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  • Writer's pictureNick Allen

Financial incentives for health behaviors

Revenue sharing is all the rage in the college sports world, which I follow closely. The concept is simple: many feel that student-athletes should be provided with a share of the revenue that they generate for their universities. A similar concept could be considered in healthcare, and I actually think it has some merit. 


While we don’t generate revenue, we each cost the healthcare system a certain amount of money over our lifetime. The healthier we are, the less we cost the system over our lifetime. In a single-payer system, like the United Kingdom’s National Health Service (NHS), healthy individuals are saving money for the government. In the United States, it’s either the government or private insurers that are saving money when individuals stay healthy. Wouldn’t it be nice if you actually received a cut of this savings?


Obviously, a significant amount of our healthcare expenses are out of our hands. Nevertheless, health behaviors do have a large role to play. Incentivizing healthy behavior is not a new concept, but I’m not aware of a program as straightforward as a recent one published in JAMA earlier this year. The “Game of Stones” trial placed 585 overweight men into three groups: one group receiving no weight loss support, one group receiving supportive text messages, and the last group receiving supportive text messages and financial incentives. The financial incentives included up to $500 for the participants that reached specific weight loss benchmarks.


At the end of the trial, the financial incentives (unsurprisingly) proved to be beneficial. Those in the group eligible for the payments lost 5% of their body weight on average, significantly more than the control group. Will this success lead to the widespread implementation of financial incentives for healthy behaviors? Though I think the concept holds a lot of promise, many questions remain unanswered.


In a real-world setting, without the precise control enjoyed by the “Game of Stones” trial, can health behaviors be fairly evaluated and compensated without spending too much on oversight? There’s also the question of equity. A single mother working two jobs is undoubtedly going to have a harder time earning these incentives than someone without the same obligations. In the weight loss example, having the resources to exercise and eat healthy is a huge advantage. We’d probably find that those better off to begin with have easier access to the financial rewards.


If these problems could be sorted out, this approach holds a lot of promise. It has the potential to create a win-win scenario across the board. A healthy population is something we should strive for regardless of finances, but the reality is that it’s a great investment as well. There are a plethora of ways we as a society can invest in health, but direct payments for healthy behaviors could be part of the strategy.





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