Is it right to pay people to be healthy?

Money The NHS has a mixed record when it comes to offering people financial incentives to be healthy

Offering people financial incentives to adopt healthy behaviour is a controversial area of public policy.

People understandably question why some people should be paid for doing something that many others do for nothing.

Surely, the fact it benefits them personally in terms of their health - or their baby in the case of the latest idea put forward to offer mothers £200 of shopping vouchers to encourage breastfeeding - should be enough of an incentive?

However, advocates of this approach argue sometimes it is not.

They point out that behaviour can be so ingrained or subconscious that people may need something to jolt them out of their bad habits.

As far as the NHS is concerned, what matters is what is cost-effective: do the gains outweigh the costs?

In terms of breastfeeding, the UK has some of the worst rates in the developed world.

Mixed record

Unicef estimates £40m a year could be saved if the numbers were improved because of the health benefits - breastfeeding has been shown to reduce cases of stomach problems, asthma and other respiratory conditions.

But the NHS does have a mixed record with financial incentives.

In 2009, officials in Kent set up a weight-loss scheme - Pounds for Pounds - which offered participants cash payments of up to £425.

Less than half achieved significant weight loss and a high drop-out rate meant that evaluators were unable to recommend it as a way of tackling obesity.

However, health officials in Dundee have had more success with a stop smoking scheme.

The NHS there ran a two-year programme offering smokers £12.50 a week to quit smoking.

By the end of three months, nearly a third of participants end up kicking the habit - more than twice as many as other smoking cessation projects achieved, figures released last year showed.

But one of the key reasons this was a success was that it was easy to police.

Judgement the key

Smokers were asked to take regular breadth tests which were extremely accurate at gauging whether the person had lit up.

By comparison this latest initiative is going to rely on the judgement of midwives and health visitors to determine whether the women taking part are indeed breastfeeding.

This raises the question about whether it will be open to abuse.

Prof Theresa Marteau, director of the Behaviour and Health Research Unit at Cambridge University, says this is often cited as a concern for such schemes.

She is carrying out research into gaming with early findings suggesting it is limited to the "minority".

"It is a debate we need to have. There is understandable sensitivity about rewarding people like this when the finances are so tight. But just because if does happen it doesn't mean we shouldn't do it."

Another potential hurdle is that the team behind it are not imposing any restrictions on what the vouchers could be used for.

It means those taking part could purchase cigarettes and alcohol.

This contrasts with work done by what was the National Treatment Agency five years ago with drug users.

They were offered vouchers, but were not allowed to spend them on luxury items.

One of the key reasons for this was to make sure the project retained the confidence of the public.

But to be fair researchers say this is only the first stage of the piloting of this idea.

If it goes forward for a nationwide pilot next year, changes could be made to the way its run.

What happens next with this project will be watched with interest.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

NHS strike: A walkout with a difference

Health workers have taken part in their second strike of the autumn. Once again disruption looks like it has been limited, but that does not mean it is a dispute that will peter out, says Nick Triggle.

Read full article


This entry is now closed for comments

Jump to comments pagination
  • rate this

    Comment number 28.

    Its just wrong, how is it paid out ? does some one watch ? what about mothers who cannot breast feed as they are taking medication, its a life choice not a job, NHS cannot afford life saving drugs but can pay some one to breast feed and why are they saying that if you haven't been breast feed as a baby you are second rate

  • rate this

    Comment number 27.

    Is it right to pay people to be healthy?

    Lol, course it is.

    The reason why developed/3rd world have improved so much is because people are gradually being paid more.

    In UK, a moral/logical living wage will enable people to buy better quality food, hence improverd health & less health costs to all taxpayers.

    Thing in UK, this is mainly targetted at dumbos

  • rate this

    Comment number 26.

    The reverse might be better - fine people for doing things that are bad for them, or make them pay for any medical treatment resulting. You'd need a very clear list of what could result in a fine or what treatment would have to be paid for. If people know the consequences in advance then their choices are informed, and their responsibility.

  • rate this

    Comment number 25.

    #16 JamesStGeorge
    So basically if you ran the NHS if I drank 2 pints (enough to be over the drink drive limit) then a total stranger walks up to me and punches me in the face or a roof tile falls off my house and hits me on the head I get billed an extra grand on top of my tax bill?

    What if I can't afford a grand? I die in the gutter outside A+E?

  • rate this

    Comment number 24.

    18. And_here_we_go_again

    ##Many people injure themselves playing sport, e.g. do we charge skiers for their broken bones?##


    20. Ben
    No, it is just an increase in it if you like to see it that way.

  • rate this

    Comment number 23.

    This type of behaviour perpetuates the absolution of all responsibility on the part of the subject who will no longer do anything (even in their own interests) unless given an incentive.

    We are witnessing the dumbing down of the human species to become dependent only on the “voice from above”

    Are we nothing other than sheep to be herded and cajoled into doing what our shepherds deem fit?

  • rate this

    Comment number 22.

    We could pay politicians to shut up, go home and spend the year doing nothing. THat would have an enormous benefit for us all - the national average blood pressure would plummet, for starters..



    They've been doing that for years anyway, its just the few blowhards that actually do turn up at Wastemonster that are causing all the problems.

  • rate this

    Comment number 21.

    How about a tax refund if you don't use the NHS for 12 months, if the government could make it a retrospective payment I'll have 240 months worth please.

  • rate this

    Comment number 20.

    @16. JamesStGeorge

    Isn't that just alcohol and tobacco duty?

  • rate this

    Comment number 19.

    I wouldn't mind being paid a little extra. But seriously, what a stupid idea. We would then have unhealthy AND healthy people costing the economy whilst the food giants continue unperturbed, fully able to continue selling their frankly unsatisfactory but extremely addictive foods, to those fatties that love it so.

  • rate this

    Comment number 18.

    "The harm (& costs that we all pay) for those who persist against all rationality to damage their bodies in an avoidable, but entirely predictable way -charge them!"

    Where does it stop though? Many people injure themselves playing sport, e.g. do we charge skiers for their broken bones?

  • rate this

    Comment number 17.

    I have no problem with financial incentives if they are available to all, but they never are.

  • rate this

    Comment number 16.

    Reverse the principle. Harm yourself, pay a fee. So need a hospital when you are over, for simplicity the drink driving level of alcohol, then there is a standard fee for any attention. £1k for whatever is done so it is simple and needs no pricing, accounting staff etc.

  • rate this

    Comment number 15.

    Just 2 tools to incentivise people, education & money.

    If one needs/requires money incentive to do whats better/right, then it evidentially shows a lack of education & logical reasoning

    Simple equation poor logic = even a monkey can be trained to do things if given bananas as incentive

  • rate this

    Comment number 14.

    #12 I'd argue with the size of my tax bill I've already paid for a fair chunk of healthcare I've not yet used.

    In reality if you start charging for people who make themselves ill it'll be about ten minutes before someone gets charged for breaking a leg playing football or falling off a ladder doing DIY. Almost all ill health carries some degree of lifestyle choice.

  • rate this

    Comment number 13.

    4.tb "By withdrawing NHS cover from those who refuse to follow very basic health advice"

    You cant' do that - watching smokers or gluttons die on the street is unacceptable.

  • rate this

    Comment number 12.

    The converse - charging people who makes themselves ill - is a more interesting question.

    EG those who make the choice to smoke or engage in other health damaging pursuits - should they pay for their recklessness?

    The harm (& costs that we all pay) for those who persist against all rationality to damage their bodies in an avoidable, but entirely predictable way -charge them!

  • rate this

    Comment number 11.

    Is there any evidence it works long term? If you're sufficiently disinterested in your own health to pay no attention until someone gives you some money, I would suggest that as soon the flow of cash stops they will simply revert back to type. Either that or the 'jolt' that supposedly is required could be achieved without simply emptying the public purse into their bank account.

  • rate this

    Comment number 10.

    Is it right to pay corporate fatcats to take over NHS functions ?

    No Jeremy Hunt, it isn't.

  • rate this

    Comment number 9.

    I am not sure a breadth test would determine whether a smoker had given up or not - perhaps a breath test might do the trick ?


Page 11 of 12



BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.