Incentivizing Patients to Live Healthy Lives: Does it Work?

Most people know what comprises a healthy lifestyle, but few actually exercise, follow a healthy diet with low salt, fat, sugar, and avoid smoking and alcohol intake. It could be argued that society should incentivize prevention programs which lead to a healthy lifestyle instead of paying afterwards for the costly treatment of diabetes, cardiovascular diseases, and other preventable chronic diseases. The German experience shows that these programs might even work – however, they might work best for already healthy people. It’s still not clear, how prevention programs should be designed to initiate lasting behavior change in groups, which are deprived. It should be questioned whether it’s more cost-effective to simply raise taxes on unhealthy diet or pleasures. DOI: 10.4018/ijpphme.2012010101 2 International Journal of Public and Private Healthcare Management and Economics, 2(1), 1-6, January-March 2012 Copyright © 2012, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. (Tourlouki et al., 2009). The steady rise in lifeexpectancy is highly vulnerable due to obesity and its associated diseases (Olshansky et al., 2005). It is also known that tobacco use is one of the greatest risk factors for non-communicable diseases especially cardiovascular diseases, lung cancers, and other lung diseases (Benowitz, 2003; Barnes, 2000). A recent study proved that never smoking, a body mass index lower than 30, performing 3.5 h/wk or more of physical activity, and adhering to healthy dietary principles lead to a significant reduction of 78% of developing a chronic disease (diabetes (93%), myocardial infarction (81%), stroke (50%), and cancer (36%)) (Ford et al., 2005). Although most people know what comprises healthy living an unhealthy lifestyle is still common. The causes are manifold including the acceptance of society of intentional health risk behavior among individuals. However, risk factors for an unhealthy lifestyle are not randomly distributed in society. Additionally, preventive interventions that were created by the public health movement mostly attract the middle-class who already engages in healthpromoting behaviors. From a health professional’s perspective, tobacco consumption, a lack of exercises, alcohol misuse and malnutrition are modifiable behavioral risk factors, which should be targeted by primary prevention strategies (Asaria et al., 2007). Nevertheless, the current state of art in prevention and health promotion does not sufficiently meet the potentials it has regarding the amount of harmful health behavior and the resulting burden of disease. Against this background, the previous study aims on giving an overview on the options to suspend the trend of harmful health behavior and increasing mortality and morbidity due to noncommunicable diseases. INCENTIVIZING HEALTHY LIVING Independent of the causes, the health care system will inevitably be confronted with the financial and organizational burden of the consequences of unhealthy lifestyles – no matter who will pay for them. Today, The U.S. Centers for Disease Control and Prevention estimate that more than 75% of health care costs are attributable to chronic diseases, including heart disease and diabetes and infers that a comprehensive approach to prevention can considerably reduce the disease burden and save tremendous costs to the health care system (CDC, 2009). The impact on life expectations, disease burden and economics leads inevitably to the question whether these undesirable consequences could be avoided – for example by paying people for a healthy lifestyle today, and thus save future costs of medical treatments. Some liberal economists argue that individuals with unhealthy lifestyles should pay for the costly consequences themselves. We do not emphasize on this concept. In most European societies, the coverage of healthcare includes some scheme of solidarity (redistribution of money, i.e., healthy individuals pay for the sick). Additionally, the causes of chronic illness cannot be easily and undoubtedly attributed to chance, genetics, or choice of lifestyle. What share of the total burden should a solidaristic society pay for? Moreover, the authors think that society itself should have an interest in keeping their workforce healthy rather than punishing unhealthy workers. The loss of overall productivity in the economy will probably be greater than the investment in promoting a healthy lifestyle today. A politically balanced answer should therefore incorporate health-economic, societal, and ethical aspects. The health-economic perspective does not lead to a clear statement supporting societal investments to reduce unhealthy lifestyle in the form of health prevention programs (or health promoting programs), regardless of whether they are run by an agency, health plan, sports club, or the government itself. One reason for the reluctance of health economics is due to the time effect. One hundred pounds we invest in preventive programs today will be 253 pounds in 20 years based on a 5% interest rate, meaning that the potential capitals for investment will more than reduplicate. 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