Financial incentives in Public Health – how effective are they?

The BBC is reporting that NICE, the advisory body for the health service, is holding a public consultation over whether the NHS in England and Wales should offer financial incentives to encourage healthier lifestyles. This follows an expression of support for the idea from its own citizen’s council.

Will this work? So far the evidence here and here seems to indicate that financial incentives might have a short-term impact, but not necessarily a long-term one. There are also public policy challenges with it. Some members of the public may resent some people being paid for to stop previous unhealthy behaviour, when they didn’t need to themselves. There is also an issue as to whether, with the current public finances, it will be possible to sustain the incentive due to potentially large costs or what then might the impact be on public health if the incentive is then withdrawn?

Dan Pink has written in his book Drive about how in the longer-term intrinsic (non-financial rewards) motivation may prove more effective than extrinsic (payments) motivation. But how do we then determine when best to apply this? And are they the only two types of motivator? As the start of Dan Pink’s RSA lecture shows, he can easily identify at least three types! Are there a range of non-financial incentives that could be applied instead that address intrinsic, extrinsic and security/sustenance motivations?

Values based segmentation is built on the concept of people satisfying various needs, thus it is all about motivation, which is why TCC uses it in behaviour change campaigns. What it enables one to do is directly identify the things that are more likely to motivate people to act. These will vary depending on the values people hold. It also then enables one to communicate that in the right language to have far more chance of engaging with those people in a longer-term relationship.

Too often public health campaign messages are expressed in just the predominantly intrinsic values of the delivery organisation and messages to people who hold differing values are not heard by them. Effective segmentation therefore can make a difference.

In the case of public health incentives, perhaps the aim should be to avoid providing only a rational Homo Economicus approach of “exchange” – in this case money for good behaviour – and ensure one identifies a mix of “motivators” that take account of a range of values and more emotional drivers to change behaviour.

Charlie Mansell is Research and Development Officer for The Campaign Company.

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