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Are financial incentives acceptable?

Financial incentives can evoke strong reactions, both positive and negative. As well as considering the effectiveness of incentives in changing behaviour, NIHR research has looked at what patients, the public and healthcare professionals think about the use of financial incentives in healthcare.

Both patients and healthcare professionals accepted that incentives might work in some circumstances, when interviewed as part of two NIHR studies. Women asked about the use of incentives to stop smoking in pregnancy felt that, for some, the idea of a reward or recognition for managing to quit could be a motivator. Families in the vaccination study conceded that an incentive could be effective for disadvantaged parents, whilst some healthcare professionals cited examples from their experience where incentives had worked.

However, many people seemed to believe that it is morally wrong to offer a financial reward for behaviours such as stopping smoking in pregnancy, breastfeeding, or vaccinating a child. Participants considered it unfair that people might in effect be rewarded for failing to do something considered their responsibility – particularly vaccinating their children. Some suggested that parents might deliberately delay vaccinating in order to claim the incentive later. Healthcare professionals in the vaccination study echoed these views, expressing concern that individual responsibility could be eroded.

Universal incentives, where everyone in a particular group receives the incentive, regardless of behaviour, were considered fairer by patients, but there were concerns they might not be effective. Further research into public views on incentives found that people were most likely to accept their use if they could be shown to be effective and cost-effective. People also emphasised the need for fairness.

Both patients and healthcare professionals agreed that there would always be some people for whom an incentive would not be enough to change an entrenched behaviour or strongly held belief. For example, some people choose not to vaccinate their children because they believe it to be dangerous. Most people felt that a financial incentive would be unlikely to change minds in these cases.

Concern was also expressed by both patients and healthcare professionals about the cost of incentives, and how the health service could pay for them.

“I don’t think anyone should get the cash bonus, I’d feel like, as a parent that took my child to all of his appointments, I’m being penalised because of it.”

Anonymous, HTA Study 11/97/01

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