Incentivizing Patients to Live Healthy Lives: Does it Work?

Incentivizing Patients to Live Healthy Lives: Does it Work?

Markus Lüngen (University of Applied Sciences Osnabrück, Germany), Anna Marie Passon (University Hospital Cologne, Germany) and Stephanie Stock (University Hospital Cologne, Germany)
DOI: 10.4018/ijpphme.2012010101
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Abstract

Most people know what comprises a healthy lifestyle, but few actually exercise, follow a healthy diet with low salt, fat, sugar, and avoid smoking and alcohol intake. It could be argued that society should incentivize prevention programs which lead to a healthy lifestyle instead of paying afterwards for the costly treatment of diabetes, cardiovascular diseases, and other preventable chronic diseases. The German experience shows that these programs might even work – however, they might work best for already healthy people. It’s still not clear, how prevention programs should be designed to initiate lasting behavior change in groups, which are deprived. It should be questioned whether it’s more cost-effective to simply raise taxes on unhealthy diet or pleasures.
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Introduction

Healthy Lifestyle and Choice

The lifestyle the majority of western societies have adopted is well known to promote chronic diseases such as diabetes, coronary artery disease, and obesity, to name just a few. Noncommunicable diseases are the most common reasons for morbidity and mortality, especially in the industrialized countries. Of the 57 million global deaths in 2008, 36 million, or 63%, were due to noncommunicable diseases (World Health Organisation, n.d.). The WHO estimates an increase in total mortality caused by noncommunicable diseases of 15% worldwide between 2010 and 2020. The Eastern Mediterranean Region is estimated to experience the greatest increase with more than 20% (WHO, 2011).

Regarding the development and increase of noncommunicable diseases, one of the biggest threats is harmful health behavior. The most common harmful health behaviors are smoking, malnutrition, lack of exercise and alcohol misuse. High intake of saturated fat, salt, and sugar for example can cause serious damage to organs and increases the risk of high blood pressure, diabetes, and coronary heart disease (Tourlouki et al., 2009). The steady rise in life-expectancy is highly vulnerable due to obesity and its associated diseases (Olshansky et al., 2005). It is also known that tobacco use is one of the greatest risk factors for non-communicable diseases especially cardiovascular diseases, lung cancers, and other lung diseases (Benowitz, 2003; Barnes, 2000). A recent study proved that never smoking, a body mass index lower than 30, performing 3.5 h/wk or more of physical activity, and adhering to healthy dietary principles lead to a significant reduction of 78% of developing a chronic disease (diabetes (93%), myocardial infarction (81%), stroke (50%), and cancer (36%)) (Ford et al., 2005).

Although most people know what comprises healthy living an unhealthy lifestyle is still common. The causes are manifold including the acceptance of society of intentional health risk behavior among individuals. However, risk factors for an unhealthy lifestyle are not randomly distributed in society. Additionally, preventive interventions that were created by the public health movement mostly attract the middle-class who already engages in health-promoting behaviors.

From a health professional’s perspective, tobacco consumption, a lack of exercises, alcohol misuse and malnutrition are modifiable behavioral risk factors, which should be targeted by primary prevention strategies (Asaria et al., 2007). Nevertheless, the current state of art in prevention and health promotion does not sufficiently meet the potentials it has regarding the amount of harmful health behavior and the resulting burden of disease.

Against this background, the previous study aims on giving an overview on the options to suspend the trend of harmful health behavior and increasing mortality and morbidity due to noncommunicable diseases.

Incentivizing Healthy Living

Independent of the causes, the health care system will inevitably be confronted with the financial and organizational burden of the consequences of unhealthy lifestyles – no matter who will pay for them. Today, The U.S. Centers for Disease Control and Prevention estimate that more than 75% of health care costs are attributable to chronic diseases, including heart disease and diabetes and infers that a comprehensive approach to prevention can considerably reduce the disease burden and save tremendous costs to the health care system (CDC, 2009).

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