Friday, August 3, 2012

[EQ] Incentives, health promotion and equality

Incentives, health promotion and equality

Kristin Voigt

Department of Politics, Philosophy & Religion, Lancaster University, Lancaster, UK

Health Economics, Policy and Law (2012), Volume 7 - Issue 03 -Cambridge University Press

Website – PDF [27p.] at:

“……The use of incentives to encourage individuals to adopt ‘healthier’ behaviours is an increasingly popular instrument in health policy. Much of the literature has been critical of ‘negative’ incentives, often due to concerns about equality; ‘positive’ incentives, however, have largely been welcomed as an instrument for the improvement of population health and possibly the reduction of health inequalities. The aim of this paper is to provide a more systematic assessment of the use of incentives from the perspective of equality.

The paper begins with an overview of existing and proposed incentive schemes. I then suggest that the distinction between ‘positive’ and ‘negative’ incentives – or ‘carrots’ and ‘sticks’ – is of limited use in distinguishing those incentive schemes that raise concerns of equality from those that do not.

The paper assesses incentive schemes with respect to two important considerations of equality: equality of access and equality of outcomes. While our assessment of incentive schemes will, ultimately, depend on various empirical facts, the paper aims to advance the debate by identifying some of the empirical questions we need to ask. The paper concludes by considering a number of trade-offs and caveats relevant to the assessment of incentive schemes….” Abstract

“…………….The framework of incentive schemes is very broad and, as the survey of existing and proposed schemes in Section 2 showed, they can be designed in very different ways; our assessment of incentive schemes must be sufficiently sensitive to these differences. In this paper, I suggested that the distinction between ‘carrots’ and ‘sticks’, or ‘rewards’ and ‘penalties’, is of only limited benefit in assessing these schemes. I identified a number of criteria relevant from the perspective of equality.

These criteria could be helpful both in evaluating the ‘equality impact’ of incentive schemes and in designing schemes in a manner that is sensitive to considerations of equality. I also commented on how these considerations should feed into an overall evaluation of incentive schemes as a tool for improving population health.

At the same time, the paper raised a number of questions that can be answered only on the basis of empirical evidence; the paper identified some of the empirical questions we need to ask to determine whether incentive schemes are consistent with considerations of equality or even a policy tool for the reduction of social inequalities in health……” Author




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