Does Throwing Money at Numbers Support Healthy Behaviors?

November 01, 2011

Money talks when it comes to inspiring short-term wellness action — but does it deliver sustainable results? A recent survey by Towers Watson and the National Business Group on Health reveals more employers are using incentives and penalties to drive participation in health management programs.

Between 2009 and 2011, the use of financial rewards increased by 50% among survey respondents — and 4 out of 5 companies plan to dangle the carrot of financial incentives for participation by 2012. Likewise, the use of financial penalties more than doubled during the same period — and is expected to double again by 2012.

The report goes on to tout significantly higher participation in health risk appraisals (HRAs) and biometric screenings when financial rewards are offered. And 12% of survey respondents reward or penalize based on biometric outcomes such as body mass index or cholesterol levels, with more planning to jump on the bandwagon next year.

Interesting as these numbers are, they beg a couple of questions:

1. Does the carrot and stick approach really make employees care about wellness?

Extrinsic rewards — like money or gifts — can be very effective in motivating people to do something, even if they don’t really want to do it or don’t care about the end result. The reward itself is the motivation. Here’s the problem: once the reward goes away, or the excitement of it wears off, the desired behavior often stops. If you’re running only because someone is chasing you, what happens when you lose them? You stop running.

With intrinsic rewards — like enjoyment, purpose, and personal satisfaction — behavior is self-motivated. If you’re running because it makes you feel good, chances are you’ll stick with it over time.

Employers that offer financial rewards and penalties for wellness participation may not be fostering long-term behavior change; there’s a good chance they’re simply giving employees a reason to jump through a few hoops once or twice a year.

2. Is focusing on biometric outcomes the best way to reduce health risks?

Rubber sweat suits were long touted as a fast and easy way to lose weight by perspiring off extra pounds. People lost weight — through dehydration — and put it right back on when they replaced the fluids they lost. It’s an example of a short-term focus on numbers instead of a long-term focus on behavior.

Give people a number to achieve for a financial incentive, and they’ll come up with all kinds of ways — healthful and stupid — to meet the criteria and claim their rewards. But for a variety of reasons (including genetics) many people struggle to achieve an ideal blood pressure, cholesterol, or body mass index measurement — despite abstaining from tobacco, eating plenty of vegetables, and exercising regularly. Healthcare professionals have a saying: “Don’t focus on the numbers; look at the patient.” Numbers don’t tell the full story… and they don’t give a complete picture of risk or well-being.

In a well-known observational study by Dr. Steven Blair and colleagues, 20,000 men ages 30-83 were followed for an average of 8 years. Results linked fat weight gain with increased risk of dying from heart disease; not a big surprise. But at every level of fatness, physically active subjects had a lower risk of death and disease than sedentary subjects — even normal-weight sedentary subjects.

The behavior made the difference in risk — not a number on the scale; not body mass index. If employers invest resources and energy into helping workers change behavior in sustainable ways — instead of throwing money at numbers — we might see a real change in employee well-being and healthcare expenses.