The idea that health insurance companies should pay or reward their customers to lead healthier lives poses a set of moral conundrums. Those opposed to such a policy correctly state that a health insurance company should not need to pay individuals to improve their own health. Are not such benefits so appealing in and of themselves that no additional incentives are required? Supporters of such plans will often respond in the following way: Use whatever means that work because the end justifies the means in terms of cost savings and the pursuit of wellness. Here is an excerpt from an article on this topic as it relates to medication compliance (see: Insurers Try Incentives to Improve Medication Adherence):
The poor compliance not only affects quality—nonadherent patients have higher hospitalization and mortality rates, according to research—but it also makes healthcare more expensive. The overall cost of poor adherence, measured in otherwise avoidable medical spending, may account for as much as $290 billion per year, or 13% of total healthcare expenditures, according to an estimate from the New England Healthcare Institute. Insurers have yet to find the right "spoonful of sugar" to cut some of these alarming statistics, but many are experimenting with new incentives and getting creative in their approaches. For instance, Aetna Inc. is funding several pilot projects that test how giving medications to patients for free, rewarding patients for lowering blood pressure, and even giving financial incentives for compliance can improve adherence....The latter approach has been one of the most successful so far. Funded in part by Aetna, a group of researchers from the University of Pennsylvania recently set up a daily lottery with potential financial rewards for patients who had been prescribed warfarin (see: Testing Strategies to Improving Warfarin Adherence). Each day when patients remembered to take their medicine, they had a one-in-five chance of winning $10, or a one-in-100 chance of winning $100. When they missed their medicine, they could still see what they would have won, but didn't, that day.
I personally think that the idea of enrolling patients in a lottery to improve adherence to drug therapy is a brilliant idea. Let's face it, different patients and healthcare consumers respond to different types of incentives. One of the strongest predictors of healthy habits and a long life is the amount of education achieved. This, in turn, correlates strongly with family income, role models, and the quality of public education (see: Family, culture affect whether intelligence leads to education). For many people, the deck is stacked against them in terms of their attitudes toward higher education as well as improving their health status. If a lottery underwritten by small amount of prize money can serve as an incentive for people to take their meds or follow a therapeutic regimen, I support the idea. Note that I say here "a small amount of money." In such a case, the program costs are relatively trivial. They can serve as an incentive but not a false get-rich-quick scheme.