Monday, October 24, 2011: 2:00 PM
Columbus Hall AB (Hyatt Regency Chicago)
(BEC) Behavioral Economics

Scott D. Halpern, MD, PhD, MBE, University of Pennsylvania School of Medicine, Philadelphia, PA
Background: The insufficient success of conventional strategies to promote healthy behaviors suggests the need for novel approaches.  Two broad motivations exist for such innovation.  First, considerable reductions in productivity and increases in avoidable healthcare costs represent substantial externalities attributable to the unhealthy choices people make for themselves.  At least as important are what have been called internalities – in this case, peoples’ tendencies to make decisions that are easiest or most gratifying for in the present (e.g., to eat chocolate cake) despite the substantial costs these decisions carry for their future selves.  The externalities of present choices provide a rationale for intervention based on social justice; the internalities of present choices provide a rationale for intervention based on beneficence.  

Approach: This presentation will analyze the role of health incentives for promoting healthier behaviors – specifically, the use of money to reward (or penalize) individuals or groups for adopting (or failing to adopt) healthier behaviors. I will focus on the theme of comparative ethics – the idea that although all approaches to using or not using incentives for health promotion have ethical pros and cons, on balance some strategies have greater propriety than others. 

Conclusions:  The presentation will defend three key conclusions.  First, incentive programs are not created equally, no more so in their ethics than in their effectiveness, and so judgments of propriety require both specificity and comparative thinking.  Second, considering the concerns with incentive programs requires thinking broadly, comparing these concerns with those we might levy against either not intervening, or intervening in different, non-incentive-based ways.  Third, a comparative ethics approach suggests the need for empiricism – a view that the most compelling concerns we might levy against incentive programs rest on empirically testable, but as yet untested, assumptions about such programs’ unintended consequences.