Should people be paid to live healthily?
It is well known that the cheapest way of having healthcare is to encourage people to stay healthy, not to eat too much and eat the right things, to exercise and not to do harmful things like drinking too much or smoke. Such prevention can save large amounts of money by reducing the chances of people needing to go to the doctors or have treatment. Money seems to be the answer to everything, is it the correct motivation here? source references:
http://www.nytimes.com/2010/06/14/health/14meds.html; http://news.bbc.co.uk/1/hi/health/7951325.stm; http://www.msnbc.msn.com/id/22995659/ accessed on 23.06.2010
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for the greater good
If financial incentives offered are relatively small compared to the overall amount of money saved ,through preventing persons from becoming admitted to hospital for more severe treatment, then financial incentives are economically justified. This is supported by Valerie Fleishman (as reported by P Beluck in The New York Times). This would help to reduce overall hopsital admissions and free up hospital beds, which of course, is a current problem for the British NHS. It is often reported that there are not enough beds available.
There are better ways to free up hospital beds. These schemes aren't proven to work in the long run. What is indeed proven that people will enthusiastically play a lottery. And that they would do an extra effort for a prize. But we have known this since our pediatrician gave us a lolly-pop after a shot. It doesn't necessarily have to be money. You could get points in an online game. The right to a preferred time to have your appointment.
The money would be better spent teaching these same people the relationship between their actions and their health.
It is well-known that donor organs for transplants are in high demand. It is often alcoholics who are given liver transplants and smokers that are in need of a heart-lung transplant. It is also well-known that preventon is better than cure. Therefore this financial incentive scheme makes sense. The second source reference (BBC News) reports that some smokers have been given a financial incentive to quit smoking. This is beneficial in the long-term for the NHS and for the smokers themselves. To help persons quit smoking lessens the risk of them developing smoking-related diseases and lessons the burden on the NHS if they do not become ill.
This argument only makes sense if financial incentives are not the only driving force behind the smokers/ patients or those being paid. It is greatly undermined if, once the incentives stop being paid, the smokers/ patients will revert back to ther bad habits.
It will improve the lives of our children
Far from the financial gains society has to make from this proposal, there are many social benefits surrounding our children. Children will be able to enjoy their parents company more so if their parents are healthy; their childhood will be improved. In addition, children will pick up on the habits of their parents and in turn will lead healthy lives. This will solve the problem of obesity in society; a currently growing phenomenon.
This is something that people should naturally want for their own children; without any financial incentive. People should wan to improve their child’s health. People should want to live longer and healthier for their kids. Why should we pay people to do what they should want to do anyway?
Healthy living is expensive.
The cost of buying fresh fruit everyday, the cost of sporting activities and clothing; these costs all add up. If the Government wants to save itself money by having less people queuing for NHS treatments then they should help to fund the healthy options. It is no coincidence that the least well off in society have the poorest nutritional diet and the least exercise. Therefore, the financial incentive should be offered to those from poorer backgrounds in order to fund a healthy lifestyle. This is what is necessary.
Healthy living is not expensive. Eating bad food is more often a result of ignorance about prices and benefits than a genuine need to save money. Eating chips and burgers is much more expensive than buying decent food and cooking it at home. People don't need to have high quality sporting equipment in order to get exercise. Playing football in the park requires nothing more than a football and jumpers for goalposts.
It is arguable that offering people financial incentives to take their medicine is the start of a slippery path. This is a point supported by Joanne Shaw (as reported by P Belluck in The New York Times), who suggests that to offer financial incentives to one group of people taking a particular medication would set a bad precedent for the future. Indeed, in light of the need for non-discriminatory actions by public bodies, it places hospitals in a tricky situation. A hospital would have to justify its reasons for treating one group of patients differently to another group of patients for whom it was not granting financial incentives. This is clearly not an ideal financial situation.
The other side said "would set a bad precedent for the future." The future is not that relevant if people die because they aren't motivated to take their medicine. The hospital could start with that when explaining that they gave financial incentives to one group and not another. Then they could rationally explain that they simply gave these incentives to this group and not the other because they thought it would work. Just like a doctor could not be accused of discriminatory actions if she gave a kid a child sized dose and an adult a bigger one. Treatment is supposed to be tailored to the patient's need. He very well need financial incentives.
To incorporate a fincancial incentive system for prescriptions would send out the wrong message. It would reward persons who need a financial incentive in order to take their medicine but would not advantage dilligent and conscientious persons who take their medicine in full knowledgethat they are doing it for their own health and not to benefit their pockets. Indeed, if patients need to take beta-blockers or other such medication to prevent heart attacks but they will only do so if given a finacncial incentive then this is not educating them or giving them knowledge about why or how to change their lifestyle. For instance, there would be little reasoning in giving a patient a financial reward if the outcome would just be that they would spend their financial reward on more unhealthy food. Perhaps a better incentive would be to pay such persons if they present evidence of changing their lifestyle e.g. evidence of visiting the gym or buying healthy food. Meanwhile if conscientious patients who take their medicine without financial reward, become aware of this differential treatment theny they may themselves be encouraged to alter their behaviour and not take their medicine unless they also receive financial award. Hence the scheme could become more expensive than first considered.
Not so, it would create a very good message. If the NHS pays for all treatment people are left with the mentality that his/her involvement is not needed. The government has made all the decisions for the citizen and sent the message that no matter what the person does (smoke, not take his medicine) he would still be treated.
Paying the patient gives the message that he has a huge impact and that his actions are valued. It works as any paid work. It doesn't necessarily have to be a huge pay. But the fact that you are given a salary motivates your work even if that work is not agreeable, like cleaning dishes or taking your medicine.
From reading the source references as above, it is clear that financial incentives appear to be working. However, personally I find it quite worrying that people seem to place greater importance on their financial wealth as opposed to their health. Perhaps the better soluion would be to educate persons on what will happen to them if they do not take their prescriptions. Arguably, most people would prefer to take a pill each day rather than having to undergo an operation.
[[Arguably, most people would prefer to take a pill each day rather than having to undergo an operation.]] When opp says this they are leaving thousands of people in the outside. Some people indeed will change just from getting a lecture from doctors but others will not. Most overweight people know about the risks. Most people know that they have to take steps to better their health, but they still don't. Because education campaigns alone don't give enough motivation. There is always the rationalization that "i'll start/stop tomorrow". The lottery described here [[http://www.nytimes.com/2010/06/14/health/14meds.html?pagewanted=2]] is a way to make today count.
The major flaw with paying perople for taking their medication is that there is no complete way of policing whether the persons have actually taken their medication or whether they are just saying that they have. To set up a policing regime in addition to handing out financial incentives would be costly. Moreover the BBC have reported the government as saying that 'there is no consensus on the effectiveness' of financial incentives. This undermines the scheme and throws into doubt any extra costs incurred by health authorities who pay the financial incentives to patients.
The lack of consensus is not on wether money is a good incentive in general. It's about wether it can continue forever, wether everyone will be equally motivated. The first is not important, if you can motivate a number of people for a while and then keep them out of the hospital for some time, it would still make sense. If some people don't like to be motivated by money, but want to be self motivated, that is great. That doesn't mean it doesn't work for ohers.
What if your idea of a healthy lifestyle differs from the Government's?
For instance, my GP may prescribe me drugs that I am unwilling to take because I don't want to risk the side-effects or don't believe in relying on drugs unless absolutely necessary. I may have been told to drink less or eat the healthier food I can cook at home rather than what I can afford when eating out to increase my physical fitness, but feel that the social side of my lifestyle is more important to me. I would begrudge a person who was being given money just because they conformed more to the rules.
Healthy life style is not about drug choice. In fact many would agree that taking medication for the slightest of illnesses is not healthy.
What is proposed here is a supplement offered to those who lead healthy lives. People who do not binge on food or alcohol, people who exercise. This would not be so strict as to demand certain fruits and vegetables are to be eaten, and what intensity of exercise is needed. Instead it would be an incentive to stick to broad guidelines set by and independent medical board. It is not athletes we are after, but people who look after themselves.
People should be responsible for themselves.
We are always complaining about the nanny state, and yet look what we are proposing; to get pocket money for eating and living well?! This is ridiculous. People should live healthy lifestyles for their own reasons, not for a Government financial incentive! This would just be another area of our lives in which the Government are trying to encroach and control. Something which I believe is typical of a communist state, not a democratic one.
We already have so many cash incentives surrounding issues that we felt as a society needed addressing. We give parents child benefit in order to help with the cost of bringing up children. We give job seekers allowance to those who are actively seeking employment. We give out care allowances to those who look after another individual. How would a healthy living benefit be any different? How can we determine this as one step too far when we already have so many other benefits?
This is only a cover up for failing education
Not just education of our children, but also of our adults. People who know the effects of poor health, people who knew of the benefits of a healthy lifestyle will naturally want to achieve such a state. What the incentive is doing is covering up the lack of knowledge. Instead of people being healthy because they know of the benefits, they will become healthy because of the Government benefits. Surely however this is covering up the real issue with health merely being the side effect – poor education in society. Instead of trying to trick people into caring about their health, we should instead educate them into it.
The Government has spent vast amounts of money into trying to get people educated in health. The measures range from anti-smoking campaign and the recent change for life healthy living campaign. The media has helped bring the issue into the forefront as well. It is not just education we need though; we need to give people that kick in order to make a change. We need that spark. For most people that spark is finance. In the future then, people will use the education to fuel their motivation to live healthy.
In addition, children brought up, even if under the motivation of finance will grow up with a healthy lifestyle and will see the benefits of it first hand. That then will be their motivation to live a healthy life.
How could we possibly measure healthy living?
What possible guidelines would we set? Are you allowed one cigarette a day if you were previously a smoker? Do people have targets that they have to attain in order to qualify for the benefit? Would it be left to GP discretion as to whether their patient got the benefit? Could this not lead to people bribing doctors? The whole idea is so wild that it is unworkable! There are too many variables. Everyone is different. Therefore a consistent approach could not be achieved.
There are taxes set where it is difficult to measure the actual amount of damage done. A carbon tax for example, is based on the amount of damage that will be done to the environment, which is very tricky to measure since we don't know what will happen in the future, but is still taxed.
Tax payers should not have to fork out money to force other's to save themselves
For many healthy living is normal but for those people to have to pay for other people to help themselves. It may save money but it is unethical, those who get paid are benefiting from a longer life (and therefore a longer payment plan) and health as well as receiving money to do so. Those who are healthy any way just lose money
What do you think?