The current health reform proposals do not make enough of an effort to encourage patients to take care of themselves. After all, the frequency of two leading causes of death, diabetes and heart disease, can be markedly reduced with lifestyle changes.
What is the best way to encourage patients to take responsibility for their own health?
Rewards or penalties can indeed motivate change. Several years ago, West Virginia’s Medicaid program asked patients to agree in writing to do three things: take their medications, keep their appointments, and avoid unnecessary visits to the emergency room. Penalties for not complying ranged from reductions in benefits to eliminating coverage.
An editorial from The New England Journal of Medicine argues that requiring physicians to report on their patients’ behaviors fundamentally places physicians at odds with patients’ welfare. It can harm patients’ trust in their doctors, and if patients are penalized for their health habits, they’re likely to be less candid with their doctors.
The key to incentive programs is ensuring that they don’t backfire. Instead of negative pressure to improve patient behavior, it may be both more ethical and more persuasive to reinforce healthy behaviors with positive rewards – like reducing the cost of co-pays or insurance premiums, or token cash payments or prizes. By focusing on positive incentives, we can avoid the unintended consequences that will result from punishing patients.
I encourage you to listen and vote in this week’s poll, located both below, and in the upper right column of the blog.
Please suggest future ReachMD Poll topics by emailing Poll@ReachMD.com.
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{ 8 comments }
I’m totally in favor of “facilitating” patients’ treatment compliance.
As every case is different, there’s a huge percentage of chronic patients who abandon their treatments of neglect their therapies.
We all know that the long-term costs of these attitudes are high, however, there’s also a big impact that a fail treatment could have in the physician’s image with relatives or the patients themselves.
Six months ago, I wrote this article regarding the different kinds of interventions for improving patients’ compliance: Behavioral, Educational, Social and Structural.
The text is in this link: http://blogs.strat-cons.com/?p=1475
The concept of rewarding patient for their participation may actually work. BCBS of NC does reward its subscribers with points for doing physical activity every day. The subscribers can then choose gifts from thier website based on number of points they accumulate over next few months. I liked it. I am sure something like that could be worked out for all thse patient’s decision making. How about a free dinner delivery at home if you do decide to leave the hospital before noon after being discharged?
absolutely agree that punishments are not the way to go. drop someone’s coverage and what will they do? go to the ED and cost the rest of us more money.
but how will we track people to make sure they’ve really stopped smoking?
Ha, ha. Why don’t we make doctors responsible for their treatments, i.e., if they don’t work, patients don’t have to pay.
Hey, docs, heal thyself. Patients would be must more accountable with their own health, it you stood by your own treatments.
Should patients be rewarded for taking care of themselves??? That is the craziest thing I have ever heard! People get rewarded by taking care of themselves, with good health! Rewarding most people will not work, neither will artificial rewards. The consequences of neglecting our health is the punishment of poor health.
Very true. However, many people do not seem to think long term, so long term good versus poor health may not be as much of an incentive compared to more immediate incentives, whatever they may be.
Haven’t studies already shown that rewards work better than punishments? I think if rewards are used, it’s important to make sure that people who already have healthy habits aren’t inadvertently punished. For example, rewarding patients for quitting smoking means those who never smoked or already quit aren’t rewarded; rewarding overweight patients for losing weight means those already at a healthy weight aren’t rewarded.
I agree that the reward for healthy behavior is better health, but as already mentioned, not everyone has the capacity to do something now for a vague reward in the distant future. Small rewards can be just the incentive some people need to get started.
Here’s a non-health example: my city recently decided to increase residents’ level of recycling by instituting a pay-as-you-throw program, requiring residents to buy ridiculously expensive ($2 apiece) flimsy plastic bags for their trash. Trash not in the special bags won’t be picked up. The program had the desired effect on recycling, which increased greatly, but the level of resentment is so high that an initiative petition to eliminate the program will be on the ballot next election.
Meanwhile, a neighboring city that also wanted to increase recycling used a different tactic: instead of “punishing” residents for not recycling by charging for trash pickup, they hired a company that offers rewards (in the form of gift coupons for stores like CVS) based on the number of pounds of material residents put in their recycle bins. The program has induced many residents who previously refused to separate recyclables to start, and not only hasn’t created resentment but is actually very popular.
Skeptikus == that’s a great idea. So if I’ve got someone with poor compliance and a chronic disease I’ll refuse to treat them. And as for that poor slob with a potentially but not absolutely curable stage III colon cancer — well they’re on their own.
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