The ethics of giving people incentives to take personal responsibility for their health

One of the major problems the health care field faces is the unwillingness of many people to take personal responsibility for their own health. They make unwise behavioral decisions, prefer to look for “magic pills” to address health issues, and choose only those health care approaches that are paid for by insurance companies or other third-party payers.

Many suggestions have been made as to how to solve this problem and one of the most frequently discussed is to offer some kind of “incentive” for people to change their ways. But too many of those incentives end up rewarding people for having the bad habits to begin with, and penalizing the rest. Others seem to do the opposite and impose punitive measures on people who often make the wrong choices due to ignorance.

ACP logoIn recognition of this problem, the American College of Physicians (ACP) recently released a position paper concerning the ethics of using incentives to promote personal responsibility for health. In it, the ACP stressed that “programs designed to motivate behavior change should be part of a comprehensive strategy for well-being and prevention using evidence-based practice to develop nondiscriminatory programs that do not punish patients for unhealthy behaviors.”

ACP used the West Virginia Medicaid program — one of the early, controversial programs to use incentives — to highlight its positions. Programs that support the patient’s role in promoting positive health outcomes, ACP emphasizes in the paper, should be evidence-based and should focus on increasing access to strategies for prevention and treatment of disease; support patient autonomy and participation in decision making; consider variables influencing comprehension and learning; and respect cultural, religious, and socioeconomic conditions. ACP opposes the use of negative incentives that penalize patients for failing to meet stated goals by withholding or reducing benefits, or by increasing premiums for health insurance.

“Incentive programs should not discriminate against a class or category of people,” said Virginia Hood, MBBS, MPH, FACP, a co-author of the paper for ACP’s Ethics, Professionalism and Human Rights Committee. “Age, gender, race, ethnicity, and socioeconomic status should be carefully considered in designing, implementing, and interpreting results of social and behavioral interventions.”

One of the most interesting and important points the ACP made was that incentive programs should “support a patient’s right to refuse treatment without punitive consequences.” This should also be expanded to include a specific qualification that these programs should support the right to choose any licensed and qualified health and wellness approach, without punitive consequences. The role of chiropractic and other non-medical disciplines in prevention and wellness is well-documented, and if we are to encourage people to take responsibility for their own health, we must ensure they have the rights that go along with the responsibilities — and those rights must include access to non-invasive, drug-free alternatives.

SOURCE:Ethical Considerations for the Use of Patient Incentives to Promote Personal Responsibility for Health: West Virginia Medicaid and Beyond” American College of Physicians, Sept. 2010

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