Choi, Seul Ki; Lee, Subin; Park, Eun-ja; Kang, Haeli; Choi, Eunjin; Hwang, Jongnam; Lee, Chung Gun
건강행동; 인센티브; 건강증진; health behavior; incentive; health promotion
국민의 건강생활 실천에 인센티브를 제공하는 건강생활실천지원금제가 2021년 7월부터 시범사업으로 시작되었다. 이 연구는 건강인센티브의 본격적인 제도화 이전에 제도의 설계와 시행과정에서 고려해야 할 점을 파악하고, 정책적 활용 가능성과 예상되는 효과성을 높이기 위한 고려사항을 제시하고자 하였다.
이를 위해 국민의 건강행동 실천 현황을 분석하고 건강인센티브와 관련한 선행연구 및 국내외 사례를 살펴보았으며, 국민과 전문가 대상 인식 조사를 수행했다. 연구 결과를 바탕으로 건강인센티브 제도의 긍정적·부정적 영향에 대한 예상을 제시하였으며, 건강인센티브를 정책적으로 시행하기에 앞서 고려해야 할 사항과 시범사업 운영과 평가에 대한 제언을 제시했다.
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.
Abstract 1 요 약 5
제1장 서론 9 제1절 연구의 배경 및 목적 11 제2절 연구의 내용 및 방법 16
제2장 건강인센티브의 이론적 고찰 21 제1절 건강인센티브에 대한 이론적 논의 23 제2절 건강인센티브 관련 선행연구 고찰 33 제3절 소결 47