Paying People to Lose Weight and Stop Smoking

Unhealthy behaviors, such as smoking, poor diet, and sedentary lifestyles, account for as much as 40% of premature deaths in the U.S. Although behavioral interventions have the potential to improve health, behavior change is difficult, especially over the long term. Many people have difficulty changing health behaviors because it requires trade-offs between immediate consumption and delayed and often intangible health benefits. Incentives can provide people with immediate and tangible feedback that helps make it easier for them to do in the short term what is in their long-term best interest. This Issue Brief explores the use of financial incentives to motivate and sustain smoking cessation and weight loss

Reward-Based Incentives for Smoking Cessation: How a Carrot Became a Stick

Health care payers have an increasing interest in using financial incentives to change personal health behaviors, with an estimated 82% of employers using financial incentives for healthy behavior in 2013.1 Several factors are fueling this increased interest: steadily increasing costs that have been resistant to traditional forms of control, the realization that the majority of costs are driven by chronic conditions, which are themselves in large part a result of lifestyle choices, and emerging reports that incentives have successfully modified behaviors in a variety of contexts.2,3 In addition, the Affordable Care Act allows employers to use up to 30% of total premiums (50% if programs include smoking) for outcomes-based rewards or penalties.

Comparative Effectiveness — Thinking Beyond Medication A versus Medication B

The American Recovery and Reinvestment Act of 2009 (ARRA), the stimulus package signed into law by President Barack Obama on February 17, 2009, directs $1.1 billion to support “the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies, including through efforts that . . . conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.

On the Way to Health

Information technology (IT) has fundamentally changed the way we work, bank, and communicate. Its impact on health care and health research, however, has been limited by the lack of a comprehensive infrastructure to connect patients, providers, and researchers. As we learn more about how to address the unhealthy behaviors that underlie many chronic conditions, researchers are seeking IT solutions to connect to patients in scalable ways. This Issue Brief describes the development and use of a new web-based IT platform, Way to Health, to deliver and evaluate behavioral interventions to improve health

A Wake-Up Call: Quality of Care After Resident Duty Hour Reform

On first glance, it seems self-evident: sleep-deprived physicians-intraining (residents) are more likely to make mistakes that could harm patients. Like pilots and truck drivers, these new physicians might need restrictions on how much they work. Such restrictions were created in 2003, but the impact of these new rules is unclear. Are patients any safer? Is hospital care more fragmented? Who’s doing the work that residents performed prior to duty hour reform? This Issue Brief summarizes several studies that offer evidence about the impact of these regulations on patient mortality, as well as on residents’ perceptions of the effects on quality of care, medical education, and residents’ quality of life

What Business are We In? The Emergence of Health as the Business of Health Care

On January 19, 2012, after 131 years of operation, the Eastman Kodak Company filed for Chapter 11 protection in U.S. bankruptcy court. No doubt some people were surprised by this filing, because they grew up at a time when bright yellow boxes of film accompanied every family vacation and celebration. Those who were paying more attention offered many explanations for the bankruptcy. Central among them was that Kodak was late to recognize that it was not in the film and camera business: it was in the imaging business. With the advent of digital imaging, Kodak was outpaced by other companies that could better achieve consumer goals

Incentives in Health: Different Prescriptions for Physicians and Patients

Financial incentives abound in health care. They are found in the ways physicians are paid and in the ways health insurance coverage, co-payments, and deductibles are structured for patients. The effects of these incentives are often understood through conventional economic principles, with the assumption that individuals are self-interest maximizers who respond directly to changes in incentives. In contrast, behavioral economics imports insights from psychology and recognizes that individuals often do not respond to incentives as rationally as they might. In some cases, individuals lack information, but in others, they just seem to act contrary to their own known interests, for example, when they overeat, fail to take medication, or neglect to wear seat belts

Assessing Value in Health Care Programs

Many health care services provided in the United States are of low value, meaning that the cost of providing those services is high relative to the health care benefit they confer. In some cases, the care provided may have no value or even, on average, may be harmful. Examples of low- or negative-value services include unnecessary surgery or diagnostic imaging that will not change management. Given estimates that 30% of the $2.5 trillion the United States spends on health care services each year may provide little benefit,1 there is a widespread eagerness to enhance the ratio of benefits to costs

Commitment Devices: Using Initiatives to Change Behavior

Unhealthy behaviors are responsible for a large proportion of health care costs and poor health outcomes.1 Surveys of large employers regularly identify unhealthy behaviors as the most important challenge to affordable benefits coverage. For this reason, employers increasingly leverage incentives to encourage changes in employees’ health-related behaviors. According to one survey, 81% of large employers provide incentives for healthy behavior change.2 In this Viewpoint, we discuss the potential and limitations of an approach that behavioral science research has shown can be used to influence health behaviors but that is distinct from incentives: the use of commitment devices (Table).

Commitment Devices to Improve Unhealthy Behaviors—Reply

In Reply Our Viewpoint described commitment devices and argued that they should be more widely used in health care. Commitment devices enforce voluntarily imposed restrictions on people until they have accomplished their goals or enforce voluntarily imposed penalties if they do not accomplish their goals