Obese patients in Kent, southern England, are being paid up to £425 ($1000) to lose weight by the National Health Service in a trial to test whether financial incentives can be used to change unhealthy behaviour.
In Essex, pregnant women who smoke are being offered up to £100 in food vouchers on the NHS if they give up. Payments are made after one week, one month and one year.
A review of the use of financial incentives in health says the approach has divided Britain's health community. Some condemn it as bribery and coercion, which rewards people for unhealthy behaviour. Others see it as the obverse of taxation, giving money back to people for healthy behaviour instead of making them pay (in tobacco and alcohol duty) for unhealthy behaviour.
Personal financial incentives are increasingly being used to persuade people to change unhealthy habits. But unlike tax they are targeted at individuals rather than populations. One of the highest rewards was offered by General Electric in the United States to staff who stopped smoking. They were paid up to US$750 ($1300) with the major part (US$400) payable only after 12 months of abstinence.
Theresa Marteau, professor of health psychology at Kings College, London, lead author of the review published in the online version of the British Medical Journal, said: "The theory is that much of our behaviour - 45 per cent - is habitual. The idea of incentives is to help break bad habits and once the new habit is established, the incentive can be removed. But unless you change the environment the chances of success are reduced."
She added: "This is about understanding human frailty. Most people don't want to be overweight or keep smoking but find it difficult to do anything about it. If we can kick start a change in their habits then that is good for them and for the rest of us."
Paying people to change their habits works because it offers immediate rewards for behaviour that will only provide a health benefit in years ahead. The approach was recommended last month in a report by Health England, a government advisory group chaired by a former No 10 health adviser, Professor Julian Le Grand.
Le Grand, a health policy expert at the London School of Economics, said: "One of the main problems facing both individuals and the Government is that we reap the costs of unhealthy activities in the future whereas we experience their pleasures and benefits today. The 18-year-old smoker does not think about dying of lung cancer at 60. Policies have to be developed that bring some of the costs of unhealthy activities - or the benefits of healthy ones - back from the future."
The idea of paying patients to promote health originated in the developing world where it has been successfully used to encourage one-off responses, such as attendance at clinics or uptake of vaccinations. But changing behaviour has proved harder. A review of 17 trials of the use of payments to help people give up smoking found the effects only lasted as long as the incentives were paid. Similarly nine weight loss trials showed no benefit from payments after 18 months.
