Getting paid to take your medicine - good incentive or bad policy?
Or to put in another way, could some of the financial elements of NBC's The Biggest Loser get translated into real life?
Those questions are being asked in several studies from two University of Pennsylvania School of Medicine researchers, Dr. Kevin G. Volpp and Dr. Stephen E. Kimmel.
In the first set of three studies, all relatively small in size, patients with a possibility of strokes who regularly fail to take their blood thinner medicine warfarin are offered a lottery-like incentive program.
Each day patients open a videocassette-sized pill box with multiple compartments and take out a pill. By doing so, they can win from $10 to $100. In the latest version of the study, when they open the pill box, an LCD screen pops up saying whether they won and how much. The winnings come frequently -- one out of five times for the $10 and one out of 100 times for the $100 -- and checks come monthly. The LCD results are regularly checked against the levels of warfarin in a patient's blood level.
This fall, through a grant from the National Institute of Health, similar incentives will be offered to quit smoking, lose weight and take pills for sleep apnea.
It may seem illogical that concerns for their health aren't sufficient enough to motivate patients to take their pills, but according to Volpp, director of the Center for Health Incentives at the university, that's unfortunately not the case. "You would think there would be adequate motivation to prevent a stroke, but it's not what we see," Volpp said. "People tend to [put more weight on] the immediate cost and benefits, versus long term."
Plus, Volpp added, "A lot of people don't like having to take medicine because it reminds them about having an illness they don't like to remember."
The studies and several others are examining whether some outside financial motivation could change bad habits and get people used to taking their pills.
"The current health care financing system is that we let people make decisions about themselves and then just deal with the consequences of that decision," said Volpp. "If someone in a company chooses to smoke, his fellow employees subsidize him."
According to Volpp, the study indicates that the payments work. But he said there is no anticipation people would get paid long term to take their medicines. Instead, the studies seek to determine whether "micro incentives" can lower health care costs by getting people used to taking their pills.
Volpp said that while the studies are small, there has been no evidence so far that socioeconomic differences affect the effectiveness of the incentives. He also said that while costs of the program are dropping, the study is still a test. Implementing the incentives nationally would require costs for the pill box to drop further.
The studies purposely use smaller payments rather than a lottery-like chance for a mega-payment to win over patients, who see the rewards as more obtainable. "Our general sense is we want to give people positive feedback and the allure of a [$100] award," he says. "To have a large prize that people never win in a six-month program might have led to negative reinforcement."