Why is it hard to make positive changes in our behavior, like getting into a weekly workout rhythm or eating healthier?
We asked a team of scientists a few questions about behavior change and will be sharing their answers to our questions over the next few months.
This month’s question: How do cash incentives influence behavior change?
Here’s what a few of them had to say.
Assess the incentive’s lifespan
The question of cash incentives influencing behavior is a complicated one, according to Kevin Volpp, MD, PhD, Director at Center for Health Incentives and Behavioral Economics and the Founders President’s Distinguished Professor, Perelman School of Medicine and the Wharton School at the University of Pennsylvania.
For starters: The amount of cash. “If it’s very small, it’s probably demotivating since the cash may ‘crowd out’ intrinsic motivation without providing sufficient supplemental motivation. If the incentives are too large, they may become the reason people are doing an activity,” says Volpp.
Another factor to consider is the duration of the incentive. “Careful assessment of the comparative effectiveness of different incentive designs is important, in terms of making sure that the short- and long-term effectiveness is as high as possible,” adds Volpp.
However, in some cases, cash can be effective. “Quitting smoking is difficult and requires a lot of effort up front. The evidence suggests that incentives can triple long-term smoking cessation rates,” Volpp says.
Use cash incentives as a jump-start
Previous research has shown that small cash incentives can help people jump-start healthy routines like working out regularly, says John Beshears, PhD. He is the Terrie F. and Bradley M. Bloom Associate Professor of Business Administration at Harvard Business School.
“Financial rewards, even if they are temporary, can help people focus on starting down the path toward building positive habits,” Beshears says. “Once they start on that path, they begin to figure out ways of integrating those positive habits more seamlessly into their day-to-day lives, so when the incentives are no longer available, people are still left with those positive habits embedded into their daily routines.”
Don’t let money do the heavy lifting
“Chlorophyll isn’t the only green catalyst. There are plenty of examples where cash incentives influence behavior change in health,” says David Asch, MD, MBA, Executive Director of the Penn Medicine Center for Health Care Innovation, the John Morgan Professor of Medicine, Medical Ethics, and Health Policy at Perelman School of Medicine, and a professor of Health Care Management and Operations, Information, and Decisions at the Wharton School at the University of Pennsylvania. “People’s choices about health lifestyles (including their fitness, weight, smoking or medication adherence) have each been shown to be affected by financial incentives.”
But that’s only the superficial story, adds Asch, as much of the time cash incentives are used transactionally.
“That’s a somewhat simplistic and, it turns out, tepid approach to changing behavior. It assumes that the cash is, literally, the currency of the motivation. That may make sense in piecework settings where people are already selling goods or services for money,” Asch explains. But it makes less sense in most health care situations, he says. “After all, although people like more money than less, they already have many motivations to improve their health. And in some cases, adding money to a system fundamentally fueled by intrinsic motivation can cheapen the process and backfire. Any parent who has tried to bribe a child for good behavior knows this.”
Instead of transactional incentives, Asch suggests cash should be used more “as a garnish than an entrée: something to enhance the main event but not replace it. In a friendly wager of $1, or a penny stakes poker game, people aren’t seeking riches. They’re just keeping it real.”
A good approach would be using cash incentives to complement the positive behavioral pathways we’re already on—with a focus on the present instead of the future.
“We worry more about losing ground than gaining it. We stick with our current pathway even when a new pathway is better. Those are some of the main motivators in our lives,” say Asch. “Cash incentives can leverage those behavioral pathways to great effect but, in matters of health, cash can’t do the heavy lifting on its own.”
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