Financial incentives encourage weightloss, smoking cessation; less so in Medicaid

A study published in the Journal of Preventive Medicine has shown that financial incentives, such as those offered through workplace wellness programs, can help achieve sustained changes in health-related behaviors. While such incentives can be effective in the workplace, recent pushes to utilize financial incentives in Medicaid have been less successful.

Effect of financial incentives

The study was undertaken with the goals of determining whether financial incentives achieve sustained changes in habits such as smoking, eating, alcohol consumption, and physical activity and whether the effectiveness of these incentives are modified by the behavior targeted, the value and attainment certainty of the incentive, and the level of deprivation experienced by the individual.

The researchers analyzed 34 trials in which adults were offered financial incentives and outcomes related to pre-specified behaviors were assessed for at least six months and found that financial incentives increased behavior changes in the individuals for 18 months from the start of the incentives. Changes as a result of the incentives were sustained up to three months after the incentives were removed.  High levels of deprivation resulted in increased incentive effects, but only at more than 6 to 12 months from the start of the incentives.

Other variables, such as the behavior targeted, incentive value, and attainment certainty were not found to independently modify the behaviors studied.

Wellness incentives and the ACA

The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) has encouraged the use of wellness incentives in Medicaid. However, participation in such incentive programs has been reportedly low. One Idaho program offering a $100 voucher as an incentive for Medicaid recipients to lose weight or quit smoking garnered the participation of less than 2 percent of eligible adults.

The lack of participation was attributed lack of understanding of how the incentives work, as well as transportation and other barriers to accessing doctor appointments and educational classes required under such programs.