Just Antisocial? A Key Brain Difference Tells the Tale

Though psychopaths and antisocial people may seem similar, what occurs in their brains isn’t.

The Big One

One in two full-time American fast-food workers' families are enrolled in public assistance programs, at a cost of $7 billion per year. July/August 2014 fast-food-big-one
Subscribe Now

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.