Healthcare providers’ views on the acceptability of financial incentives for breastfeeding: a qualitative study The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. Coupling Financial Incentives With Direct Mail in Population-Based Practice Patients as Mercenaries?: The Ethics of Using Financial Incentives in the War on Unhealthy Behaviors Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013-15 Study. The effect of physician disclosure of financial incentives on trust. Patient navigation and financial incentives to promote smoking cessation in an underserved primary care population: A randomized controlled trial protocol. Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): a randomized controlled trial of a six month pedometer program with financial incentives. The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland: a natural experiment A systematic review of the use of financial incentives and penalties to encourage uptake of healthy behaviors: protocol Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public You can't pay me to quit: the failure of financial incentives for smoking cessation in head and neck cancer patients. Financial Incentives for Home-Based Health Monitoring: A Randomized Controlled Trial The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care An RCT protocol of varying financial incentive amounts for smoking cessation among pregnant women Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care Some Recent Developments on Financial Incentives for Smoking Cessation Among Pregnant and Newly Postpartum Women Are financial incentives cost-effective to support smoking cessation during pregnancy? Incentives in Diabetic Eye Assessment by Screening (IDEAS): study protocol of a three-arm randomized controlled trial using financial incentives to increase screening uptake in London Effects of Subsidies and Prohibitions on Nutrition in a Food Benefit Program: A Randomized Clinical Trial. Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial Financial incentives and purchase restrictions in a food benefit program affect the types of foods and beverages purchased: results from a randomized trial Strategies for maximizing consent rates for child dental health surveys: a randomised controlled trial
Background Despite a gradual increase in breastfeeding rates , overall in the UK there are wide variations , with a trend towards breastfeeding rates at 6–8 weeks remaining below 40 % in less affluent areas . While financial incentives have been used with varying success to encourage positive health related behaviour change , there is little research on their use in encouraging breastfeeding . In this paper , we report on healthcare providers ’ views around whether using financial incentives in areas with low breastfeeding rates would be acceptable in principle . This research was part of a larger project looking at the development and feasibility testing of a financial incentive scheme for breastfeeding in preparation for a cluster r and omised controlled trial . Methods Fifty – three healthcare providers were interviewed about their views on financial incentives for breastfeeding . Participants were purposively sample d to include a wide range of experience and roles associated with supporting mothers with infant feeding . Semi-structured individual and group interviews were conducted . Data were analysed thematically drawing on the principles of Framework Analysis . Results The key theme emerging from healthcare providers ’ views on the acceptability of financial incentives for breastfeeding  was their possible impact on ‘ facilitating or impeding relationships ’ . Within this theme several additional aspects were discussed : the mother ’s relationship with her healthcare provider and services , with her baby and her family , and with the wider community . In addition , a key priority for healthcare providers was that an incentive scheme should not impact negatively on their professional integrity and responsibility towards women . Conclusion Healthcare providers believe that financial incentives could have both positive and negative impacts on a  mother ’s relationship with her family , baby and healthcare provider . When design ing a financial incentive scheme we must take care to minimise the potential negative impacts that have been highlighted , while at the same time recognising the potential positive impacts for women in areas where breastfeeding rates are low BACKGROUND This study tested the effects of two organizational support processes , the provision of financial incentives for superior clinical performance and the availability of a  patient ( smoker ) registry and proactive telephone support system for smoking cessation , on provider adherence to accepted practice guidelines and associated patient outcomes . METHODS Forty clinics of a large multispecialty medical group practice providing primary care services were r and omly allocated to study conditions . Fifteen clinics each were assigned to the experimental conditions " control " ( distribution of printed versions of smoking cessation guidelines ) and " incentive " ( financial incentive pay-out for reaching preset clinical performance targets ) .  Ten clinics were r and omized to receive financial incentives combined with access to a central ized patient registry and intervention system ( " registry " ) . Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients ' smoking cessation behaviors . RESULTS  Patients ' tobacco use status  was statistically significant ( P < 0.01 ) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition . Patients visiting registry clinics accessed counseling programs statistically significantly more often ( P < 0.001 ) than patients receiving care in the control condition . Other endpoints did not statistically significantly differ between the experimental conditions . CONCLUSIONS The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practice s and patient behaviors was mixed . Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy . However , little is known about how to translate incentive-based strategies to public health practice geared toward improving population -level health , and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail . This study reports results of a population -based r and omized controlled trial testing a direct mail , incentive-based intervention for promoting mammography uptake . The study population was composed of a r and om sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening . Participants ( N = 18,939 ) were r and omized into three groups : ( 1 ) Direct Mail only , ( 2 ) Direct Mail plus Incentive , and ( 3 ) Control . Both direct mail groups received two mailers with a message about the importance of mammography ; however , Mail plus Incentive mailers also offered a $ 25 incentive for getting a mammogram . Logistic regression analyses measured intervention effects . Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups . The use of incentives also proved to be cost-effective . Additionally , the Direct Mail only group was more likely to receive mammography than the Control group . Findings offer experimental evidence on how the population -based strategy of direct mail coupled with a financial incentive can encourage healthy behavior , as well as how incentive-based programs can be translated into health promotion practice aim ed at achieving population -level impact Consider the following paradox : few people would balk if research ers offered smokers $ 1,000 to participate in a year-long r and omized trial of a smoking cessation intervention , yet many would find it distasteful for a large employer to pay its smoking employees an extra $ 1,000 if they remained smoke-free for one year . Such discrepant judgments are underst and able from the perspective of classical economics . Research participants merit compensation for the risks and opportunity costs they endure in the service of public health , whereas individuals should need no reward for promoting their own well being . However , contrary to traditional theories of rationality , people frequently fail to make health-promoting choices , particularly when such choices require short-term sacrifices to foster long-term goals .1,2 Thus , corporate and government health plan leaders are increasingly applying extrinsic motivations such as financial incentives and other programs to augment health – particularly cardiovascular health – while hopefully increasing productivity and restraining costs.3 , 4 Early evidence suggests that financial incentives can effectively promote the cardioprotective behaviors of smoking cessation,5 , 6 weight loss,7 , 8 and cholesterol reduction.9  Incentives are also currently being studied as a means of promoting warfarin adherence.10 Although the results of these early studies are promising , further research is needed to determine which incentive structures and amounts are optimal , assess the ability of incentives to produce sustained behavior changes , and evaluate the cost-effectiveness of implementing incentive programs  . Ethical dimensions of the incentives themselves are also in need of further analysis . For example , some have charged that financial incentive programs are coercive , inequitable , and inconsistent with shared social values.11 Others have even suggested that implementing incentive programs serves to punish patients for their illnesses.12 In this essay , we outline the rationale for incentive programs to promote cardiovascular health , identify the ethical arguments that have been used to challenge such programs , and assess the merits of these arguments Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior , but the effectiveness of those adjustments is controversial . We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight . They were r and omly assigned to a control arm , with no financial incentive for achieving the goal , or to one of three intervention arms offering an incentive valued at $ 550 . Two intervention arms used health insurance premium adjustments , beginning the following year ( delayed ) or in the first pay period after achieving the goal ( immediate ) . A third arm used a daily lottery incentive separate from premiums . At twelve months there were no statistically significant differences in mean weight change either between the control group ( whose members had a mean gain of 0.1 pound ) and any of the incentive groups ( delayed premium adjustment , -1.2 pound ; immediate premium adjustment , -1.4 pound ; daily lottery incentive , -1.0 pound ) or among the intervention groups . The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive design s , larger incentives , or both BACKGROUND Many physicians receive financial incentives to limit their ordering of expensive tests and procedures . While Medicare m and ates disclosure of incentives , it is not clear how to inform patients without undermining trust . METHODS Our objective was to determine public opinion about physician  disclosure of financial incentives and how this might be best communicated to patients . The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households . The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image . Respondents heard 1 of 6 r and omly selected disclosure strategies . The measurements included ratings of trust , satisfaction , agreement with the physician 's decision , and likelihood of remaining with the physician/health plan or seeking a second opinion . RESULTS Nearly half ( 48.8 % ) of respondents had previously heard of financial incentives to limit test ordering . Of the respondents , 94.8 % wanted to be told about incentives , at the time of enrollment in a health plan ( 80.5 % ) , by a health plan representative ( 44.8 % ) , their physician ( 17.1 % ) , or both ( 38.1 % ) . Of the 6 different disclosure strategies , " addressing emotions " and " negotiation " were associated with the best outcomes , while " common enemy " and " denying influences " were most negatively perceived . Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion . CONCLUSIONS The public wants information about physician financial incentives . Specific communication styles enhance how this information is conveyed to patients , increasing trust and supporting the physician-patient relationship Despite the high risk of tobacco-related morbidity and mortality among low-income persons , few studies have connected low-income smokers to evidence -based treatments . We will examine a smoking cessation intervention integrated into primary care . To begin , we completed qualitative formative research to refine an intervention utilizing the services of a patient navigator trained to promote smoking cessation . Next , we will conduct a r and omized controlled trial combining two interventions : patient navigation and financial incentives . The goal of the intervention is to promote smoking cessation among patients who receive primary care in a large urban safety-net hospital . Our intervention will encourage patients to utilize existing smoking cessation re sources ( e.g. , quit lines , smoking cessation groups , discussing smoking cessation with their primary care providers ) . To test our intervention , we will conduct a r and omized controlled trial , r and omizing 352 patients to the intervention condition ( patient navigation and financial incentives ) or an enhanced traditional care control condition .  We will perform follow-up at 6 , 12 , and 18 months following the start of the intervention . Evaluation of the intervention will target several implementation variables : reach ( participation rate and representativeness ) , effectiveness ( smoking cessation at 12 months [ primary outcome ] ) , unintended consequences ( e.g. , purchase of illicit substances with incentive money ) , adoption ( use of intervention across primary care suites ) , implementation ( delivery of intervention ) , and maintenance ( smoking cessation after conclusion of intervention ) . Improving the implementation of smoking cessation interventions in primary care setting s serving large underserved population s could have substantial public health impact , reducing cancer-related morbidity/mortality and associated health disparities Non-communicable diseases ( NCDs ) are emerging as the predominant global health challenge of this century . Physical inactivity is one of the primary risk factors for NCDs . Therefore , increasing physical activity levels is a public health imperative . The arrival of affordable wearable technologies , such as wireless pedometers , provides one strategy for encouraging walking . However , the effectiveness of these technologies in promoting sustained behavior change has not been established . Insights from economics suggest that incentives may be a useful strategy for increasing maintenance and effectiveness of behavior change interventions , including physical activity interventions that rely on wearable technologies . The aim of this trial is to test the effectiveness of a common wireless pedometer with or without one of two types of incentives ( cash or donations to charity ) for reaching weekly physical activity goals . We present here the design and baseline characteristics of participants of this four arm r and omized controlled trial . 800 full-time employees ( desk-bound office workers ) belonging to 15 different worksites ( on average , 53 ( sd : 37 ) employees at each worksite ) were successfully r and omized to one of four study arms . If shown to be effective , wearable technologies in concert with financial incentives may provide a scalable and affordable health promotion strategy for governments and employers seeking to increase the physical activity levels of their constituents Background Financial incentives are often used to influence professional practice , yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood . In keeping with clinical guidelines , Childsmile ( Scotl and ’s oral health improvement programme ) advocates twice yearly fluoride varnish application ( FVA ) for children in dental practice . To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2–5-year-olds ’ teeth through a pilot . In October 2011 payment was extended to all dental practitioners . This paper compares FVA pre- and post-roll-out and explores the financial incentive ’s behavioural mechanisms . Methods A natural experimental approach using a longitudinal cohort of dental practitioners ( n = 1090 ) compared FVA pre- ( time 1 ) and post- ( time 2 ) financial incentive . Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2–5-year-old patients ( novel incentive group )  were compared with all other responses ( continuous incentive group ) . The Theoretical Domains Framework ( TDF ) was used to measure change in behavioural mechanisms associated with the incentive . Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups . Results At time 2 , 709 74 % , of eligible responders , were followed up . In general , FVA rates increased over time for both groups ; however , the novel incentive group experienced a greater increase ( β [ 95 % CI ] = 0.82 [ 0.72 to 0.92 ] ) than the continuous incentive group . Despite this , only 33 % of practitioners reported ‘ always ’ varnishing increased risk 2–5-year-olds ’ teeth following introduction of the financial incentive , 19 % for st and ard risk children . Domain scores at time 2 ( adjusting for time 1 ) increased more for the novel incentive group ( compared to the continuous incentive group ) for five domains : knowledge , social/professional role and identity , beliefs about consequences , social influences and emotion . Conclusions In this large , prospect i ve , population -wide study , a financial incentive moderately increased FVA in dental practice . Novel longitudinal use of a vali date d theoretical framework to underst and behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems . While financial incentives are useful in narrowing the gap between clinical guidelines and FVA , multiple intervention approaches are required Background The use of financial incentives and penalties to encourage uptake of healthy behaviors is increasingly seen as a viable intervention in developed countries . Previous review s of the effectiveness of financial incentives and penalties for encouraging the uptake of healthy behaviors have focused on individual behaviors making it difficult to draw overall conclusions about the effectiveness of such interventions . This systematic review will explore the effectiveness of financial incentives and penalties for encouraging a wide range of behaviors , including : smoking cessation , increased physical activity , healthier dietary intake , sensible patterns of alcohol consumption , safe sun , safe sex , and primary preventive clinical behaviors . Methods Systematic methods will be used to search existing literature and screen studies for inclusion . All studies that meet the following inclusion criteria will be included in the review : participants were 18 years old or older and living in high-income countries ; interventions included cash or cash-like incentives to promote the uptake of healthy behaviors , or cash or cash-like penalties to discourage unhealthy behaviors ; the comparator was usual care or no intervention ; study design was r and omized controlled trial , cluster r and omized controlled trial , controlled before and after study , or interrupted time series analysis . Two review ers will independently screen the publications to ensure they meet the inclusion criteria . Quality will be assessed by two research ers , working independently , using the Cochrane risk of bias tool . Meta- analysis will be conducted , if appropriate . Any studies identified as at ‘ high risk of bias ’ will be excluded from meta- analysis . Discussion This systematic review will provide policy-relevant recommendations for the use of financial incentives and penalties as a method of encouraging uptake of healthy behaviors Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design . Design Cross-sectional survey . Setting and participants British general public . Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers . These were shopping vouchers for : ( 1 ) vali date d smoking cessation in pregnancy and ( 2 ) after birth ; ( 3 ) for a smoke-free home ; ( 4 ) for proven breast feeding ; ( 5 ) a free breast pump ; ( 6 ) payments to health services for reaching smoking cessation in pregnancy targets and ( 7 ) breastfeeding targets . Ipsos MORI used area quota sampling and home-administered computer-assisted question naires , with r and omised question order to assess agreement with different incentives ( measured on a five-point scale ) . Demographic data and target behaviour experience were recorded . Analysis used multivariable ordered logit models . Results Agreement with incentives was mixed ( ranging from 34 % to 46 % ) among a representative sample of 1144 British adults .  Mean agreement score was highest for a free breast pump , and lowest for incentives for smoking abstinence after birth . More women disagreed with shopping vouchers than men . Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump . Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over , particularly provider targets for smoking cessation . Non-white ethnic groups agreed particularly with breastfeeding incentives . Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours . Up to £ 40/month vouchers for behaviour change were acceptable ( > 85 % ) . Conclusions Women and the less educated were more likely to disagree , but men and women of childbearing age to agree , with incentives design ed for their benefit . Trials evaluating reach , impact on health inequalities and ethnic groups are required prior to implementing incentive interventions . Trial registration number CRD42012001980 OBJECTIVE A prospect i ve r and omised study was conducted at a tertiary care hospital to evaluate the effects of financial incentives for smoking cessation targeted at a high-risk population . METHODS Patients with a past history of head and neck cancer were voluntarily enrolled over a two-year period . They were r and omised to a cash incentives or no incentive group . Subjects were offered enrolment in smoking cessation courses .  Smoking by-product levels were assessed at 30 days , 3 months and 6 months . Subjects in the incentive group received $ 150 if smoking cessation was confirmed . RESULTS Over 2 years , 114 patients with an established diagnosis of head and neck cancer were offered enrolment . Twenty-four enrolled and 14 attended the smoking cessation classes . Only two successfully quit smoking at six months . Both these patients were in the financially incentivised group and received $ 150 at each test visit . CONCLUSION Providing a financial incentive for smoking cessation to a population already carrying a diagnosis of head and neck cancer in order to promote a positive behaviour change was unsuccessful ABSTRACT BACKGROUND Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases , but daily engagement rates among these patients may be low . OBJECTIVE To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes . DESIGN R and omized , controlled trial . ( Clinical trials.gov Identifier : NCT01282957 ) . PARTICIPANTS Seventy-five patients with a hemoglobin A1c greater than or equal to 7.5 % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System . INTERVENTIONS Twelve weeks of daily home-monitoring of blood glucose , blood pressure , and weight ( control group ; n = 28 ) ; a lottery incentive with expected daily value of $ 2.80 ( n = 26 ) for daily monitoring ; and a lottery incentive with expected daily value of $ 1.40 ( n = 21 ) for daily monitoring . MAIN MEASURES Daily use of three home-monitoring devices during the three-month intervention ( primary outcome ) and during the three-month follow-up period and change in A1c over the intervention period ( secondary outcomes ) .KEY RESULTS Incentive arm participants used devices on a higher proportion of days relative to control ( 81 % low incentive vs. 58 % , P = 0.007 ; 77 % high incentive vs. 58 % , P = 0.02 ) during the three-month intervention period . There was no difference in adherence between the two incentive arms ( P = 0.58 ) . When incentives were removed , adherence in the high incentive arm declined while remaining relatively high in the low incentive arm . In month 6 , the low incentive arm had an adherence rate of 62 % compared to 35 % in the high incentive arm ( P = 0.015 ) and 27 % in the control group ( P = 0.002 ) . CONCLUSIONS A daily lottery incentive worth $ 1.40 per day improved monitoring rates relative to control and had significantly better efficacy once incentives were removed than a higher incentive Objective . Immunizations and other cost-effective preventive services remain underused by many children , especially those living in poverty . Given the effectiveness of provider-based tracking systems and the widespread use by managed care organizations of financial incentives to influence physician practice patterns , we design ed and tested an intervention combining these strategies . We studied whether a system of semiannual assessment and feedback , coupled with financial incentives , could improve pediatric preventive care in a Medicaid health maintenance organization ( HMO ) . Methodology . We r and omly assigned primary care sites serving children in a Medicaid HMO to one of three groups : a feedback group ( where physicians received written feedback about compliance scores ) , a feedback and incentive group ( where physicians received feedback and a financial bonus when compliance criteria were met ) , and a control group . We evaluated compliance with pediatric preventive care guidelines  through semiannual chart audits during the years 1993 to 1995 . Results . Compliance with pediatric preventive care improved dramatically in the study period . Repeated measures ANOVA demonstrated a significant increase in all three study groups throughout the time in total compliance scores ( from 56%–73 % ) , as well as scores for immunizations ( from 62%–79 % ) and other preventive care ( from 54%–71 % ) . However , no significant differences were observed between either intervention group and the control group , nor were there any interaction ( group-by-time ) effects . Conclusions . Feedback to physicians , with or without financial incentives , did not improve pediatric preventive care in this Medicaid HMO during a time of rapid , secular improvements in care . Possible explanations include the context and timing of the intervention , the magnitude of the financial incentives , and lack of physician awareness of the intervention Background Smoking during pregnancy is harmful to the unborn child . Few smoking cessation interventions have been successfully incorporated into st and ard antenatal care . The main aim of this study is to determine the feasibility of a personal financial incentive scheme for encouraging smoking cessation among pregnant women . Design A pilot r and omised control trial will be conducted to assess the feasibility and potential effectiveness of two varying financial incentives that increase incrementally in magnitude ( $ 20 vs. $ 40AUD ) , compared to no incentive in reducing smoking in pregnant women attending an Australian public hospital antenatal clinic . Method Ninety ( 90 ) pregnant women who self-report smoking in the last 7 days and whose smoking status is biochemically verified , will be block r and omised into one of three groups : a. No incentive control group ( n=30 ) , b. $ 20 incremental incentive group ( n=30 ) , and c. $ 40 incremental incentive group ( n=30 ) . Smoking status will be assessed via a self-report computer based survey in nine study sessions with saliva cotinine analysis used as biochemical validation . Women in the two incentive groups will be eligible to receive a cash reward at each of eight measurement points during pregnancy if 7-day smoking cessation is achieved . Cash rewards will increase incrementally for each period of smoking abstinence . Discussion Identifying strategies that are effective in reducing the number of women smoking during pregnancy and are easily adopted into st and ard antenatal practice is of utmost importance . A personal financial incentive scheme is a potential antenatal smoking cessation strategy that warrants further investigation . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) number : Abstract Background Uptake of health checks for cardiovascular risk assessment in primary care in Engl and is lower than anticipated . The question -behavior effect ( QBE ) may offer a simple , scalable intervention to increase health check uptake . Purpose The present study aim ed to evaluate the effectiveness of enhanced invitation methods employing the QBE , with or without a financial incentive to return the question naire , at increasing uptake of health checks . Methods We conducted a three-arm r and omized trial including all patients at 18 general practice s in two London boroughs , who were invited for health checks from July 2013 to December 2014 . Participants were r and omized to three trial arms : ( i ) St and ard health check invitation letter only ; ( ii ) QBE question naire followed by st and ard invitation letter ; or ( iii ) QBE question naire with offer of a financial incentive to return the question naire , followed by st and ard invitation letter . In intention to treat analysis , the primary outcome of completion of health check within 6 months of invitation , was evaluated using a p value of .0167 for significance . Results 12,459 participants were r and omized .  Health check uptake was evaluated for 12,052 ( 97 % ) with outcome data collected . Health check uptake within 6 months of invitation was : st and ard invitation , 590 / 4,095 ( 14.41 % ) ; QBE question naire , 630 / 3,988 ( 15.80 % ) ; QBE question naire and financial incentive , 629 / 3,969 ( 15.85 % ) . Difference following QBE question naire , 1.43 % ( 95 % confidence interval −0.12 to 2.97 % , p = .070 ) ; following QBE question naire and financial incentive , 1.52 % ( −0.03 to 3.07 % , p = .054 ) . Conclusions Uptake of health checks following a st and ard invitation was low and not significantly increased through enhanced invitation methods using the QBE Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes and immediate and longer-term adverse health outcomes among exposed offspring . Developing more effective smoking cessation interventions for pregnant women has been a public health priority for more than 30 years . We review developments over the past 3 years ( 2012–2015 ) on the use of financial incentives to promote smoking cessation among pregnant women . We search ed the literature for reports on primary and secondary analyses and review s of controlled trials on this topic published in peer- review ed journals using the search engine PubMed , review ed bibliographies of published articles , and consulted expert colleagues . The search revealed several important developments , with the following three being especially noteworthy . First , the review identified four new r and omized controlled trials , three of which further supported the efficacy of this treatment approach . One of the three trials supporting efficacy also included the first econometric analysis of this treatment approach showing financial incentives with pregnant smokers to be highly cost-effective . Second , two Cochrane review s were published during this 3-year period covering the more recent and earlier efficacy trials . Meta-analyses in both review s supported the efficacy of the approach . Lastly , the first effectiveness trial was reported demonstrating that  financial incentives increased abstinence rates above control levels when implemented by obstetrical clinic staff in a large urban hospital working with community tobacco interventionists . Overall , there is a growing and compelling body of evidence supporting the efficacy and cost-effectiveness of  financial incentives for smoking cessation among pregnant women AIMS To investigate the cost-effectiveness of up to £ 400 worth of financial incentives for smoking cessation in pregnancy as an adjunct to routine health care . DESIGN Cost-effectiveness analysis based on a Phase II r and omized controlled trial ( RCT ) and a cost-utility analysis using a life-time Markov model . SETTING The RCT was undertaken in Glasgow , Scotl and . The economic analysis was undertaken from the UK National Health Service ( NHS ) perspective . PARTICIPANTS A total of 612 pregnant women r and omized to receive usual cessation support plus or minus financial incentives of up to £ 400 vouchers ( US $ 609 ) , contingent upon smoking cessation . MEASUREMENTS Comparison of usual support and incentive interventions in terms of cotinine-vali date d quitters , quality -adjusted life years ( QALYs ) and direct costs to the NHS . FINDINGS The incremental cost per quitter at 34 - 38 weeks pregnant was £ 1127 ($1716).This is similar to the st and ard look-up value derived from Stapleton & West 's published ICER tables , £ 1390 per quitter , by looking up the Cessation in Pregnancy Incentives Trial ( CIPT ) incremental cost ( £ 157 ) and incremental 6-month quit outcome ( 0.14 ) . The life-time model result ed in an incremental cost of £ 17 [ 95 % confidence interval ( CI ) = -£93 , £ 107 ] and a gain of 0.04 QALYs ( 95 % CI = -0.058 , 0.145 ) , giving an ICER of £ 482/QALY ( $ 734/QALY ) . Probabilistic sensitivity analysis indicates uncertainty in these results , particularly regarding relapse after birth . The expected value of perfect information was £ 30 million ( at a willingness to pay of £ 30 000/QALY ) , so given current uncertainty , additional research is potentially worthwhile . CONCLUSION Financial incentives for smoking cessation in pregnancy are highly cost-effective , with an incremental cost per quality -adjusted life years of £ 482 , which is well below recommended decision thresholds Background Diabetes is an increasing public health problem in the UK and globally . Diabetic retinopathy is a microvascular complication of diabetes , and is one of the leading causes of blindness in the UK working age population . The diabetic eye screening programme in Engl and aims to invite all people with diabetes aged 12 or over for retinal photography to screen for the presence of diabetic retinopathy . However , attendance rates are only 81 % , leaving many people at risk of preventable sight loss . Methods This is a three arm r and omized controlled trial to investigate the impact of different types of financial incentives ( based on principles from behavioral economics ) on increasing attendance at  diabetic eye screening appointments in London . Eligible participants will be aged 16 or over , and are those who have been invited to screening appointments annually , but who have not attended , or telephoned to rearrange an appointment , within the last 24 months . Eligible participants will be r and omized to one of three conditions:1.Control condition ( usual invitation letter)2.Fixed incentive condition ( usual invitation letter , including a voucher for £ 10 if they attend their appointment)3.Probabilistic incentive condition ( invitation letter , including a voucher for a 1 in 100 chance of winning £ 1000 if they attend their appointment ) . Participants will be sent invitation letters , and the primary outcome will be whether or not they attend their appointment . One thous and participants will be included in total , r and omized with a ratio of 1.4:1:1 . In order to test whether the incentive scheme has a differential impact on patients from different demographic or socio-economic groups , information will be recorded on age , gender , distance from screening center , socio-economic status and length of time since they were last screened . A cost-effectiveness analysis will also be performed . Discussion This study will be the first trial of financial incentives for improving uptake of diabetic eye screening . If effective , the intervention may suggest a cost-effective way to increase screening rates , thus reducing unnecessary blindness . Trial registration IS RCT N14896403 , 25 February Importance Strategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program ( SNAP ) are of interest to policymakers . Objective To evaluate whether the proposed policy of incentivizing the purchase of fruits and vegetables and prohibiting the purchase of less nutritious foods in a food benefit program improves the nutritional quality of participants ' diets . Design , Setting , and Participants Lower income participants ( n = 279 ) not currently enrolled in SNAP were r and omized to 1 of 4 experimental financial food benefit conditions : ( 1 ) incentive ( 30 % financial incentive for fruits and vegetables purchased using food benefits ) ; ( 2 ) restriction ( not allowed to buy sugar sweetened beverages , sweet baked goods , or c and ies with food benefits ) ; ( 3 ) incentive plus restriction ( 30 % financial incentive on fruits and vegetables and restriction of purchase of sugar sweetened beverages , sweet baked goods , or c and y with food benefits ) ; or ( 4 ) control ( no incentive or restrictions on foods purchased with food benefits ) . Participants in all conditions were given a study -specific debit card where funds were added every 4 weeks for a 12-week period . Outcome measures were collected at baseline and in the final 4 weeks of the experimental period . Main Outcomes and Measures Primary outcomes ( from 24-hour dietary recalls ) included intake of energy , discretionary calories , and overall diet quality . Results A number of favorable changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition . These included ( 1 ) reduced intake of energy ( -96 kcal/d , st and ard error [ SE ] , 59.9 ) ; ( 2 ) reduced intake of discretionary calories ( -64 kcal/d , SE 26.3 ) ; ( 3 ) reduced intake of sugar sweetened beverages , sweet baked goods , and c and ies ( -0.6 servings/d , SE 0.2 ) ; ( 4 ) increased intake of solid fruit ( 0.2 servings/d , SE 0.1 ) ; and ( 5 ) improved Healthy Eating Index score ( 4.1 points , SE 1.4 ) . Fewer improvements were observed in the incentive only and restriction only arms . Conclusions and Relevance A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions . Clinical Trial Registration clinical trials.gov Identifier : NCT02643576 Objectives To test the impact of provider performance pay for anaemia reduction in rural China . Design A cluster r and omised trial of information , subsidies , and incentives for school principals to reduce anaemia among their students . Enumerators and study participants were not informed of study arm assignment . Setting 72 r and omly selected rural primary schools across northwest China . Participants 3553 fourth and fifth grade students aged 9 - 11 years . All fourth and fifth grade students in sample schools participated in the study . Interventions Sample schools were r and omly assigned to a control group , with no intervention , or one of three treatment arms : ( a ) an information arm , in which principals received information about anaemia ; ( b ) a subsidy arm , in which principals received information and unconditional subsidies ; and ( c ) an incentive arm , in which principals received information , subsidies , and financial incentives for reducing anaemia among students . Twenty seven schools were assigned to the control arm ( 1816 students at baseline , 1623 at end point ) , 15 were assigned to the information arm ( 659 students at baseline , 596 at end point ) , 15 to the subsidy arm ( 726 students at baseline , 667 at end point ) , and 15 to the incentive arm ( 743 students at baseline , 667 at end point ) . Main outcome measures Student haemoglobin concentrations . Results Mean student haemoglobin concentration rose by 1.5 g/L ( 95 % CI –1.1 to 4.1 ) in information schools , 0.8 g/L ( –1.8 to 3.3 ) in subsidy schools , and 2.4 g/L ( 0 to 4.9 ) in incentive schools compared with the control group . This increase in haemoglobin corresponded to a reduction in prevalence of anaemia ( Hb < 115 g/L ) of 24 % in incentive schools . Interactions with pre-existing incentives for principals to achieve good academic performance led to substantially larger gains in the information and incentive arms : when combined with incentives for good academic performance , associated effects on student haemoglobin concentration were 9.8 g/L ( 4.1 to 15.5 ) larger in information schools and 8.6 g/L ( 2.1 to 15.1 ) larger in incentive schools . Conclusions Financial incentives for health improvement were modestly effective . Underst and ing interactions with other motives and pre-existing incentives is critical . Trial registration number IS RCT N76158086 Background This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people . Methods Participants ( n=279 ) were r and omized to groups : 1 ) Incentive- 30 % financial incentive for fruits and vegetables purchased with food benefits ; 2 ) Restriction- no purchase of sugar-sweetened beverages , sweet baked goods , or c and ies with food benefits ; 3 ) Incentive plus Restriction ; or 4 ) Control- no incentive or restrictions . Participants received a study -specific debit card where funds were added monthly for 12-weeks . Food purchase receipts were collected over 16 weeks . Total dollars spent on grocery purchases and by targeted food categories were computed from receipts . Group differences were examined using general linear models . Results Weekly purchases of fruit significantly increased in the Incentive plus Restriction ( $ 4.8 ) compared to the Restriction ( $ 1.7 ) and Control ( $ 2.1 ) groups ( p < .01 ) . Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction(−$0.8 per week ) and Restriction ( $ -1.4 per week ) groups compared to the Control group ( + $ 1.5 ; p < .0001 ) . Sweet baked goods purchases significantly decreased in the Restriction ( −$0.70 per week ) compared to the Control group ( + $ 0.82 per week ; p < .01 ) . Conclusions Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions . Clinical trial registration Clinical trials.gov Identifier : NCT02643576 Background Poor response rates can jeopardise the validity of the findings of epidemiological surveys . The aim of this study was to undertake a r and omised controlled trial to determine the effectiveness of different strategies for maximizing parental consent rates for dental health surveys of young children . Methods The trial took place within the 2007/2008 NHS Epidemiological Dental Health Survey of 5-year-old children in the North West of Engl and . Schools were r and omised to one of five interventions : multiple letters to parents ; promoting the research by providing additional information to parents and children ; a financial incentive to the school ; a financial incentive to the school administrator plus direct mailing to parents ; and a control intervention comprising of usual practice , that is a single letter home to parents via the children . Results A total of 335 schools ( 11,088 children ) were recruited . The mean percentage consent rates ranged from 47 % ( financial incentive to school administrator plus direct mailing ) to 63 % ( multiple letters ) . Pair-wise comparisons indicated that the multiple letter group had a statistically significantly greater consent rate than the financial incentive to the school administrator plus direct mailing group and promoting the research by providing additional information group , but was not statistically significantly different from the financial incentive to the school group and the control group . Conclusions There was little evidence to show that any of the five interventions made a significant difference to consent rates when compared to the control group . Financial incentives to schools were less effective than multiple reminder letters to parents . Trials should be built into surveys to test different interventions , in different context s to exp and the evidence base for improving consent rates in health surveillance programmes
Results Current evidence indicates that incentives can be effective in driving health behaviour change under certain provisos , while a number of misgivings continue to be deliberated on .
Conclusion These key principles can assist policy makers in making decisions on the use of financial incentives directed at achieving improvements in public health
Background The use of financial incentives or pay-for-performance programs for health care providers has triggered emerging interest in the use of financial incentives for encouraging health behaviour change .
Purpose This paper aims to identify key conditions under which the use of financial incentives for improvements in public health outcomes is most likely to be effective and appropriate .