Op-ed: Paying patients to stay healthy widens the wealth gap

The following op-ed was published on June 15th, 2010 in the New York Times’ Room for Debate blog.

In an effort to control health spending, companies are spending more money than ever to keep their employees healthy. More than half of large businesses, for instance, offer financial incentives to employees who complete smoking cessation or weight management programs.

When you consider that over 40 percent of premature deaths in the U.S. is associated with smoking, inactivity or obesity, it seems like money well spent. There is evidence to support such an approach.

Last year, the New England Journal of Medicine found that paying patients $750 significantly increased their chances of quitting smoking. And in a Journal of the American Medical Association study in 2008, cash rewards made patients more likely to lose weight.

One question, however, is whether every socioeconomic class will respond to such incentives. The patients in the studies cited above were well-educated, white, and had high incomes — hardly a representative demographic cross-section.

Those with more limited economic means may not have the ability to pay for gym memberships, smoking cessation drugs, or more nutritious food. Indeed, data from several studies confirm that those in lower socioeconomic classes have poorer smoking cessation rates and diets with less whole grains, lean meats and fresh fruits and vegetables.

A financial incentive for health therefore has the potential of worsening the socioeconomic disparity between people who have the resources to become healthier, and those who don’t.

As a primary care doctor, it’s frustrating to see patients fail to lose weight or continue to smoke despite my counseling attempts. A monetary incentive program can indeed be a powerful motivating tool. But it has to be carefully implemented so that all patients, from every background and class, can potentially benefit.

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