'Pay for Performance for Patients' (P4P4P) schemes are designed to provide incentives to people who make healthy lifestyle changes. Research has revealed that such schemes find die-hard supporters among smokers and overweight people while the response from otherwise healthy people is always lukewarm.
Judith Long and her colleagues at the University of Pennsylvania School of Medicine have observed that much of the argument in favor of such schemes revolves around the point that long-term savings in healthcare costs can be achieved if the payments result in lifestyle changes, such as giving up smoking or maintaining a lower body weight.
The researchers also say that those against such programmes doubt whether these payments actually do result in a change in behavior.
For their study, the team surveyed 515 patients in waiting rooms in primary care practices, and found that the respondents were split almost 50/50 as to whether P4P4P was a good or bad idea.
Overall, smokers and obese individuals were of the view that paying for lifestyle change was a good idea because it would lower everyone's healthcare costs, and insisted that it might be the only effective way to bring about lifestyle change.
The authors attribute this to their difficulties in the past trying to change the behavior in question, whereas individuals without these problems have no idea of the difficulties involved and cannot therefore see the point of incentives.
The study has also revealed that the responses received to some questions were very much based on how the questions were worded.
The researchers observed that, when questioned about health insurance and P4P4P, all respondents were keen on incentives that rewarded individuals for good health behavior, but not keen on those that were seen as punishments.
The respondents thought that it was a good idea to give lower premiums to non-smokers, but not to charge higher premiums to smokers in an effort to get them to stop smoking.
According to the researchers, this finding has dramatic consequences for the planning of future initiatives.
They say that their survey may hold importance for companies planning to give financial incentives for healthy behaviors as well as insurers and policy makers considering its widespread use.
"Given the prevalence of unhealthy behaviors in the US population, serious consideration needs to be given to any approach that may effectively motivate improvements in the rate of healthy behavior," the authors conclude.
They concede that further evidence of effectiveness and cost effectiveness is required because this may lead to wider support for such programs and their efficient targeting.
The findings have been reported in the Springer publication, Journal of General Internal Medicine.