Research on Incentives for Promoting Health Behaviors

Abstract

Many health policies have been implemented aiming at improving people’s health behaviors, however, with limited impacts thereon. Many people know why they need to conduct health behaviors, but they face difficulties in conducting and maintaining health behaviors. In that respect, there has been incentives as a means of promoting health behaviors. The Korean government announced a 3-year pilot program in July 2021 to provide incentives to people for conducting health behaviors. Upon the announcement, some health advocates expressed concerns that there is no evidence that incentives could improve people’s health behaviors. In addition, they were concerned that such incentives may worsen the existing health inequity. This study aimed to provide suggestions for consideration on the development and implementation of the government-led healthy incentive program. We conducted an umbrella review on the effectiveness of the incentives on the health behaviors. We also reviewed the domestic and the international health promotion programs and policies using incentives. Statistical analyses using nationally representative survey data were performed to find out differences in conducting and maintaining health behaviors by population groups. Online and phone surveys as well as an expert survey were conducted to assess people’s perception of the incentives for health behaviors. Focus group interviews with people who have participated in incentive programs were conducted. Our literature review showed that incentives could increase health behaviors in the short term, but there is a lack of evidence on the long-term impacts. Incentive programs and policies vary in terms of target populations, behaviors, types of incentives, etc., especially those in other countries. However, some programs showed uncertain impacts on the health behaviors and some were discontinued due to budget issues. Online and phone surveys showed that more than 70% of the survey participants perceived that incentivizing health behaviors is needed. Most experts who participating in our survey also had the same opinion. However, some people were disfavoring such incentives because they think health management is the individual’s responsibility. Some experts expressed concerns about worsening health inequity because disadvantaged people might not be benefitted from the incentive programs. Surveys and focus group interviews revealed that people who already conduct health behaviors or those who consider initiating health behaviors are more willing to participate in incentive programs. This study showed that most people and experts are in favor of the incentive programs, however, the effectiveness of incentives on health behaviors is uncertain. To achieve the aims of incentivizing health behaviors, which are improving people’s health behaviors and health status and reducing medical costs due to unhealthy behaviors, a well-designed pilot health incentive program and its in-depth evaluation would be important. The pilot program could take the advantage of being the ‘pilot’ in testing the various designs in the types of incentives, target populations, target behaviors, etc. The pilot program also needs to be evaluated of its process and short- and long-term impacts on the health behaviors. Improving built environments that could support health behaviors and other health policies that address social determinants of health should be considered with the incentive program.