Health rewards only effective for three months

Incentives that encourage healthy behaviours are only effective for three months, according to research.

A systematic review of schemes that pay people to lose weight, get fit or quit smoking has found that they have limited impact and only work in the short term. The study, published in
Preventive Medicine (2015;75:75–85), found that the only initiatives that had any significant impact involved giving up smoking, with the largest effect found among pregnant women and those from deprived groups. But even in these cases, the effects stopped within three months of payments ending.

The study reviewed 81 papers and concluded that incentives are more acceptable if they are effective and cost effective and that much scholarly critique of incentives does not draw on empirical evidence. Its authors suggested that further research is needed to determine the acceptability of incentives to policy makers.

Several schemes to reward healthy behaviours have been suggested and piloted, but this is the first review of such schemes. Eleni Mantzari, from the Centre for the Study of Incentives in Health at King’s College London, said: “Our study is the first systematic review to provide an overall estimate of the impact of financial incentives across habitual health-related behaviours and to focus explicitly on effects after the incentives stop. The offer of financial incentives does not seem to lead to changes that are sustained beyond a few months after their removal.”

Head of the NHS Simon Stevens suggested in 2014 that rewards for weight loss could help tackle obesity crisis, and the majority of a NICE Citizen’s Council held in 2010 voted in favour of incentives under certain conditions. It concluded that incentives were best when targeted and used as part of a wider package that included support and education.

More than 4,000 new mothers have been enrolled in national pilots that pay up to £200 in shopping vouchers in an attempt to improve breastfeeding rates in some parts of the country. The NHS has offered overweight people up to £425 for successful weight loss on slimming programmes, while councils have offered children cinema tickets for walking to school. Research published in
The Lancet (2014;384:153–163) found that heroin addicts were far more likely to complete a one-month course of hepatitis B vaccinations if they were given £30 of shopping vouchers.