Financial incentives encourage healthy behavior—why aren’t they used more often?

Move more, quit smoking, lose weight: great resolutions, hard to keep. But does it get easier if there is a financial incentive in return? According to research by Radboud University and others, it can be an effective tool, although there are still some obstacles. They presented their findings this week in Economisch Statistische Berichten (ESB).

Some lifestyle interventions are more effective than others, but in general, financial incentives are a ‘powerful tool to help reduce health inequalities in the Netherlands,” says Koen van der Swaluw of Radboud University.

Despite knowing more and more about the effectiveness of financial incentives to promote lifestyle, they are still relatively little used. Health insurer ASR scrapped a reward program for healthy behavior earlier in 2024. Together with colleagues Stefan Lipman (Erasmus University) and David de Buisonjé (Delft University of Technology, Leiden University), Van der Swaluw mapped the barriers to introducing rewards for healthy behavior.

“Around financial incentives, there are often objections about the limited long-term effects: will someone continue the changed behavior once the incentive ends? There are opportunities for follow-up research there,” says van der Swaluw. “For instance, there have been successful programs to discourage smoking during pregnancy, programs that have long-term effects.”

Not opera, but football

ASR changed its rewards program because mainly active people used it. “But if you align the rewards with the desires of people who are not yet active, you probably have a better chance. What we see in literature reviews is that rewards do not always match the recipient. Simply put: don’t give away tickets to the opera, for example, but to football matches.” Finally, there are often concerns about the cost of financial incentives.

Van der Swaluw and colleagues suggest that financial incentives—like curative care—could be reimbursed from collective health insurance if they prove cost-effective on the basis of a social cost-benefit analysis. Employers could also play a role in encouraging healthy behavior and assume (part of) the costs.

No panacea

Although the effectiveness of incentives is becoming increasingly clear, they should not be seen as a panacea, according to the researchers. “In no way are they a replacement for policies aimed at structural aspects of unhealthy behavior, such as exercise or food supply in the neighborhood someone lives in, poverty, cultural influences and national or international laws and regulations. Healthy behavior is and remains a consequence of an interplay of individual behavior and environmental influences.”

From November 2024, van der Swaluw and colleagues will start the SPRINTS (Sports Pricing Research to INcrease Sport Participation) project in collaboration with the HAN University of Applied Sciences, among others, investigating how prices influence sports and exercise participation. They previously published a study on rewards for smoking cessation, which appeared in BMC Public Health.