Offering patients vouchers on the National Health Service as an incentive to reduce unhealthy behaviour such as smoking or drinking could help encourage healthier lifestyles, a public health advisor has suggested.

In a report by Health England, chairman Julian Le Grand suggests that individual behaviours lying at the root of many health problems - such as smoking, excessive drinking, lack of exercise and a poor diet – could be tackled by offering people a financial carrot to change their lifestyles.

“It has long been known that raising the price of cigarettes or alcoholic beverages can be a powerful instrument for reducing smoking or excessive drinking. But there is also an increasing interest in less familiar forms of economic incentive schemes, such as paying people to undertake screening programmes or subsidising gym membership”, he explained.

Citing evidence in support of such incentive schemes, the report highlights a study comparing the effectiveness of methods to promote exercise in Newcastle. In the trial, 55% of patients receiving a combination of motivational interviews and financial incentives increased their levels of physical exercise compared to 35% in the group receiving the interviews alone, showing the potential of such measures.

Furthermore, the report says lessons could be learnt from other countries and sectors already employing the use of incentives to better the health of their populations.

Bonuses and rewards for healthy behaviour are a core aspect of German social health insurance, it points out. And, similarly, private health insurance groups in the UK, such as PruHealth and Humana, are also encouraging members to lead healthier lifestyles by offering free gym membership, for example.

Pilots underway
Incentive schemes are already being tested some trusts in England, although as yet their effectiveness remains to be ascertained.

A local health authority in Dundee, Scotland, for example, has introduced a 12-week scheme under which smokers will be given £12.50 a week for groceries if they have managed to not smoke, which will be checked by a carbon monoxide test.

In another initiative, the Young Foundation Health Launch Pad and Birmingham East and North PCT has set up a social enterprise in which those taking part in healthy activities – such as smoking cessation or undertaking medical reviews - will be awarded points that are redeemable for a variety of benefits, such as sports equipment and mobile phone vouchers.

It is hoped that more trusts throughout the UK will test similar schemes as the need for action on improving public health grows more urgent, and as the government pushes a shift in focus from treatment to prevention to help the NHS cope with the increasing demands of an ageing and fattening society.