Financial incentives in the German Statutory Health Insurance: New findings, new questions

Stock, Stephanie; Schmidt, Harald; Büscher, Guido; Gerber, Andreas; Drabik, Anna; Gräf, Christian; Lüngen, Markus; Stollenwerk, Björn

doi:10.1016/j.healthpol.2009.12.015

Cited by 38 publications

(42 citation statements)

References 8 publications

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“…My analysis is based on a review of the public health literature on incentive use and behavior change, personal insights resulting from involvement in the evaluation of incentive programs, 7 and conceptual analysis of the characteristics of incentive users. I began with established concepts and developed a more nuanced framework that can be applied directly to wellness programs in planning, practice, or evaluation.…”

Section: The 5 Groups Problemmentioning

confidence: 99%

“…This assumption appears to underlie the German incentive framework. 7 However, despite the much lower levels of incentives used in Germany, proponents of this view ought to explain why it should be acceptable for the unlucky ones to lose out. It would also be desirable to justify identical treatment for the I'lldo-it-tomorrow group, who have the same aspirations as the yes-I-can group, and the leave-me-alone group.…”

Section: Universal Incentivesmentioning

confidence: 99%

“…Other countries, such as Germany, have had similar systems in place for some time, although incentive levels are usually much lower (generally <$100), no difference in amounts is specified between outcome and process incentives, and financing may come from gain sharing only and not from cost shifting. 7 Individual-level incentives have been used widely outside of health policy. For example, many airlines and supermarkets provide discounts for loyal customers, and auto insurers offer lower premiums for customers with few or no claims.…”

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confidence: 99%

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Wellness Incentives, Equity, and the 5 Groups Problem

Schmidt

2012

Am J Public Health

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Wellness incentives are an increasingly popular means of encouraging participation in prevention programs, but they may not benefit all groups equally. To assist those planning, conducting, and evaluating incentive programs, I describe the impact of incentives on 5 groups: the “lucky ones,” the “yes-I-can” group, the “I'll-do-it-tomorrow” group, the “unlucky ones,” and the “leave-me-alone” group. The 5 groups problem concerns the question of when disparities in the capacity to use incentive programs constitute unfairness and how policymakers ought to respond. I outline 4 policy options: to continue to offer incentives universally, to offer them universally but with modifications, to offer targeted rather than universal programs, and to abandon incentive programs altogether.

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Section: The 5 Groups Problemmentioning

confidence: 99%

Section: Universal Incentivesmentioning

confidence: 99%

mentioning

confidence: 99%

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Wellness Incentives, Equity, and the 5 Groups Problem

Schmidt

2012

Am J Public Health

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“…Despite the growing research on the relation between solidarity and personal responsibility (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) few studies have directly and systematically explored this question for a broad range of unhealthy behaviours.…”

Section: Introductionmentioning

confidence: 99%

Should I pay for your risky behaviours? Evidence from London

Miraldo¹,

Galizzi²,

Merla³

et al. 2014

Preventive Medicine

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We investigate the extent to which respondents from a general population sample in London (JulyAugust 2011) agree or disagree with the NHS covering the healthcare costs related to five risky health behaviours: overeating, unhealthy diet, sedentary life, excess of alcohol, and smoking. For each behaviour, we also directly explore the main factors associated with the likelihood to agree or disagree. Half of the respondents (N=146) manifest agreement with the idea. Wider agreement exists for covering the costs associated to smoking, heavy drinking, and sedentary lives than to overeating, or poor diets. With the exception of alcohol drinking and sedentaray life, there is an almost one-to-one relationship between the agreement that the NHS should pay the healthcare costs associated to a specific behaviour, and the respondents' actual engagement in that behaviour. Those at higher risk of depending on publicly funded healthcare, are more likely to agree.

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“…For example, negative financial incentives are widely applied in the form of taxes on products such as alcohol or tobacco [Grossman et al 1993]. Incentive programs are not unusual for health insurers, who would like their customers to engage in healthy behavior [Stock et al 2010]. However, the use of financial incentives in the treatment of obesity and overweight still raises ethical concerns [Halpern, Madison, and Volpp 2009], and its effectiveness is not well-established with respect to the issue of weight maintenance [Jeffery 2012;John et al 2011;Augurzky et al 2015].…”

Section: Introductionmentioning

confidence: 99%

Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial

Paloyo

Reichert

Reuß‐Borst³

et al. 2015

Social Science & Medicine

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There is a paucity of evidence on the heterogeneous impacts of financial incentives on weight loss. Between March 2010 and January 2012, in a randomized controlled trial, we assigned 700 obese persons to three experimental arms. We test whether particular subgroups react differently to financial incentives for weight loss. Two treatment groups obtained a cash reward (€150 and €300 with 237 and 229 participants, respectively) for achieving an individually-assigned target weight within four months; the control group (234 participants) was not incentivized. Participants and administrators were not blinded to the intervention. We find that monetary rewards effectively induced obese individuals to reduce weight across all subgroups. However, there is no evidence for treatment-effect heterogeneity for those groups that were incentivized. Among those who were in the €300 group, statistically significant and large weight losses were observed for women, singles, and those who are not working (all above 4 kg in four months). In addition, the magnitude of the reward matters only for women and migrants. The effectiveness of financial incentives to reduce weight nevertheless raises sensitive ethical issues that should be taken into consideration by policymakers. In a randomized controlled trial involving 700 obese persons assigned to three experimental arms, we test whether financial incentives have heterogeneous effects over subgroups on weight reduction. Two treatment groups obtained a cash reward (€150 and €300 with 237 and 229 participants, respectively) for achieving an individually-assigned target weight within four months; the control group (234 participants) was not incentivized. Participants and administrators were not blinded to the intervention. We find that monetary rewards effectively induced obese individuals to reduce weight across all subgroups. However, there is no evidence for treatment-effect heterogeneity for those groups that were incentivized. Among those who were in the €300 group, statistically significant and large weight losses were observed for women, singles, and those who are not working (all above 4 kg in four months). In addition, the magnitude of the reward matters only for women and migrants.

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Financial incentives in the German Statutory Health Insurance: New findings, new questions

Cited by 38 publications

References 8 publications

Wellness Incentives, Equity, and the 5 Groups Problem

Wellness Incentives, Equity, and the 5 Groups Problem

Should I pay for your risky behaviours? Evidence from London

Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial

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