Why we should never pay for people to be healthy!
11 October 2010
To encourage people to ditch bad habits, Government health advisory body NICE is considering providing financial incentives (or bribes!).
The idea is to reduce lifestyle-related diseases and save the NHS billions in the long term. Suggestions include supermarket points for unfit people who make it to an exercise class, grocery vouchers for smokers who quit and cash for obese people who shed weight.
At best I'd call this optimistic, at worst, ridiculously na´ve, deeply unfair and a shocking waste of money at a time when cancer patients are denied drugs on the basis of cost. Think of the message it would send: 'Sorry, you have cancer and a drug exists that could prolong your life but you can't have it because there's no money. But there is money for people who've smoked all their lives but have decided it's worth stopping for shopping vouchers.'
Paying someone to ditch bad habits is the ultimate in nanny state mentality - absolving them of any responsibility for their health. The idea is also fraught with practical problems.
Last year an estimated 337,000 stopped smoking in the UK. Would the NHS reward all of them for doing this? What's to stop people taking the rewards and then reverting to their old behaviour? Will people start smoking to cash in on the incentives for giving up? And how practical is it to monitor progress accurately? Plus there's no convincing evidence it would work.
When the Cochrane Collaboration, which reviews health research, looked into incentives to stop smoking, it found early success waned after rewards were no longer available. Meanwhile, a weight-loss scheme in England offering cash incentives saw three-quarters of participants drop out within a year.
The incentive to be healthier already exists in the form of a longer life and massively reduced risk of serious illness. What people need is encouragement and moral support. I'd like to see more money put into methods we know work - prescriptions for WeightWatchers and Slimming World sessions, for instance - and more clinics run at GP surgeries. Nice is now interested in hearing the public's views before issuing guidance.
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