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.
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